The New Jersey Society of Plastic Surgeons (NJSPS) and ASPS Council on State Affairs Chair, Dr. Gary Smotrich, have been working to pass legislation (S. 2079) to limit the types of surgical procedures that can be performed in an unaccredited office. The bill, which would require that breast implant procedures, abdominoplasty, and certain liposuction procedures be performed in an accredited facility, successfully passed the Senate Health, Human Services and Senior Citizens Committee on May 9 and awaits further consideration. ASPS is supporting the efforts of the NJSPS to pass this important patient safety measure. See coverage.
The American Recovery and Reinvestment Act (ARRA) of 2009 authorized The Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to physicians that demonstrate Meaningful Use of certified electronic health record (EHR) technology. Physicians will need to engage in meaningful use of EHRs by 2015 to avoid 1% penalty in 2015, 2% penalty in 2016, and a 3% penalty in 2017; penalty could increase up to 5% by 2021.
This online interactive course demonstrates key items plastic surgeons should know about Meaningful Use - Stage 1. Additionally, 0.5 Patient Safety credit can be earned.
The 2013 Electronic Prescribing (eRx) Incentive Program 6-month reporting period (January 1, 2013 to June 30, 2013) is the final reporting period to avoid the 2014 eRx payment adjustment.
Individual Medicare providers and group practices participating in the Group Practice Reporting Option (GPRO) who were not successful electronic prescribers in 2012 can avoid a 2% eRx payment adjustment in 2014 by reporting one of below requirements between January 1, 2013 and June 30, 2013:
- eRx Individual physicians - 10 eRx events via claims (report code G8553 on at least 10 eligible Evaluation and Management (E/M) codes through the claims)
- eRx GPRO of 2-24 eligible providers - 75 eRx events via claims
- eRx GPRO of 25-99 eligible providers - 625 eRx events via claims
- eRx GPRO of 100+ eligible providers - 2,500 eRx events via claims
Otherwise, physicians who wish to avoid this penalty must apply here for the significant hardship exemption by June 30, 2013. Physicians who applied and received CMS approval for the eRx significant hardship exemption for any previous year must reapply for 2014.
The Centers for Medicare & Medicaid Services (CMS) urges physicians with questions about their individual situations to e-mail the QualityNet Help Desk or call (866) 288-8912 Monday through Friday from 7 a.m. to 7 p.m. CDT.
View a tip sheet on how to avoid the penalty.
On April 22 the American Society of Plastic Surgeons signed on to a letter with other specialty societies to the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services' (CMS) Request for Information (RFI) on Advancing Interoperability and Health Information Exchange. The RFI is in response to input U.S. Dept of Health and Human Services is seeking on a series of potential policy and programmatic changes to accelerate the electronic health information exchange across providers. The letter states that while specialties value the work that ONC and CMS are doing to achieve their goal of widespread interoperability and electronic exchange of information, we remain concerned that ONC and CMS are not doing enough to remedy current challenges within the Electronic Health Record (EHR) Incentive Program. ASPS believes that significant work needs to be done to improve the current EHR program before CMS and ONC make major changes that physicians are not prepared for and could possibly lead to penalties for non-compliance.
On April 8, The American Society of Plastic Surgeons and The Plastic Surgery Foundation (ASPS/PSF) submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) Request for Information (RFI) on the use of Clinical Quality Measures (CQMs) reported under the Physician Quality Reporting System (PQRS), the Electronic Health Record (EHR) Incentive Program, and other reporting programs. The RFI is in response to provisions stated in the American Tax Payer Relief Act of 2012 (ATRA) that address the underuse and inflexibility of the programs.
ASPS/PSF supports the expanded use of specialty registries for increasing participation in these incentive programs and strongly encourages CMS to allow plastic surgeons to select appropriate quality measures and processes. Since 2002, the ASPS/PSF has operated Tracking Operations and Outcomes for Plastic Surgeons (TOPS) and, since 2009, TOPS has incorporated the BREAST-Q tool for measuring patient reported outcomes following breast surgery. In addition to the TOPS registry, efforts are underway to develop disease specific registries such as the Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE), the National Breast Implant Registry, and a General Registry for Autologous Fat Transfer (GRAFT).
ASPS/PSF is also exploring opportunities to collaborate with the American Board of Plastic Surgery (ABPS) to utilize TOPS to help facilitate Maintenance of Certification (MOC) by allowing TOPS users to transfer their case information to ABPS and eliminating duplicate data entry, as well as to ease integration of TOPS with external EHR systems.
The Centers for Medicare & Medicaid Services (CMS) has released the "2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program Reporting Experience Including Trends (2008-2012)" appendix and report. Overall, the growth in participation across all reporting options has increased.
