the road to “meaningful use” ehr stimulus paymentsthe road to “meaningful use” ehr stimulus...

PHYSICIANNORTHERN OHIO

THE VOICE OF PHYSICIANS IN NORTHERN OHIO www.amcnoma.org

September/October 2010 | Volume 95 | No. 5

AMCNO6100 Oak Tree Blvd. Ste. 440Cleveland, OH44131-0999

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The Road to “Meaningful Use” EHR Stimulus PaymentsBy Amy S. Leopard, Walter & Haverfield LLP

One day prior to the release of the final meaningful use rules, AMCNO physician leadershipmet with Dr. Derek Robinson at the AMCNO offices. Dr. Robinson is the new MedicalDirector for the Centers for Medicare and Medicaid Services (CMS) in Region V. Region Vencompasses Ohio, Michigan, Indiana, Minnesota, Illinois, and Wisconsin.

AMCNO Meets with Region V the Centersfor Medicare and Medicaid Services (CMS)Medical Director

providers and their vendors have a fairlyclear picture of what it will take to earn theEHR ARRA stimulus dollars.

Background on the Meaningful Use Rule Congress established the ARRA EHRincentive program to incentivize providersto use EHR to improve healthcare delivery,

In addition to discussing the AMCNOcomments on the meaningful use rules, theAMCNO outlined several other concerns —the most prevalent of which was the issue ofthe ongoing Medicare payment problem andthe lack of action on the part of Congress toscrap the SGR formula. Every year there aredelays and changes in the debate in Congressbut there has been no permanent solution to

On July 28, 2010, the Centers for Medicare and Medicaid Services (CMS) published a finalrule regarding what constitutes the “meaningful use” of electronic health records (EHRs) (the“Meaningful Use Rule”) for physicians interested in qualifying for EHR incentive paymentsfrom Medicare and Medicaid under the the American Recovery and Reinvestment Act of2009 (ARRA).1 The Meaningful Use Rule addresses many of the issues and recommendationsfrom providers and associations on the proposed rule, including comments submitted bythe Academy of Medicine of Cleveland & Northern Ohio (AMCNO).2

the problem. The AMCNO representativesalso noted that with all the new rules comingforward from CMS and the Office of theNational Coordinator dealing with e-prescribing, meaningful use, as well as theneed to install an electronic health record andtrack quality items through the PhysicianQuality Reporting Initiative (PQRI) initiative the

At the same time, the HHS Office of theNational Coordinator (ONC) for HealthInformation Technology issued a relatedfinal rule on the standards EHR vendorsmust meet in order to have their EHRtechnology certified for use by physicians toqualify for the EHR incentive payments (the“Certified EHR Technology Rule”). Now,

Dr. Robinson, Region V Medical Director (center)poses with AMCNO physician leadership – left to rightDr. James Sechler, Dr. Laura David, Dr. Robinson,Dr. Ronald Savrin and Dr. George Topalsky.

(Continued on page 3)

(Continued on page 13) Ohio Health Information Page 5Partnership

AMCNO Legislative Update Page 9

NOMPAC 1

Third Party Payor Page 15Puzzle Seminar

INSIDE THIS ISSUE

quality, efficiency and patient safety in atransformative way. Under this program,CMS will make EHR incentive payments toeligible professionals and hospitals whoqualify for extra Medicare and Medicaidpayments by (1) demonstrating use of acertified EHR technology in a meaningfulmanner, including e-prescribing forphysicians; (2) connecting the certifiedEHR technology to exchange healthinformation electronically to improvequality and care coordination; and (3)submitting clinical quality and othermeasures selected by HHS.

2 NORTHERN OHIO PHYSICIAN n September/October 2010

NORTHERN OHIO PHYSICIAN n September/October 2010 3

MEANINGFUL USE The Road to “Meaningful Use” EHR Stimulus Payments (Continued from page 1)

CMS established a three-stage, graduatedapproach to meaningful use. Each biennialstage will include criteria that become morestringent over time. The stages contemplatean evolution from initially just capturing andusing health information in a structuredformat to tracking clinical conditions and usinghealth IT for order entry, result reporting andimproving quality at the point of care, andfinally to interoperability among EHRtechnologies with clinical decision support.

The final rule covers the first two (2) years ofthe incentive program, which begins as earlyas 2011 under Medicare. CMS will proposethe next two stages of criteria for meaningfuluse through future rulemaking. For the firstpayment year only, physicians maydemonstrate meaningful use of certified EHRtechnology over any continuous 90-day periodwithin a calendar year - allowing physiciansusing certified EHR technology in a meaningfulmanner as late as October 1, 2011 to qualifyfor incentive payment for 2011. After the firstyear, however, physicians must demonstratemeaningful use for the entire calendar year.

Medicare EHR Incentive ProgramAs originally set forth in ARRA and theproposed rule, Medicare EHR incentivepayments for eligible professionals will be75% of Medicare fee-for-service allowablecharges up to an annual cap for up to fiveyears beginning in calendar year 2010. (SeeMedicare Incentives Table pg. 6.) Eligibleprofessionals can receive up to a total of$44,000 over a five-year consecutive period,including $18,000 in the first year for earlyadopters qualifying by calendar year 2012.Eligible professionals must begin by 2014 andthe last payment year is 2016. Eligibleprofessionals furnishing more than 50% oftheir Medicare covered services in a healthprofessional shortage area (HPSA) earn anadditional 10%. Eligible professionals who donot establish meaningful use by 2015 will facereductions in their Medicare fee schedule.

Medicare carriers will pay physiciansdemonstrating meaningful use in a singlelump sum payment during each annualreporting period. The payments will be madeto the physician or to a single employer undera valid Medicare reassignment. Physicianscannot allocate payments among multipleentities. Most health systems and grouppractices will want to review their employmentand professional contractor agreements anddetermine who is entitled to receive thepayments. CMS makes clear that the purposeof the Medicare EHR incentive payments is not

to be a reimbursement or cost pass through ofsoftware costs to encourage purchasing andadopting EHR technology, but to be anincentive to actually use the EHR technology ina manner that supports the HITECH healthpolicy priorities.

Medicaid EHR Incentive ProgramMedicaid payments will be made throughthe states and states must prepare a healthinformation technology plan to receive theCMS match for their EHR incentiveprograms. The Medicaid incentive programwill allow eligible professionals and hospitalsto qualify for initial payments beforeachieving meaningful use. Eligibleprofessionals who adopt, implement, orupgrade their certified EHR technology in thefirst payment year are still eligible forMedicaid payments during the firstparticipation year only and do not have tomeet the meaningful use objectives andassociated measures of the Stage 1 criteriauntil the second participation year.

CMS defines this as requiring eligibleprofessionals to at least (1) acquire, purchaseor secure access to certified EHR technology,(2) install or begin utilization of certified EHRtechnology capable of meeting meaningfuluse requirements, or (3) upgrade from existingtechnology to certified EHR technology or addnew functionality to meet the definition ofcertified EHR technology at the practice site,including staffing, maintenance, and training.

The Medicaid EHR incentive program payseligible professionals up to $63,750 over a 6-year period for most physicians. (See MedicaidIncentives Table pg. 6.) The maximumMedicaid incentive payment is $21,250 in thefirst payment year and $8,500 annually in fivesubsequent years, with pediatricians in the20-29% Medicaid patient volume corridorreceiving one-third less. There is no HPSAbonus. Physicians must enter the MedicaidEHR incentive program by 2016 to receive fullMedicaid incentive payments availablethrough 2021.

Consistent with the proposed rule, CMSallows that the Medicaid payment amount forany particular professional to be reduced forEHR technology or support service paymentsreceived from outside sources other than stateor local governments. This reduction can be upto $29,000 in the first year or $10,610 insubsequent years. However, technologyprovided through an employer-employeerelationship, vendor discounts, and in-kindcontributions do not need to be backed out.

