“It’s no surprise at all doctors don’t want to participate.”
T
hanks to TMA members’ vigilance and staff persistence, physi- cians in Texas and beyond won’t have to bear the full brunt of these Medicare messes. In both cases, TMA members brought the issues to light, and investigations and advocacy by TMA’s Clinical Advocacy, Payment Advocacy, and Medical Economics
staff put Medicare on the path to a fix. The missteps come as Congress finally acted in April to eliminate a major
source of frustration that plagued physicians for years. The Medicare Access and CHIP Reauthorization Act permanently and immediately repealed Medicare’s fatally flawed Sustainable Growth Rate (SGR) formula, which threatened phy- sicians with steep pay cuts every year since 2003. Going forward, the overhaul also promises to streamline some of the administrative headaches, like those mentioned above, with Medicare’s various quality reporting programs and their penalties. (See “R.I.P. SGR,” June 2015 Texas Medicine, pages 26–37.)
SHADY “AUDITS” Dallas pulmonary and critical care specialist Michelle N. Chesnut, MD, brought the under-the-radar PQRS audits to TMA’s attention. Having already dropped out of Medicare once before to avoid these kinds of misfortunes, she says: “It’s no surprise at all doctors don’t want to participate.” In February, Dr. Chesnut received what reads like a rather threatening au-
dit letter from a mysterious Medicare contractor. Arch Systems claimed to be a “business associate” of the Centers for Medicare & Medicaid Services (CMS) and asked her to turn over dozens of patient records to validate the quality data she submitted to PQRS. “I had no idea who this was, and they wanted us to give over all this protected
health information,” which Dr. Chesnut says she wasn’t about to do. “We take very seriously our patients’ privacy.” Her immediate response was to call TMA.
“I remember reading in TMA’s publications that the meaningful use [of elec-
tronic health records] audits were coming and that you could get big penalties, so I was prepared for that,” she said, adding that she helped her practice partner through such an audit in 2013. “But I knew nothing about the PQRS audits until I got the letter,” despite her participation in PQRS since 2013. Before TMA’s investigation into Dr. Chesnut’s report, nothing on the CMS
website forewarned physicians of the upcoming PQRS review, says TMA Direc- tor for Clinical Advocacy Angelica Ybarra. It took two weeks, she says, for CMS representatives to verify that Arch Systems is an approved contractor and that the surveys are legitimate. After more digging and prodding, TMA, in collaboration with the American
26 TEXAS MEDICINE July 2015
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68