- In the 2011 PQRS Program 428 (9.8%) out of 4,362 eligible plastic surgeons participated, while in 2010, there were 4,303 eligible plastic surgeons and 365 (8.5%) participated.
- In the 2011 eRx Program 466 (10.8%) out of 4,302 eligible plastic surgeons participated, while in 2010, there were 4,280 eligible plastic surgeons and 148 (3.5%) participated.
Participation in PQRS and other CMS quality initiatives is likely to increase since CMS is transitioning from an incentive payment for participation to a payment adjustment (penalty) for non-participation.
The Centers for Medicare and Medicaid Services (CMS) has recently announced that ICD-10 is moving forward for the October 1, 2014 deadline. The AMA stated that they are not planning to further pursue a delay. The CMS implementation guides have been updated and provide detailed information for planning the ICD-10 transition: ICD-10 Implementation Guide for Small and Medium Practice. More information: ICD-10 Provider Resources.
ASPS is planning to provide more education on ICD-10-CM in the Plastic Surgery News, at the ASPS Coding Workshops and ASPS Annual Meeting in San Diego.
The ASPS Executive Committee recently approved the Evidence-Based Clinical Practice Guideline on Breast Reconstruction with Expanders and Implants. This document was developed by a guideline-specific work group, comprised of ASPS members and representatives from stakeholder organizations including the American Society of Breast Surgeons, American College of Radiology, and American Society of Clinical Oncology. The work group adhered to a detailed and thorough guideline development plan and ensured that all clinical questions and recommendations presented in the guideline are a product of work group consensus. The guideline underwent peer review by select ASPS membership as well as by representatives from The American Society for Therapeutic Radiology and Oncology (ASTRO) and The National Accreditation Program for Breast Centers (NAPBC).
This Evidence-Based Clinical Practice Guideline is designed to promote evidence-based clinical decision-making and to improve the quality of care for breast cancer patients. The recommendations presented in this document address the issues of patient education, immediate versus delayed reconstruction, risk factors for post-operative complications (smoking, obesity, breast size, diabetes, radiation therapy, chemotherapy, and hormonal therapy), antibiotic prophylaxis, acellular dermal matrix use, monitoring for cancer recurrence, and the effect of implant-based reconstruction on oncologic outcomes.
Beginning today, physicians are subject to a 2% payment cut due to sequestration requirements under the Budget Control Act of 2011. Unless Congress acts to stop the sequestration through budget cuts or increasing revenue, the reductions will continue through 2022.
For additional information, Hart Health Strategies has prepared several briefing papers on behalf of ASPS:
- General Information on Sequestration
- Impact of Sequestration on Health Programs
- Impact of Sequestration on Medicare
While debt reduction is clearly a priority of this Congress, ASPS opposes an arbitrary and formulaic sequestration approach to attain our nation's long-term fiscal goals.
Lawmakers in Minnesota are currently considering legislation (H.F. 661) which would extend the state's sales tax to cosmetic medical procedures. This tax would be an add-on to the existing provider tax in the state. Minnesota legislators want to double-dip into your practice! As defined in the bill, cosmetic medical procedures include, but are not limited to, cosmetic surgery, hair transplants, cosmetic injections, cosmetic soft tissue fillers, dermabrasion and chemical peels, laser hair removal, laser skin resurfacing, laser treatment of leg veins, sclerotherapy, and cosmetic dentistry.
MN ASPS members are urged to register their opposition to this damaging cosmetic tax legislation. Click here to contact your legislator via a ready-made, customizable message and ask them to oppose H.F. 661.
On January 17, the U.S. Department of Health and Human Services (HHS) released a final rule to strengthen the patient privacy protections established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The rule implements new requirements for business associates and protected health information (PHI). The rule now requires physicians to report all breaches to HHS unless he or she can prove the unsecured PHI was uncompromised. The rule takes effect March 26, 2013; however, physicians and business associates have until September 23, 2013 to become compliant.
On January 23, 2012, Congressman Phil Roe, MD (R-TN) re-introduced H.R. 351, the "Protecting Seniors Access to Medicare Act of 2013." This bipartisan legislation currently has 123 cosponsors and would repeal the Independent Payment Advisory Board (IPAB). On February 14, 2013 Senator John Cornyn (R-TX) introduced companion legislation in the Senate, and the bill has garnered 31 cosponsors. ASPS strongly supports this legislation.