Multiple ProgramsUnlike hospitals that may obtain both Medicareand Medicaid incentives, physicians mustchoose between the Medicare and MedicaidEHR incentive program. However, a one-timeswitch between programs can be made before2015. Choosing between the two programsrequires an analysis of the different paymentamounts, years and whether the physician hasreceived any cash support payments (e.g.,hospital EHR donations).

In the final rule, CMS allows eligibleprofessionals to also participate in theMedicare Physician Quality Reporting Initiative(PQRI) and the Medicare EHR Demonstrationwhile participating in the Medicare EHRIncentive Program. However if an eligibleprofessional participates in the Medicare e-prescribing incentive program, they cannotparticipate in the Medicare EHR Incentiveprogram in the same year, but could choose toparticipate in the Medicaid EHR IncentiveProgram. HHS is required under the recenthealth reform legislation to develop a plan tointegrate the EHR incentive programs andPQRI by January 1, 2012.

Eligibility and the Hospital-basedExclusionThe strongest recommendation from theAMCNO was that CMS should ensure thebroadest possible physician participationallowed by statute. Medicare and Medicaidare separate and distinct programs withdiffering eligibility requirements, butphysicians could qualify under either EHRincentive program. Under the Medicareprogram, the professionals eligible for theincentives are doctors of medicine orosteopathy, dental surgery and medicine,podiatrists, optometrists, and chiropractorsparticipating in Medicare. Physicians, dentists,certified nurse-midwives, nurse practitioners,and physician assistants who practicepredominantly in a federally qualified healthcenter (FQHC) or rural health clinic (RHC) if itis led by PAs are all eligible for the MedicaidEHR program by meeting certain patientvolume criteria. The Medicaid EHR programvolume requirements are 30% of Medicaidpatient encounters, with an allowance forpediatricians having at least 20% of Medicaidpatient encounters to qualify at a reducedlevel, and a special formula allowingprofessionals who practice predominantly inFQHC and RHCs to meet the 30% thresholdby serving needy individuals, such as patientscovered by CHIP, sliding scale, and free care.

Hospital-based eligible professionals are noteligible for Medicare or Medicaid incentive



MEANINGFUL USE The Road to “Meaningful Use” EHR Stimulus Payments (Continued from page 3)

payments. Unfortunately the ARRA definitionwas ambiguous and subject to a broadinterpretation. CMS originally proposed toexclude all professionals furnishing 90% ormore of their professional services in a hospitalinpatient, outpatient or emergency departmentusing place of service codes on the professionalclaim form to calculate eligibility. AMCNO wasvery concerned about the expansive definitionof hospital-based physicians in the proposedrule and argued that CMS should interpret thestatute considering the goals of ARRA topromote EHR adoption. The AMCNO arguedthat CMS should interpret the statuteconsidering the goals of ARRA to promote EHRadoption and provided CMS with severalalternatives consistent with the statute. Inconjunction with area academic medicalcenters and integrated health systems,AMCNO estimated that this proposal wouldhave a devastating effect on the number oflocal physicians eligible to participate.

AMCNO recommended that CMS eliminatethe hospital outpatient department place ofservice code 22 from the exclusion criteria. OnApril 15, 2010, President Obama signed theContinuing Extension Act of 2010 to amendthe statutory definition of hospital-based EPs.After reviewing public comments and theamendment, CMS revised the definitionaccordingly. Under the final Meaningful UseRule, if more than 90% of an eligibleprofessional’s services on claim forms areprovided in the Inpatient Hospital place ofservice code 21 or Emergency Departmentplace of service code 23, the professional willnot qualify for incentive payments. CMSestimates that the revised definition wouldexcludes only 14% of Medicare eligibleprofessionals, down from 27% in theproposed rule. This revised definition excludesmany hospitalists and traditional hospital-based eligible professionals, but allows manyprimary care physicians and others practicingin a hospital outpatient department setting.

Realistic Objectives and MeasuresAMCNO expressed concern in its commentsover the breadth and depth of the objectivesand measures required under the proposed ruleand suggested that CMS scale back themeasures to eliminate the “all or nothing”approach to qualification. In particular, theAMCNO expressed concern that requiringphysicians to directly enter 80% of their ordersfor ancillaries, obtaining 50% of all lab resultsin the EHR, and requiring e-prescribing for 75%of permissible prescriptions were too high.

In a welcome relief, CMS lowered the thresholdsfor most objectives and provided for a core setof objectives and a menu (optional) set ofcriteria from which to choose. Beginning inStage 1, eligible professionals must demonstratethat they meet a core set of 15 objectives, and amenu set allowing the professional to choose 5out of 10 other measures. In Stage 2, allStage 1 objectives will be core. (See page 6for information on these objectives).

CMS also lowered the thresholds for many ofthe objectives it retained. For example, usingcomputerized physician order entry (CPOE) forat least 80% of all ambulatory EHR orders waslowered to 30% of patients that havemedication orders, with at least one medicationordered through CPOE. Eligible professionals willneed to transmit more than 40% of allpermissible prescriptions electronically.Professionals must implement at least oneclinical decision support rule relevant to theirspecialty or high clinical priority and be able totrack compliance with that rule, down from the5 decision support rules initially proposed.

While lowering thresholds, CMS held the line onrequiring health information to be recorded asstructured data. The requirement to maintain anactive problem list for at least 80% of uniquepatients must be recorded as structured data,and eligible professionals must still maintain atleast 80% of all active medications andmedication allergies as structured data.

Quality Measures The AMCNO commented that the initial list ofquality measures should be scaled back to arealistic level with only a few straightforward,achievable measures clearly identified for eachspecialty. Those measures should be evidence-based measures having full endorsement by therespective medical specialty societies and at thelevel of maturity where implementationspecifications have already been developed. Inthe final rule, CMS limited the Stage 1 measuresto those that are already in existence and notunder development, but stated that they willseek to align the quality measures for Stage 2with other quality measures development andreporting related to health care reform andother CMS quality measures programs.

Administrative BurdensThe AMCNO commented that CMS shouldstreamline the administrative burden onphysicians for easier creation of the compliancedocumentation, especially considering thetechnical criteria and the potential for manual

calculations. In 2011, eligible professionalsmust submit aggregate clinical quality measurenumerator, denominator, and exclusion data toCMS or the States by attestation, and CMSnow estimates about 9 1/2 hours for EligibleProfessionals to attest and report objectivesand quality measures during the first year.Despite commentator concerns that CMScompliance burden estimates were far too low,CMS says it believes that EHR technology willhelp reduce the burden as it evolves tocalculate the clinical quality measures requiredfor meaningful use incentives. State Medicaidprograms will have some flexibility on howthey approach provider compliancedocumentation, although CMS will review thestate attestation and provider reportingmechanisms before they are implemented.

The EHR Technology RuleWhat is most important is that the EHRtechnology not only meet the certificationcriteria, but actually be certified. ARRA requiresproviders to use EHR technology certified byONC. The Certified EHR Technology Ruleadopted by ONC provides certificationstandards and a pathway for EHR vendors tohave their technology certified, either as acomplete EHR or as one or more EHR modules.

Vendors are now gearing up to ensure thattheir software has the capabilities required orcan work with other certified modules to allowproviders to meet the minimum standards foran EHR, including the standards fordemographics, history and problem list, clinicaldecision support, physician order entry, qualitymeasures, and exchanging information.Eligible professionals should be working withtheir vendors to confirm that the vendor canand will pursue certification of the technologyunder the initial standards and is committed toramping up over the three stages.

The AMCNO plans to continue to provide ourmembers with educational materials andupdates on this issue in the coming months.

Amy S. Leopard heads the health care practicegroup at the law firm of Walter & Haverfield LLPand may be reached at [email protected] article presents general information andeducation on legal developments and doesnot constitute legal advice.

