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From the December ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

College continues fight to restore Medicare cuts

Throughout the fall, ACP-ASIM's Washington office kept up the pressure on Congress and the Bush administration to avert Medicare fee cuts that are scheduled to take effect early next year.

Physicians are facing a 4.4% reduction in Medicare fees in January. Those cuts would come on top of a 5.4% reduction that took effect in early 2002.

In late October, the College sent an e-mail alert to 43,000 ACP-ASIM members. The alert encouraged physicians to contact their members of Congress about the cut and to enlist patients to do the same.

ACP-ASIM also created a Medicare Crisis Action Kit and put it on ACP-ASIM Online. The kit contains tools to help internists and their patients ask legislators to halt the cuts.

As of mid-November, the alert had generated 3,300 letters to Congress from internists and their patients. ACP-ASIM officials noted that the campaign had generated the most responses to a single issue in the history of the College or ASIM.

While Congress had not acted on the issue before recessing for the November elections, College officials were urging internists to continue to contact their legislators to continue to protest the cuts. At press time, they were hoping that Congress would take action to avert the cuts during the session in November, or early in January at the latest.

In October, the College issued a strongly worded press release that assailed leaders in Congress and the Bush administration for failing to avert the cuts before recessing for the election break. The College urged legislators to take up the issue when they returned for the lame-duck session.

To draw legislators' attention to the issue, the College ran an ad in the Oct. 14 Roll Call, a Capitol Hill newspaper. The ad warned that if the cuts are not restored, fewer physicians will care for Medicare patients, and patients will face longer waiting times to get appointments and will have greater out-of-pocket expenses.

More information on the College's efforts is online.

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CMS needs to improve communication between doctors, Medicare carriers

The College called on the Centers for Medicare and Medicaid Services (CMS) to make sure that Medicare carriers do a better job of communicating with physicians and educating them about coding errors.

ACP-ASIM officials met with staff from the HHS Office of Inspector General (OIG) to discuss goals for the coming year. In an Oct. 25 letter to the OIG, the College addressed the following areas.

  • Coding errors. ACP-ASIM suggested changes to Medicare's correct coding initiative that would help physicians improve how they code patient services. The College pointed out that physicians have inadequate access to information such as edits or changes made to codes submitted by physicians.

    To help internists learn from other physicians' mistakes, ACP-ASIM officials asked the OIG to put a database of edits on the Web that can be searched by CPT code to make it easy to use. Currently, physicians must purchase much of this information from the Commerce Department.

    The College also asked the CMS to change how it handles claims that list two procedures or services that are mutually exclusive because they are performed on the same day. The CMS currently pays for the service with the lower value to give physicians an incentive to avoid incorrect coding.

    ACP-ASIM officials, however, said that this policy will not help educate physicians unless the CMS gives a reason for rejecting the service with the higher value. The College asked the CMS to explain its rationale to physicians.

  • Medicare carriers. ACP-ASIM asked the CMS to do a better job of monitoring Medicare carriers and endorsed recommendations in a report from the General Accounting Office.

    That report found that physicians often have difficulty using communications from carriers, in part because those communications are out of date, inaccurate or incomplete. The report also found that the CMS does not always adequately monitor carriers to make sure they communicate with physicians effectively.

    ACP-ASIM would like the CMS to publish a national bulletin with information on carriers' policies, establish new performance standards for carrier call centers, and use expert teams to review the quality and accuracy of communication between carriers and physicians.

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College supports protections, care for refugees

The College has come out in support of proposed legislation that would help provide medical and mental health services to immigrants seeking asylum.

In a Nov. 4 letter, ACP-ASIM President Sara E. Walker, MACP, commended Rep. Christopher Smith (R-N.J.) and Sen. Patrick J. Leahy (D-Vt.) for introducing the Refugee Protection Act of 2002.

The legislation focuses on the harmful effects suffered by refugees who have undergone torture and abuse in their homelands, and on the harmful effects of detainment in the United States. The legislation would authorize government contracts with agencies to help coordinate necessary services for refugees, including medical services.

The letter is available online.

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