Once again, members of the New York State Senate are considering legislation (SB 1918) that would expand the scope of practice of dentistry to allow non-physician oral surgeons to perform surgical procedures that fall within the practice of medicine, including rhinoplasty, blepharoplasty, rhytidectomy, otoplasty and liposuction. New York currently has model language in statute which appropriately limits the scope of practice of dentistry to procedures and treatment of conditions related to oral health. This legislation creates a loophole which allows oral and maxillofacial surgeons with hospital privileges to perform cosmetic surgical procedures in their offices.
NY ASPS members are urged to register their opposition to Senate Bill 1918. ASPS is working with the New York State Society of Plastic Surgeons and the Medical Society of the State of New York to defeat this bill which has passed the Senate several times in recent years. Contact your legislator via a ready-made, customizable message and ask them to oppose Senate Bill 1918.
On February 1, 2013, the Centers for Medicare and Medicaid Services (CMS) released the final rule regarding Transparency Reports and Reporting of Physician Ownership or Investment Interests (also known as the "Sunshine Rule"). Among other things, this final rule requires applicable manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid or the Children's Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers of value provided to physicians or teaching hospitals ("covered recipients").
- Sunshine Act: Final Regulation and Short Summary for Physicians
- Sunshine Spotlight: Physician Engagement in CME Events
Physician Quality Reporting System (PQRS) is transitioning from an incentive payment for participation to a payment adjustment (penalty) for non-participation. Penalties for non-participation in PQRS reporting begin in 2015, and will be based on year 2013, so physicians who don't successfully participate in PQRS in 2013, will not only forgo a 0.5 % bonus, but a payment adjustment of -1.5 percent will be applied to their Part B Medicare reimbursement in 2015. This penalty increases to 2% in 2016.
In order to help maximize accuracy and successful reimbursement from CMS, the ASPS, jointly with CECity Registry offer an easy-to use online tool ASPS PQRIwizard to collect, validate and submit the quality measures to CMS for payment.
For more information about PQRS, click here to read, "Begin PQRS Participation in 2013 to avoid 1.5 percent penalty in 2015" from Plastic Surgery News. If you have any questions, please contact the ASPS Research and Scientific Affairs Department at firstname.lastname@example.org
On January 1, 2013, Congress passed critical legislation halting the fiscal cliff. This bill included a delay to the 27% Medicare physician payment cut due to the flawed SGR formula. ASPS will urge the new Congress to repeal the unsustainable SGR formula permanently.
The additional 2% cut included in the "sequestration" provisions of the Budget Control Act of 2011 is delayed until March 1,2013. ASPS will continue to fight arbitrary cuts such as this sequestration provision that fall on top of already mandated SGR cuts.
ASPS joined the Surgical Coalition in advocating for this bill recently introduced in the House by Congresswoman Diane Black (R-TN). H.R. 6598 would create a "hardship exemption" for small practices and physicians in and near retirement to avoid workforce shortages as physician practices and hospitals transition to EHRs.
The 2013 Federal Regional Advocacy Program dates have been announced! Plastic surgeon advocates meet in Washington, D.C. on Tuesday for a dinner reception and briefing. On Wednesday, advocates meet with their members of Congress and their staffs.
Registration is free for the events, and ASPS will provide dinner Tuesday as well as breakfast and lunch on Wednesday. You are responsible for your airfare, hotel, and other incidentals. Please RSVP to Patti Swakow at (847) 228-3343 or via email at email@example.com.
Please locate your state/region and mark your calendar for the 2013 program:
- May 14-15, 2013 (Southeast/Midwest Regions): Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Virginia, West Virginia, Wisconsin.
- September 10-11, 2013 (Northeast and West Regions): Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Idaho, Kansas, Maine, Maryland, Massachusetts, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Washington, Wyoming.
On November 14, 2012, the U.S. Senate introduced the Breast Cancer Patient Education Act (S. 3628). This legislation will direct the Secretary of the Department of Health and Human Services to create an education campaign to help women understand their reconstructive choices prior to a mastectomy. Senators Roy Blunt and Sherrod Brown (D-OH) are the sponsors, with Senator David Vitter (R-LA) listed as an original cosponsor.
Representatives Leonard Lance (R-NJ) and Donna Christensen (D-VI) introduced H.R. 5937, which is the House version of the same legislation. It currently has 19 cosponsors.
Through the legislation, the Secretary may develop information for distribution or may have other entities do so. The educational materials would inform women that breast reconstruction is possible at the time of breast cancer surgery, it may be delayed until after other treatments, or they may choose not to have reconstruction and be informed of the availability of prostheses or breast forms. Also, educational materials would inform breast cancer patients that federal law mandates coverage of breast reconstruction, even if such reconstruction is delayed until after other treatments.
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