1 This article updates “The Proposed Pathwayfor Achieving 'Meaningful Use' and EHRStimulus Payments,” Northern Ohio Physician(March/April 2010).

2 The AMCNO comments on the January 2010proposed rule are posted on the website. n


ELECTRONIC HEALTH RECORDS

The Ohio Health Information Partnership(OHIP) is a non-profit entity, funded through a combination of state and federal grants, toassist physicians and other providers withimplementation and adoption of healthinformation technology (HIT) throughout Ohio.

OHIP’s MissionOHIP was created as a result of two grantawards created from the American Recoveryand Reinvestment Act (ARRA) legislation thatwas enacted in 2009. OHIP’s mission is toimprove the quality and value of health care byallowing authorized providers to have access toa patient’s health information regardless of thecare setting. The overall goal of OHIP is toimprove health care quality, outcomes andexperience for the citizens of Ohio.

OHIP is committed to assisting 6,000physicians adopt and “meaningfully use” anEHR by 2012. Nationally, the goal is to have100,000 physicians adopt an EHR within thenext few years. By the end of the decade, theU.S. Department of Health and HumanServices would like to have at least 75% of allphysicians adopt an EHR.

Statewide Health Information ExchangeOne of OHIP’s two grant awards was fundingto build a statewide health informationexchange (HIE) for Ohio. The purposes of thegrant and subsequent HIE are to accelerate theelectronic exchange of health informationamong health care providers, hospitals, labs,pharmacies and other groups and to ensurethat the exchange conforms to all establishedprivacy and security requirements.

Qualifying for Federal IncentivesOHIP’s other grant award provided funding tocreate a Regional Extension Center (REC) thatwould be responsible for assisting Ohioproviders with the purchase, adoption andimplementation of electronic health records(EHRs). This grant allows OHIP to providesubsidized services that will offer practiceworkflow redesign and implementationassistance to make the selection of an EHRsystem easier for health care providers. OHIPalso plans to promote greater EHR adoption by:

1. Providing physicians and other providerswith access to free or low cost experiencedconsultants who will work with individual

practices to provide assistance throughoutthe selection, adoption, implementation,and use of an EHR. OHIP will workthrough seven Regional Partners who havea wide range of EHR expertise to make theEHR adoption process easier and quicker.

2. Vetting EHR vendors to identify those thatare best able to meet practice needs andnegotiating discounts with those vendors.

3. Helping providers meet “meaningful use”standards. Meeting these standards, whichwere recently defined by the Office of theNational Coordinator, is necessary in orderto qualify for financial incentives throughMedicare and Medicaid.

In addition, OHIP will be identifying sources oflow interest loans for providers who wish topurchase an EHR.

OHIP: Providing Services through itsSeven Regional PartnersTo assure that health care providers in Ohiohave access to easily reachable, hands-on helpin selecting, implementing, and achieving“meaningful use” OHIP has contracted withseven Regional Partners which act as thetechnical assistance arm for adoption of EHRs.The Regional Partners in conjunction withOHIP will work with health care providers intheir individual regions, offering individualpractices an array of consulting services,including education, outreach, and technicalassistance. Also included will be discountedcertified EHR offerings and a health IT loanprogram.

• Provide the educational tools thatpractices need to understand themaximum benefits available inimplementing an EHR system.

• Assist in defining practice-specifictechnical and functional requirements.

• Assist in the selection and acquisition of acertified EHR system.

• Provide information regarding the low-cost loans available through OHIP to enable practices to purchase theequipment they need.

• Serve as liaison between practices andEHR vendors regarding the technicalassistance they need to “go live.”

• Help practices meet federally-mandated“meaningful use” requirements. NOTE:If/when it is documented these standards

are met, the practice could then qualifyfor the Medicare/Medicaid financialincentives for adoption of an EHR that are being made available through theAmerican Recovery and Reinvestment Act of 2009.

Qualification Requirements and Cost forRegional Partner ServicesThe cost of the Regional Partner services issubsidized for primary care providers (PCP):MDs or DOs who are family physicians,general internists, pediatricians or obstetrician/gynecologists (board certification not required)and who practice in individual or groupsettings of fewer than ten physicians.

Other qualifying primary care providers arenurse practitioners, nurse midwives, andphysician assistants with prescriptive privileges. Priority is also given to PCPs who provideprimary care services in the following settings:(1) public or critical access hospitals; (2)Federally Qualified Health Centers (FQHCs); (3) rural health clinics; and (4) other settingsfor predominantly uninsured, underinsured, or medically underserved populations. Directtechnical assistance will be capped at the ten-provider level for groups with more thanten physicians/providers.

Qualifying for Federal Financial IncentivesAs part of the overall effort to increase theadoption rate of EHR, the Centers forMedicare and Medicaid Services is offeringfinancial incentives to Eligible Professionals(EPs) for attaining meaningful use.

The term “meaningful use” describes a set of objectives that providers must meet todemonstrate that they are using their certifiedEHR software in a meaningful way. Providersmust be able to demonstrate “meaningful use”in order to qualify for federal financial incentives.The measures that are used to gaugemeaningful use are meant to improve healthcare quality, efficiency, and patient safety.

There are five goals of Meaningful Use:1. Improve quality, safety, efficiency, and

reduce health disparities.2. Engage patients and families.3. Ensure adequate privacy and security

protections for personal healthinformation.

The Ohio Health Information Partnership (OHIP) to AssistPhysicians with Electronic Health Record Selection andMeaningful Use IncentivesDo you have an electronic health record (EHR) system? If you do, will you be able to collect$44,000 or $63,750 from Medicare or Medicaid with your system? If you aren’t sure or needhelp setting up an EHR system, the Ohio Health Information Partnership (OHIP) is here to help.



ELECTRONIC HEALTH RECORDSThe Ohio Health Information Partnership (OHIP) (Continued from page 5)

4. Improve population and public health.

Are you eligible? How do you qualify? Whatare the timelines and deadlines? How do youregister? For answers to these questions and the specifics about the program go to www.ohiponline.org or [email protected] or contact one of theregional extension centers in the NorthernOhio region listed below:

REGIONAL CONTACTS:Case Western Reserve University,

Joseph Peter, [email protected](216) 368-5756 (For counties: Ashtabula, Cuyahoga, Geauga, Lake, and Lorain)

Akron Regional Health Foundation,Marianne Lorini, [email protected](330) 873-1500 (For counties: Ashland, Carroll, Harrison, Holmes, Medina, Portage, Richland, Stark, Summit, Tuscarawas, and Wayne.) n

WHAT PHYSICIANS NEED TO DOFor the first round of Medicare andMedicaid EMR bonuses in 2011-12,physicians must meet 15 core objectives andat least five of 10 “menu set” items. Eachobjective has a measure to determine if anEMR was used to perform the function foran appropriate number of opportunities:

Core set (must meet all)• Record patient demographics • Record vital signs/chart changes • Maintain current and active diagnoses • Maintain active medication list • Maintain active allergy list • Record adult smoking status • Provide patient clinical summaries • Provide electronic health information

copy on demand • Generate and transmit prescriptions

electronically • Use computerized physician order entry

for drug orders • Implement drug-drug/drug-allergy

interaction checks • Be capable of electronic clinical

information exchange • Implement one clinical decision support rule • Protect patient data privacy and security • Report clinical quality measures to CMS

or states

Menu set (can defer up to five for2011-12)• Implement drug formulary checks • Incorporate clinical lab test results • Generate patient lists by condition • Identify patient-specific education resources • Perform medication reconciliation

between care settings • Provide summary of care for transferred

patients • Submit electronic immunization data to

registries • Submit electronic epidemiology data to

public health agencies • Send care reminders to patients • Provide timely patient electronic access

to health information

Source: Centers for Medicare &Medicaid Serviceshttp://www.cms.gov/EHRIncentivePrograms/Downloads/NPRM_vs_FR_Table_Comparison_Final.pdf

http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdf

This article in the New England Journalof Medicine provides another tableoutlining the menu sets.

