By Chad Carlson, MD and Verle Valentine, MD, Co-Chairs; and Chris Madden, MD, Interim Chair of the Quality Measures Subcommittee
Practice Economics Survey: In an effort to identify practice economic areas of action to specifically target, the committee has devised an economic survey that is being sent out to the membership. To further incentivize response, participants are entered into a drawing for a chance for complementary tuition to the 2013 Annual Meeting in San Diego. This survey covers topics such as:
• Whether or not a member’s local hospital network credentials clinicians as “Sports Medicine” physicians.
• Whether or not insurance companies in a member’s local network recognize “Sports Medicine” as a valid subspecialty, and if so, whether they allow “dual credentialing.”
• Problems a member might be having with reimbursement for things such as musculoskeletal ultrasound, orthotripsy, prolotherapy/PRP, athletic training services, etc.
• Whether specific members have attempted to renegotiate their insurance contracts and whether these negotiations were successful.
• Whether insurance companies in a member’s local network require participation in a quality reporting measures program.
• Whether insurance companies in a member’s local network maintain different fee schedules for Sports Medicine vs. other specialty care.
• Whether there are transparency issues with the fee schedules of the third party payers in a member’s local network.
• Whether there are issues with inappropriate procedure bundling with insurance companies in a member’s local network.
• Premium trends for malpractice coverage as “sports medicine” vs. primary care.
• Whether there are scope-of-practice issues with physical therapists in a member’s local area.
As you read through the list above, please be mindful of answers to these questions as they pertain to you and be prepared to answer them as you see them come to you in the survey emails. Responses to this survey will be analyzed and work parceled out among committee members, with specific insurance companies and hospital systems targeted as appropriate. We are hopeful we can use this information immediately to drive change that is meaningful for each of you.
Salary Survey Revamp
Many of you recall the old salary survey that members have accessed on the website in the past. In reviewing this survey, we determined that it needed to be revamped to include logical flow as respondees answered questions, and that we need to keep a tighter rein on the self-categorization of respondees with regards to their self-described practice settings. By limiting the categories of employment options to a smaller, defined set of terms (i.e. private practice, small group, private practice large group, employed physician, etc.) we can increase the number of respondents in each category and bring more meaningful income data back to the membership for use during salary negotiation, etc. We have also incorporated questions about successful integration of cash-based services in order to assess what different members are doing outside of the traditional third party payer paradigm.
Economics Pre-Conference
This year, the committee is planning to present a two tiered preconference, targeting physicians new to practice in one group and more seasoned physicians in the second group. There will be one to two joint sessions in a larger theatre, as well as breakout sessions targeting each group and their unique needs. This approach is based upon feedback that we get from members each year suggesting there are separate audiences for the pre-conference, and overall attendance could be boosted over the current average by widening the scope of the information presented. Topical choices are generally based upon member feedback from prior sessions. New sessions for this year will include discussion about RVU reimbursement models, which has engendered more member interest as of late. Other recurring topics include starting a practice, practice marketing, optimal billing and coding, analyzing ancillary services for a sports medicine practice, contract negotiation, etc.
Quality Measures Subcommittee Work (Chris Madden, MD)
Quality measures and other practice transformation movements are here to stay and will likely shape the future of medicine, whether it be within Accountable Care Organizations (ACOs), medical homes, private practices linked together via organized medical neighborhoods, individual payer negotiations and projects, etc. Nobody is certain what the “final product” of all of this will be, but it will likely involve a mix of the above. As an organization, we need to march along with these changes so we are strategically in a place we can plug into successful positions in evolved care models. Practices that do not learn this language or pay attention to transformation methodology will find themselves years behind the ball and possibly unable to get up to speed quickly enough to survive if CMS, Medicaid and private payers embrace reimbursement models that reward transformed practices at the expense of traditional models.
Quality measures are just one part of the ball game, but they are a big part, and they are already embedded in various programs – pilots, PCMH, CPCI, Medicare PQRS Incentive, NCQA recognition programs, Meaningful Use and more. Beyond the programs, many QMs can add value to the system, resulting in improved patient outcomes and care, successful patient outreach programs, enhanced coordination of care, improved negotiation positions with payers and more.
In addition to developing an educational plan for the membership regarding quality measures (Phase1), the Quality Measures Task Force was charged with identifying important sports-medicine specific existing quality measures. After the QM membership survey, various conference calls and discussions, it became clear for a number of reasons that making a broad range of QMs available to the membership (based on specific member needs) was needed. More importantly, a mechanism to report these measures to Medicare and other third parties (NCQA, payers, pilots, etc.) is needed for members to be able to apply what they learn over the next year and to avoid Medicare financial penalty in 2015 for measures not reported in 2013 (1%/year up to 5% as of now).
To view the QM Survey Results: Log-in through Member Log-in; under “MEMBER-ONLY CONTENT” under “Advocacy”, click on “Quality Measures”; then click on “Quality Measures” on the Sports Medicine Practice Tools; and then click on “Quality Measure Survey Results”.
POLICY UPDATE
State Policy
As always, members should inform the committee of relevant state legislation that potentially affects the practice of Sports Medicine in their state. The policy arm of our committee has three primary goals for the upcoming state legislative season in January:
1. Continued support of state-by-state efforts to promote concussion legislation. 2. Efforts to address the loophole that affects team physicians crossing state lines. 3. Efforts to promote educational legislation on commotio cordis that parallel the successful efforts surrounding concussion legislation.
Secondary goals include promotion in strategic states of legislation promoting the following:
• Efforts to allow physical therapy assistants to bill “incident-to” a physician’s NPI number. This falls under a broader category of legislation that would guarantee a physician’s right to employ whatever clinician they feel is appropriate for their practice model.
• Efforts to limit the ability of non-physician case managers to deny requests for imaging procedures when a physician feels they are medically necessary.
• Licensure of athletic trainers.
• Bills that would ensure physicians who volunteer for team physician coverage fall under that state’s Good Samaritan statutes.
• Bills ensuring co-pay equity between physical therapy and sports medicine in states that allow direct access to physical therapy.
• Bills stipulating physical therapists cannot direct the practice of athletic training
• We will also continue to monitor and fight against any efforts to limit the use of diagnostic and interventional radiology services to certain categories of physicians to the exclusion of sports medicine.
In August, AMSSM was represented at the National Conference of State Legislators Annual Meeting in Chicago. This three day event, also attended by representatives of NATA and APTA, was a valuable chance to develop contacts with state representatives from all over the U.S. Through our interactions at this meeting we were able to put together a contact list of legislators who expressed some interest in working with our organization on some of our primary legislative goals listed above. We are hopeful these relationships will naturally expand, and begin to bear fruit in other areas as well. Our contacts from this meeting will serve as a good basis to move forward for the 2013 legislative season.
Federal Policy
We continue to work with Congressman Latham’s office on a possible Federal patch for cross-state licensing exemptions for team physicians. It is possible this issue will be bundled into the health care portion of the omnibus bill that comes before the Congress during the lame duck session in December. If not, it will be introduced into committee in January when the new Congress convenes. We will also continue to work in support of regulation that includes diagnostic ultrasound under the in-office ancillary services exception of the STARK law.
The Practice and Policy Committee exists to serve the needs of the AMSSM Membership and welcomes your participation. If you are interested in assisting us with work on any of the above, or if you have ideas for actionable items to bring before the committee, please contact Chad Carlson, MD at [email protected]
The conclusions and opinions in this news article should not be interpreted as official statements of the American Medical Society for Sports Medicine.