“The ‘Meaningful Use’ Regulation forElectronic Health Records,” New EnglandJournal of Medicine, July 13(healthcarereform.nejm.org/?p=3732)


COMMUNITY ACTIVITIES

State Medicaid executive leadershipprovided an overview of Ohio Medicaid’sgoals regarding health informationtechnology and participants provided theirinput on the incentive program.Participants discussed the adoption ofEHRs, the history of meaningful use, andthe hurdles providers will face to meetStage 1 meaningful use criteria.

As noted in the meaningful use article onpage one in this issue, eligibleprofessionals (EPs) for Medicaid includephysicians (pediatricians have specialeligibility and payment rules), nursepractitioners, certified nurse midwives,dentists and physician assistants (PA) who

lead a federally qualified health center orrural health clinic that is directed by a PA.Patient volume must be at 30% with theexception of pediatricians (20%). Medicaidis different than Medicare in that — EPsmay adopt and implement in 2011 and beup and running by 2012 in order to qualify.The meaningful use definition will becommon with Medicare, however, underMedicaid states can choose to adopt morerigorous definitions. An example of thismight be reporting of public healthmeasures through a registry. The last yearan EP may initiate the Medicaid program is2016 with the final payment in 2021, andthere are no penalties or paymentadjustments in this program.

ODJFS representatives have been travelingaround the state of Ohio trying to gatherinformation from providers, consumersand others regarding the roll out of thisplan. In order for Ohio Medicaid toreceive the federal money for thisprogram CMS had to approve their planto work with stakeholders to defineOhio’s current state of HIT and EHR,where Ohio plans to be in five years withregard to HIT and EHR, and a road mapfor getting to the vision and the basis ofthe MPIP program — i.e., their StateMedicaid Health Information Plan (SMHP)and Ohio’s I-APD (implementation of theplan). Ohio Medicaid representatives areworking to define these parameters withthe intent to develop and submit theSMHP to CMS by November and thendevelop and submit the I-APD to CMSupon approval of the SMHP. The plannedimplementation of MPIP is the Spring of2011. ODJFS cannot start buildingincentive payment software until aftertheir plan has been approved by CMS. n

Medicaid Conducts a Learning Session on the MedicaidProvider Incentive Payment Program (MPIP)In August, the AMCNO staff was pleased to participate in a strategic learning sessionconducted by the Ohio Department of Job and Family Services (ODJFS), Office of OhioHealth Plans concerning the State Medicaid Health Information Technology Plan, and theMedicaid Provider Incentive Payment Program (MPIP) at Case Western Reserve School ofMedicine (CWRU). The MPIP program offers $63,750 over six years to eligible professionalswho adopt and meaningfully use certified electronic health records (EHRs). It can also applyto professionals who upgrade their existing EHR capabilities. Hospitals are also eligible toparticipate in the MPIP program.

HITECH Temporary Certification Program for EHR TechnologyThe Office of the National Coordinator for Health Information Technology(ONC) released a final rule outlining certification for electronic health record(EHR) technology in June. The Health Information Technology for Economicand Clinical Health (HITECH) legislation directs ONC to support meaningfuluse of “certified” EHR technology through the adoption of standards andimplementation specifications.

The final rule outlines how organizations can become ONC-Authorized Testingand Certification Bodies (ONC-ATCBs) This will ensure that certain types ofEHR technology (complete EHRs and/or EHR modules such as e-prescribingsoftware) are compliant with the standards, implementation specifications andcertifications criteria adopted by the government and that the technologymeets the definition of “certified EHR technology.” In order to qualify forincentive payments, medical groups must implement EHR technology that hasbeen certified by an ONC-ATCB.

Although the Certification Commission for Health Information Technology(CCHIT) has been certifying EHR software since 2006, previous CCHITcertification is not sufficient to qualify for the incentives. Multipleorganizations are expected to apply for ONC-ATCB status, including CCHIT.

Physicians engaged in selecting EHR software are urged to review thequalifications of all ONC-ATCBs. For more information on the above HITinitiatives go to:

ONC EHR incentive program website: http://healthit.hhs.govONC Temporary Certification Program: http://healthit.hhs.gov/tempcertMedicare and Medicaid EHR incentive programs: cms.gov/EHRIncentivePrograms/

Over the summer months, the AMCNO assisted the CWRU-REC in setting up informational sessions in order to garnerinformation from physicians about their use of electronichealth records and in order to provide background on thepurpose of the REC. Participants requested additional infor-mation and written materials on the program. The AMCNOis working with the Ohio Health Information Partnership(OHIP) as a member of the OHIP communications commit-tee as well as with the CWRU-REC on this initiative and wewill continue to provide educational materials to our mem-bers and other physicians in the region.

LEGISLATIVE ACTIVITIES


Physician Ranking Legislation UpdateThe number one legislative priority of theAMCNO continues to be the physicianranking Bills. The purpose of this legislationis to provide the patient with accurateinformation when selecting a physician. The Bills would prevent the health insurancecompany from ranking physician solelybased one specific criteria such as costefficiency. Instead, the legislation willestablish standards for the physiciandesignations. It stresses that health plansmust use risk-adjusted data, base grades,and ratings at least in part on nationallyrecognized quality of care measures. Thelegislation also allows physicians the right toreview and appeal their ratings prior to theratings being released to the public.

The AMCNO worked with RepresentativeBoyd and Senator Patton to introducelegislation in both the Ohio House and OhioSenate. HB 122, sponsored by RepresentativeBoyd was introduced April 2, 2009 andpassed the full House on February 3, 2010 bya vote of 97-1! Before passage, a SubstituteBill was negotiated by the AMCNO thatincluded changes to give the OhioDepartment of Insurance rulemakingauthority, extend timelines and appeals,extend the scope of the bill to third partyadministrators, and have the Ohio Departmentof Insurance approve the appointment ofthe independent ratings examiner.

Senator Patton introduced the Senate versionof the Bill on April 7, 2009. Both Bills are nowpending in the Senate Insurance Committeethat is chaired by Senator Buehrer. The processin the Senate has been slowed due to theactive opposition of the Ohio Association of Health Plans (OAHP). OAHP voiced itsconcerns about HB 122 and SB 98 on March9, 2010 in testimony before the SenateInsurance Committee. This testimony focusedon allowing the Health Plans to work outtheir systems without state legislation. Here is an excerpt from that testimony:

“As you know, consumer engagement intheir healthcare decisions is critical at atime when health care costs are spiralingand the quality of health care outcomesdocumented are varying dramaticallyacross the country. Additionally, moreemployers, government entities and other

groups are pushing for the developmentof information systems that provideinteractive tools that among other thingshelp consumers’ research costs andquality outcomes. In response, healthplans across the country have begun toprovide information to their enrollees tohelp them make informed decisions tooptimize their health. As a result of thesevarying “designation” systems andrecognizing a need for establishingnational guidelines for public reporting ofperformance, a group of leading consumer,labor and employer organizations formedthe Consumer-Purchaser Disclosure Project.This group developed The Patient Charterwhich is endorsed by AARP, AFL-CIO, TheLeapfrog Group, and others. The charterprovides criteria for physician performancemeasurement, reporting and tieringprograms. The benefit of the work of thisgroup is to achieve consistencies in howthe programs are developed and operated,and to avoid varying differences thatoften occur with passage of state by statelegislation. Therefore, we encourage youand your colleagues to consider allowingthe Patient Charter to continue to operateunfettered by state legislation.”

This “no legislation” position of the HealthPlans is not acceptable to the Academy.Therefore, the Academy is negotiating withthe Senate on changes to our legislationthat improve on the status quo withoutoverly compromising on the core principalsof the legislation. These negotiations willintensify through the balance of September.If a compromise can be reached, there is stilltime in this General Assembly to pass thislegislation. The legislators will be returningto Columbus after the November electionsand will stay into mid-December. Iflegislation is not completed by December, itwill have to be re introduced next year andpass through the full legislative process.

State Election UpdateThere are many unknowns facing stategovernment beginning January of 2011. For instance, no one knows who will beliving in the Governor’s mansion. Additionally,no one can say with certainty which politicalparty will control the Ohio House ofRepresentatives. What is known, however, is that the next Governor, Speaker of the

House and the rest of Ohio’s electedleadership will face a budget crisis unlikeanything previously contemplated.

Over the last several years, Ohio’s budgetofficials have applied a number of tactics tobalance our state budget, a constitutionalrequirement. Transfers of funds from oneaccount to another, the depletion of thestate’s Budget Stabilization Fund, alsoreferred to as our “Rainy Day Fund,” andthe massive utilization of federal funds forongoing operational purposes have enabledthe state to ensure a balanced budgetwithout significant tax increases.

Unfortunately, very few of these measuresprovide an ongoing source of revenue forthe state. Consequently, Ohio is facing astructural budget deficit far more dire thananything that has been managed for quitesome time. Specifically, the Ohio LegislativeService Commission has determined thatapproximately $8.4 billion of funds currentlybeing used to balance our existing statebudget will not be available for the nextbiennium. Said another way, roughly 17percent of the state’s operations have nofunding source that has been identified inorder to continue.

Adding even greater challenges to Ohio’sbudget efforts over the next biennium arethe continued decline of sales and incometax receipts — Ohio’s two main sources ofrevenue, and the continued growth of thestate’s Medicaid rolls.

For these reasons, the discussion of what todo with the Fiscal Years 2012-2013 budgethas already taken center stage at our statecapital, and it will remain there until June30, 2011, when the budget must be signedby the Governor, whomever that may be.

That is what we know. What is unknown is how our state’s elected leadership willrectify this situation. Naturally, not knowingthe results of this coming November’selections — when all of Ohio’s statewideconstitutional offices, every Ohio House ofRepresentatives seat and half of the OhioSenate seats are up for election — make aprediction very difficult, there are only trulya few ways for Ohio’s budget to remain inbalance; significantly increase revenue i.e.raise taxes and fees, significantly reducefunding i.e. cut virtually all discretionaryprograms or do both.

AMCNO Legislative UpdateBy Messrs Mike Caputo and Mike Wise, AMCNO Lobbyists



LEGISLATIVE ACTIVITIES

Because of the fall elections, no one wantsto offer specifics on how they are going tofix the budget (voters don’t elect peoplewho promise to gut programs and/or raisetaxes), but this will likely change November3rd, the day AFTER the election.

That being said, each candidate for Governorhas slightly tipped his hand. CongressmanKasich has vowed not to raise taxes. Whileone can argue that what is said in acampaign may not mean much after thatcandidate is elected, reducing the taxburden in this state has been such a centraltheme of Congressman Kasich’s campaignthat is seems unlikely such a reversal wouldoccur.

Conversely, budget guidance offered byGovernor Strickland’s Office of Budget and

Management may suggest, one couldargue, that part of his plan to balance thenext budget, will in fact depend on raisingrevenue via tax and fee increases. Specifically,his budget office has asked each stateagency to submit budget requests undertwo scenarios; a zero percent reduction infunding from the current biennium and aten percent reduction for the currentbiennium. Neither scenario reduces enoughspending to offset the structural deficitfaced by the state, which suggests thatGovernor Strickland may be leaning towarda hybrid approach of reducing cost andincreasing revenue to balance the budget.

Whichever candidate wins in November,and whatever budget balancing option isultimately embraced, the effect on themedical service provider industry may besignificant. Services currently exempt fromthe state sales tax may no longer be.

Medical equipment currently exempt fromthe state sales tax may no longer be.Reimbursement rates under the state’sMedicaid program may be substantiallyreduced. Medical procedures covered underMedicaid may no longer be. These are just afew of the potential outcomes of thisbudget debate that could affect themembership of the AMCNO.

It is not too early to begin reaching out toour elected officials, in an effort to protectour interests as medical service providers.Our advocacy team is already workingtoward this end. Much work lies aheadthough, and the stronger our voice inColumbus the more we can ensurecontinued care of your patients. If youwould like to become more involved withour Government Affairs efforts, pleasecontact the AMCNO. n

(Continued from page 9)


AMCNO LEGISLATIVE ACTIVITIES

There are two choices – either get engagedor leave it to the legislators andgovernment to set the agenda. TheAMCNO believes physicians should getengaged in the process. We realize thatmost physicians do not want to drive downto Columbus and talk to legislators abouthealth care issues. And for the most partmost physicians do not want to interactwith government entities. If you are one ofthose physicians, there is another way youcan help set the agenda.

Encourage your colleagues to join theAMCNO – the organization is geared to

address legislative issues as well asproviding avenues to share your viewpointsand perspectives along with your patients’concerns. For those physicians who havechosen to be active within the Academy ofMedicine of Cleveland & Northern Ohio,we need your support and voice.

AMCNO members should becomeacquainted with an important organizationconnected to the AMCNO: NOMPAC, theNorthern Ohio Medical Political ActionCommittee. NOMPAC was established toprovide a mechanism for the AMCNOmembers to use the “PAC” model in

NOMPAC: Working on Behalf of Northern Ohio’s PhysiciansA message from the AMCNO Legislative CommitteeElection Day is right around the corner – and again physicians are faced with myriad issues.Whether you agree or not, many health care issues and medical care options are decidedby the legislature and government entities.

Over the summer months, the AMCNO through our political action committee – NOMPAC, endorsed the campaigns of OhioSupreme Court Justices Maureen O’Connor and Judith Lanzinger. We believe that in order to maintain a court that will interpret thelaw and not rewrite it we need to elect Justice Maureen O’Connor to Chief Justice for the Court and retain Justice Judith Lanzingeron the Ohio Supreme Court. These individuals are dedicated to further establish and preserve the principles of judicial fairness.

Both justices attended a fundraiser at the home of the AMCNO Vice President of Legislative Affairs, Dr. John Bastulli in August.NOMPAC also supported the event. The session was well attended by both physicians and attorneys alike. Both justices providedcomments to the attendees. Visit the NOMPAC web site for background and information on the candidates www.nompac.com

Ohio Supreme Court Candidates Meet with AMCNO Physicians

Justice Maureen O’Connor (left) spends a momentwith Ms. Amy Leopard from the law firm ofWalter and Haverfield, LLP.

Justice Lanzinger greets Dr. WilliamSeitz, Jr., past president of theAMCNO.

Justices O’Connor and Lanzinger pose with the AMCNOVice President of Legislative Affairs and the host of thefundraiser, Dr. John Bastulli and AMCNO officers. Left toright – Dr. Anthony Bacevice, Jr., AMCNO Immediate PastPresident, Dr. Laura David, AMCNO President, JusticeO’Connor, Justice Lanzinger and Dr. John Bastulli.

support of legislators who support yourperspectives and your patients’ perspectivesduring the election process.

Without NOMPAC’s voice, patients andphysicians in Northeast Ohio would findthemselves less represented at crucialtimes when decisions are made thatsignificantly impact both. It is wellunderstood that a strong NOMPACrequires significant revenues to have animpact during important electioncampaigns. We must support candidateswho have been supportive of issuesimportant to patients and physicians. ANOMPAC mailing will be arriving in youroffice soon – please take the time to readthe information and consider a donationto NOMPAC.


AMCNO LEGISLATIVE ACTIVITIES

THE ACADEMY OF MEDICINE OF CLEVELAND & NORTHERN OHIO6100 Oak Tree Blvd., Suite 440Cleveland, OH 44131-2352Phone: (216) 520-1000 • Fax: (216) 520-0999

STAFF Executive Editor, Elayne R. Biddlestone

THE NORTHERN OHIO PHYSICIAN (ISSN# 1935-6293) ispublished bi-monthly by the Academy of Medicine ofCleveland & Northern Ohio (AMCNO), 6100 Oak TreeBlvd., Suite 440, Cleveland, Ohio 44131. Periodicalspostage paid at Cleveland, Ohio. POSTMASTER: Sendaddress changes to NORTHERN OHIO PHYSICIAN, 6100Oak Tree Blvd., Suite 440, Cleveland, Ohio 44131.Editorial Offices: AMCNO, 6100 Oak Tree Blvd., Suite 440,Cleveland, Ohio 44131, phone (216) 520-1000. $36 peryear. Circulation: 3,500.

Opinions expressed by authors are their own, and notnecessarily those of the Northern Ohio Physician or TheAcademy of Medicine of Cleveland & Northern Ohio.Northern Ohio Physician reserves the right to edit all con-tributions for clarity and length, as well as to reject anymaterial submitted.

ADVERTISING: Commemorative Publishing Company c/o Mr. Chris Allen3901 W. 224th Street, Fairview Park, OH 44126 P: (216) 736-8601 • F: (216) 736-8602

© 2010 The Academy of Medicine of Cleveland &Northern Ohio, all rights reserved.

PHYSICIANNORTHERN OHIO

AMCNO Voting Guide for Members Available Soon!

The Academy of Medicine Cleveland & Northern Ohio Legislative Committee, inconcert with our lobbyists and Medical Legal Liaison Committee, is currentlyupdating a voting guide for the upcoming election on Tuesday, Nov. 2, 2010. Asalways, a summary of issues and candidates will be provided and will be madeavailable exclusively to our physician membership.

The guide will contain:

• District Information – District Number, Description, Map, and Partisan Index

• Background Information on the Democrat and Republican Candidates from ourarea as well as the candidates running in the statewide races, including theireducation and previous elected experience.

• Information on Common Pleas, Appellate and Supreme Court judicialcandidates.

• Candidate responses to questions from the AMCNO Legislative Committee onissues affecting the practice of medicine in Northern Ohio.

Look for the AMCNO 2010 Voter’s Guide in your mail soon! For information on anylegislative issues the AMCNO takes positions on, contact Elayne Biddlestone at216.520.1000.


AMCNO ADVOCACY

practice of medicine has become inundatedwith compliance issues. It can be a dauntingtask for physicians to comply with all of thenew regulations. Dr. Robinson noted that CMSbelieves that all of these concepts will enhancethe health care system and provide physicianswith the ability to have access to patientrecords and avoid duplication. Medicare andMedicaid are the largest payers in the countryand there is a real need to leverage theseconcepts and move this forward.

CMS is looking to align incentives and

determine what is safest and best for thepatient — therefore, quality of care issues and distribution of payments arealways points of discussion and review. Thetop priority right now for CMS is dealing with electronic health records and providinginformation on the meaningful use rules.CMS is working closely with the state regionalextension centers (RECs) to get a sense ofthe level of preparation and outreachneeded to make this work for physicians.The broader goal is not necessarily aboutthe incentives but to move the healthcare

community into an electronic system.

With regard to the PQRI program CMS islooking for physician input and feedback onhow that program is working and to offerassistance to physicians so that they cancomply with the PQRI reporting. CMS believesthat if all of these pieces are implemented itwill create a better health care system. Dr.Robinson expressed a willingness to continueto meet with the AMCNO and the physiciansin this community to discuss issues ofimportance to the practice of medicine. n

AMCNO Meets with Region V the Centers for Medicare and Medicaid Services (CMS) Medical Director(Continued from page 1)

The AMCNO noted that in addition to theapproximate 23 percent Medicare physicianpayment cut scheduled to occur December1, 2010, the proposed regulation includesprovisions that would reduce 2011 Medicarepayments by approximately 6.1 percent as aresult of the sustainable growth rate formula(SGR). The underlying flaw of the SGRformula is the link between the performanceof the overall economy and the actual costof providing physician services.

The AMCNO realizes that ultimately theadministration and Congress will have to actin order to replace the SGR, however, CMSand its’ administrators have the ability toreview comments from physicians, physicianorganizations and other healthcare providersregarding the proposed payment and policychanges and try to find ways to improvephysician payment without adding to overallMedicare costs.

Geographic Practice Cost Indices (GPCI)Locality The AMCNO has many concerns regardingthe usage of geographic practice cost indices(GPCIs) and we have provided our detailedcomments to CMS in previouscorrespondence. To recap, it is our belief that

the boundaries of the payment localities donot accurately address variations in physicians’costs and in particular the AMCNO stronglybelieves that Medicare’s geographic paymentadjustment formula does not accuratelyreflect practice costs in Northern Ohio. Asnoted previously by the AMCNO, the state ofOhio is designated as a statewide locality. Thisis problematic for our physician memberspracticing in Northern Ohio because CMS hasnot revised the geographic boundaries of thephysician payment localities since the 1997revision. Also, since that year, CMS hasindicated that the only mechanism the agencyhas set forth to modify the payment localitiesis for the state medical associations to petitionfor change by demonstrating that the changehas the overwhelming support of thephysician community. This mechanism forchange in the payment localities seems biasedsince the state medical association does notrepresent all of the physicians in the state ofOhio. While the proposed rule does make anumber of changes to the GPCIs in responseto the Patient Protection and Affordable CareAct (PPACA), including a requirement that theDepartment of Health and Human Services(HHS) analyze current methods of establishingpractice expense GPCIs and evaluate datathat fairly and reliably establishes distinctions

in the costs of operating a medical practice indifferent localities; it does not make changesto the payment localities in Ohio.

The AMCNO is aware that CMScommissioned Acumen to conduct a studyof alternative options for reconfiguringpayment localities on a nationwide basis.We noted that the options provided in theAcumen report are once again outlined inthe proposed rule, (CMS 1503-P), and ofthese the AMCNO would favor eitherOption 2 or Option 3. Option 2 wouldremove higher cost counties from theirexisting locality structure and each would beplaced in their own locality, while Option 3removes higher cost metropolitan serviceareas (MSAs) from the “rest of the State”locality. We believe that either of theseproposed options would result in a fairermethodology for the physicians located inNorthern Ohio. The proposed rule indicatesthat Acumen is conducting a more in-depthanalysis of the dollar impacts that wouldresult from the application of Option 3;however, as part of our comments theAMCNO encouraged CMS to require thatAcumen conduct a similar analysis forOption 2 to ascertain the dollar impact ofthis option as well.

As the regional organization representingphysicians in Northern Ohio the AMCNOcontinues to advocate for a change in thepayment localities utilized in Ohio. Anyquestions regarding this issue may beforward to E. Biddlestone at the AMCNO at(216) 520-1000, ext. 100. n

AMCNO responds to 2011 CMS Proposed Medicare PhysicianFee Schedule – Physician payment and GPCI calculation at issueOn behalf of our membership, the AMCNO submitted comments to the Centers forMedicare and Medicaid Services (CMS) in response to the Proposed 2011 changes topayment policies and rates under the Medicare Physician Fee Schedule (proposed ruleCMS-1503-P). Our comments focused on the issue of the flawed sustainable growth rate(SGR) formula currently utilized by CMS to calculate physician payments under Medicare aswell as items contained in the proposed rule relative to the geographic practice cost indices(GPCI) utilized by Medicare in Ohio.


PRACTICE MANAGEMENT ISSUES

One of the requirements is that anyphysician practicing in the NowClinic mustbe credentialed by the UHC network —and this is different than providing servicesfor UHC — therefore it is possible forlicensed Ohio physicians to be“credentialed” by UHC to provide theseservices even if they are not providingUHC services. Physicians can also set someparameters. For example, they canindicate that they only want to seeestablished patients or only scheduledpatients in this environment. Theseparameters can be reset by the physicianas well.

Once a physician has reviewed anincoming patient request the physician canthen determine if they want to connectwith the patient — and they will thenmove into the “encounter” space. If thephysician and patient are web cameraenabled they can talk face to face or theycan utilize a chat space. Anything thatgoes into the chat space becomes part ofthe permanent electronic health record. Ifthe parties choose to connect via phone,phone numbers are kept confidential —and if there are any long distance calls nocharge is made to either party. Theprogram includes automateddocumentation and record keepingcapabilities. Patients are prompted to sendthe encounter to their primary carephysician if the encounter is with anotherprovider. There is also a provision toprescribe medications powered bySureScripts, however, controlledsubstances cannot be prescribed in thisenvironment.

Physicians will use their own professionaland medical knowledge to determinewhether an in-person visit is the best caremanagement for the individual patient. Ifa physician determines at the outset of theNowClinic conversation that an in-personvisit is required, the physician will notifythe consumer, and in that event the feewill be waived. OptumHealth does notprovide physicians with legal or businessadvice relating to how the service,consultation or delivery of health care isconducted.

The payment methodology for this servicewill be done through a credit card and willnot be processed through UHC since noinsurer covers this type of service,including UHC. The patient is charged for10 minutes of time at a rate of $45. Apayment of $25 goes to the doctor (thismay be $30 if the service is on a holiday ora weekend) and the rest of the payment isutilized for credit card and other fees —including medical malpractice coverage.The doctors participating in thisenvironment do not have to worry about

the payment issues since the systemmoves the money into the physicianaccount. The only expense for thephysician is 10 minutes of their time, atelephone and access to the Internet. Themedical malpractice coverage is providedby Lexington Insurance. The policy isindependent of any other malpracticeinsurance policies and physicians enrolledin Optumhealth NowClinic areautomatically covered by the insurancepolicy.

The AMCNO board commented to theUHC representatives that as this programrolls out there should be continueddiscussion about insurers payingphysicians directly if they choose to takecalls after hours or consult with theirpatients over the phone. UHCrepresentatives noted that one of thereasons for doing this at this time is thatmany doctors do not take calls after hoursand in fact their service or answeringmachine directs their patients to call 911 or go to the emergency room rather thanleave a message since the doctor will not be taking calls. UHC believes that thisconcept will offset the costs and usage ofemergency rooms and urgent care centers.

NowClinic online care launched in Texas inDecember 2009, and there are plans tolaunch this concept in Ohio in the nearfuture. For more information go towww.MDnowclinic.com n

UnitedHealthcare (UHC) Presents NowClinic Online CareConcept to the AMCNO Board of DirectorsIn June, members of the AMCNO Board of Directors were pleased to welcome Dr. GieseleGreene, former Northern Ohio medical director for UHC to the AMCNO board meeting.Dr. Greene, along with other UHC representatives provided an overview of the NowClinicconcept. NowClinic is a service that provides real-time access to physicians through acomputer with Internet access or by phone. OptumHealth and American Well have joinedforces to create this nationwide service that offers patients the ability to access licensedphysicians and clinicians 24/7. With NowClinic physicians can ask questions, discusssymptoms, review the patient’s online record and medical history, if provided, and evenwrite electronic prescriptions. The technology brings healthcare services online with liveinteraction between patients and available network physicians. All that is needed is acomputer and access to the Internet to get together with patients. The concept is open toall physicians that are licensed to practice in the state of Ohio and physicians will be paidfor their services.

2011 MEMBERSHIP DUES REMINDER

Support for The Academy of Medicine Cleveland & Northern Ohio (AMCNO)benefits all physicians in our region. Our focus continues to be steadfast on theissues that matter to you, your patients, and effect the way you practice medicine inNorthern Ohio. Call the AMCNO’s Membership Coordinator at 216-520-1000 andrenew your commitment to organized medicine today!

AMCNO COMMUNITYACTIVITIES

AMCNO Pollen Line Update

In late June the AMCNO and Dr. Hostoffer and his two newfellows participated in another training session necessary toprovide the service for the AMCNO. The AMCNO Pollen Lineprovides pollen counts Monday through Friday with reportsrecorded by 8 a.m. The doctors’ report is updated daily, availablevia a telephone recording and at www.amcnoma.org.

The Pollen Line has been in existence for more than 48 years. Thecounts are used by local news stations, The Plain Dealer and manyNorthern Ohio residents who suffer from allergies and hay fever.

The public can call the free hotline at (216) 520-1050 or checkout the AMCNO website to get a report on the density of theallergens, probable effects on those who are sensitive to suchagents, and what precautions to take.

The AMCNO extends our sincere thanks to Allergy/ImmunologyAssociates, Inc. for providing the daily pollen counts and fortaking the time out of their practice to take the pollen counttraining necessary to provide the service for the AMCNO. n

Robert W. Hostoffer, D.O., Theodore H. Sher, M.D. and HaigTcheurekdjian, M.D., of the Allergy/Immunology AssociatesInc. and their staff have been working hard over the summer toprovide the daily pollen counts along with preventative methodsto help allergy sufferers cope with the sniffling and sneezingbrought on by the season.

The AMCNO pollen trainer illustrates how to utilize thepollen counting equipment.

AMCNO provides training on the pollen counts (picturedleft to right) Nicole Tierney, trainer, Dr. Hostoffer and twofellows, Drs. Swender and Wise.



AMCNO BOARD ACTIVITIES

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THE AMCNO’S 26TH ANNUAL

Mini-Internship Program

October 11 – 13, 2010Join your colleagues

and community leaders

“As a teacher, the interns

are like first-year residents

and that makes it fun for me.”

TOM ABELSON, M.D.

Look for complete information in your mail soon,

or call the AMCNO at (216) 520-1000.

The code sets forth 10 principles thatgovern both the business and clinicalaspects of health plans. By following theseprinciples, health insurers can help create amore efficient, patient-centered healthsystem. The code advocates for:

• Prohibition of cancellation or rescissionsof policies because of mistakes on anapplication, or because a policyholdergot sick or injured, or because insureremployees or contractors get bonusesfor rescissions;

• Clear and transparent access to medicalcare, meaning benefits that are availableto enrollees on a timely andgeographically accessible basis at thepreferred, in-network rate, and easilyaccessible physician directories that mark

those doctors who are out-of-network oronly available on a tiered plan;

• Fair and transparent pricing andaccounting of health insurance premiums,with most of the money spent on care;

• Respectful relations by plans with theirenrollees, physicians and other partners,including fair contracting, protection ofpatients’ medical information and“appropriate deference” to the physician’sskill and judgment;

• Clear information on benefit restrictionsto the patient and the physician, withbenefits based on clinically appropriatemedical guidelines;

• Medically necessary care defined by what aprudent physician would provide in a certainsituation, rather than a definition for theeconomic benefit of the health plan;

• Elimination of complexity and confusionfrom health plan processes andcommunications;

• Physician profiling systems that userelevant data to focus on quality of care,not on reducing the cost of care;

• Health insurers to conduct their businesswith the highest levels of corporatecitizenship, including complying with theletter of all laws affecting clinical andbusiness operations;

• Health insurers to pay claims accuratelyand on time, and to provide explanationsof how each claim was handled, as wellas providing fee schedules, claim editsand pay policies that are disclosed andeasily available.

At their June meeting the AMCNO approvedthe AMCNO endorsement of the AMA HealthInsurer Code of Conduct Principles andagreed to list the AMCNO as a supporter ofthese principles on the AMA web site. TheAMCNO plans to utilize this Code in futurediscussions with health insurers and the OhioDepartment of Insurance. n

The AMCNO Board Adopts Health Insurer Code of Conduct Principles

The American Medical Association (AMA) Health Insurer Code of Conduct Principles.The AMA is calling on all U.S. health insurance companies to adopt consistentcorporate practices that will bring transparency and accountability to the multibillion-dollar health insurance industry. The AMA has sent letters to the nation’s eight largesthealth insurers seeking their pledge to comply with the National Health Insurer Code ofConduct Principles.


MEMBERSHIP ACTIVITIESResidents Join the AMCNO

In all, more than 350 new physicians joined the AMCNO asresident members. Membership entitles these new physiciansto many benefits including receiving weekly updates on allmanner of health care related news as well as legislative andregulatory updates under review by the Ohio GeneralAssembly and the United States Congress, legislativerepresentation at the state house by AMCNO lobbyists, listingin the membership directory, seminars, publications andopportunities to serve on AMCNO committees and more.

Welcome to all new resident members!

Do you know of a resident or medical student interestedin free AMCNO membership? Direct them to apply onlineat www.amcnoma.orgClick on BECOME A MEMBER. n

The Academy of Medicine Cleveland & Northern Ohio (AMCNO) welcomed new residents this summerfrom the Cleveland Clinic Foundation, Fairview Hospital, Huron Hospital, MetroHealth MedicalCenter, South Pointe, St. John Westshore, St. Vincent Charity Hospital and University Hospitals.

Edwin Jackson, M.D., a 2009 Academyof Medicine Education Foundation(AMEF) scholarship recipient spends amoment with Meghan Drayton, M.D.,at the CCF residency orientation.

DATE/TIME TITLE FEE LOCATION

Sept 7-Oct 14 T & TH Medical Terminology (36 hours) $325 CCW

Sept 13-Oct 20 M & W Medical Terminology (36 hours) $325 CCE

Sept 15 ICD-9 Fundamentals and More! (6 CEU) $199 CCE9:00 am-3:30 pm

Sept 18-Nov 14 Accelerated AAPC Professional Medical Coding $950 CCESaturday mornings Curriculum (36 hours)

Sept 27-Oct 20 M & W Fundamentals of Billing Reimbursement (24 hours) $325 UTC9:00 am-12:00 pm

Sept 28 M & W Confident Communication with Physicians $159 IFHC9:00 am-12:30 pm about Coding Issues (3.5 CEU)

Oct 4-Nov 10 M & WMedical Terminology (36 hours) $325 UTC9:00 am-12:00 pm

Oct 6 CPT Coding Fundamentals and More! (6 CEU) $199 CCE9:00 am-3:30 pm

Oct 12-Nov 4 M & W Fundamentals of Billing Reimbursement (24 hours) $325 UTC9:00 am-12:00 pm

Oct 12-Nov 4 T & T Fundamentals of Billing Reimbursement (24 hours) $325 CCE6:00 pm-9:00 pm

Oct 20 ICD-10 Preparation Fundamentals of Structure plus $135 CCE8:00 am-12:30 pm Anatomy, Physiology & Terminology Review (4.5 CEU)

Oct 27 The Ins and Outs of Surgery Coding (4 CEU) $169 CCE8:30 am-12:30 pm

Nov 3 Chart Auditing Workshop and Compliance Update $169 CCW8: 30 am-12:30 pm (4 CEU)

Nov 10 Modifier Clinic: Reduce Audit Risks and Ensure $159 IFHC8:30 am-11:30 am Accurate Reimbursement (3 CEU)

Dec 9 ICD-9 and CPT Coding Updates for 2011 (3 CEU) $159 CCE8:30-11:30 am

PATIENT ACCESS SPECIALIST (PAS) for the Certified Healthcare Access Associate (CHAA)Day and evening classes available! Take the complete program and National Certification Exam for only $1,369 — call 216-520-1000 for the discount code and details!

Locations

Corporate College East Corporate College West Independence Family Health Center Unified Technologies Center4400 Richmond Rd. 25425 Center Ridge Rd. Crown Centre II 2415 Woodland Ave.

Warrensville Hts, OH 44128 Westlake, OH 44145 5001 Rockside Rd. Cleveland, OH 44115Conference Rm B

Independence, OH 44131

Cuyahoga Community CollegeFall 2010

Take advantage of discounted classes for AMCNO Members and their Staff. Contact Linda Hale at 216-520-1000 for exclusive AMCNO member course

number to register and obtain a discounted price!


ANNUAL FOUNDATION FUNDRAISER

A special thank you goes to all the event,hole and hole-in-one sponsors who helpedmake the day successful.

2010 Hole-In-One SponsorsVictor M. Bello, MDClassic Mini of Mentor

Event SponsorsVictor M. Bello, MDCleveland Anesthesia Group, Inc.Cleveland ClinicCleveland Clinic Regional Hospitals

AdministrationClinical Technology, Inc.H.C. Murray Corp.Kellison & CompanyKindred Hospitals of ClevelandDr. Matthew Levy/UHBedford Medical CenterMedical Mutual of OhioPrivate Harbour Investment Management

& CounselSagemark ConsultingWalter & Haverfield LLP

Hole SponsorsDr. Laura DavidThe Endoscopy Center at BainbridgeKapp Surgical Instruments, IncM & M ManagementMcDonald Hopkins LLCMt. Yale Capital Group, LLCRea & Associates, Inc.Reminger Co., LPASisters of Charity Health SystemSutter, O’Connell & FarchioneUnitedHealthcare of Northern Ohio

Golfers enjoyed the Kirtland Country Club onAugust 9, 2010 at the Academy of MedicineEducation Foundation’s (AMEF) seventhMarissa Rose Biddlestone Memorial golfouting. Foursomes competed in a shotgunstart tournament that raised more than$38,000 for AMEF. The funds will be utilizedfor medical student scholarships, annual CMEseminars and the Healthlines radio program.The 2010 AMEF scholarship recipients wereinvited to join the group for dinner: ShamimaAhmed, NEOUCOM, Timothy Anderson,CWRU, Alexandria Howard NEOUCOM,Andrew Ibrahim CWRU, Craig Jarrett CCFLerner, and Priya Malik, CCF Lerner.

1st Place TeamSagemark Consulting, Jim Doan, Bill Hogsett, Jim Hrivnak, Phil Moshier

2nd Place TeamThe Endoscopy Center at Bainbridge, Bruce Cameron, MD; Kevin Geraci, MD;Mike Koehler, MD; Greg Lincoln

3rd Place TeamMedical Mutual, Richard Below, MD; Chris Harris, Paul Mancino, Ken Sauer

Prizes were also awarded for the following:

Closest to the pin: Tom Maloney, TomTurner, Joe Orosz, and John Bastulli, Jr.

Longest drive: Dan McLaughlin, Bill Lynch

Longest putt holed: Mark Fusco

Get your clubs ready for next year’s event on August 8, 2011 at Canterbury Golf Club.

2010 AMEF Golf Outing

Practicing for the perfect putt.

Dr. Laura David, AMCNO president, greets thecrowd with Dr. John Bastulli, AMEF Chairman.

Members of the Hoyt Murray foursome (Mr. Murraysponsored AMEF at Kirtland this year) pose with thehole-in-one prize car (no one drove off with theprize this year).

Warming up on the driving range prior to theshotgun start.

Members of the foursome from Walter andHaverfield LLP pose on the green.

Dr. Bello’s foursome tees off “old school”.

Picking a winning ticket at the raffle that followed a day of golf.

Dr. William Seitz, Jr., and his group smile for the camera.

The foursome from the Endoscopy Center at Bainbridge spend a moment with Ms. Biddlestone.

Members of the Cleveland Clinic RegionalHospitals Administration pose with the AMCNOEVP/CEO, Elayne Biddlestone.

the road to “meaningful use” ehr stimulus paymentsthe road to “meaningful use” ehr stimulus...

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