7 minute read
Advocacy
ADVOCACY
By Gregory K. Griggs, MPA, CAE
NCAFP Executive Vice President
~ Working for You ~
Remembering the Positives During a Time of Turmoil
In tough times, it can be easy to forget the good that is occurring around us. After two full years of a global pandemic, our state’s family physicians are tired. But there continue to be small victories. As a result, I wanted to provide updates on a few of the positive things that are happening in healthcare, particularly for Family Medicine. So here is a little good news.
MEDICARE SEQUESTRATION AVOIDED
Recently, Congress passed, and the President signed, S. 610, the Protecting Medicare & American Farmers from Sequester Cuts Act into law, a true positive for Family Medicine. As part of implementing S. 610, the Centers for Medicare & Medicaid Services (CMS) released an updated 2022 Medicare physician fee schedule conversion factor (i.e., the amount Medicare pays per relative value unit). The updated conversion factor will be $34.6062. That is less than the 2021 conversion factor of $34.8931 but more than the conversion factor of $33.59 that CMS planned to implement before passage of S. 610.
Using the new conversion factor and accounting for other changes in S. 610, the American Medical Association (AMA) estimates family physicians will see no change in their total Medicare allowed charges in the first quarter of 2022, a substantial improvement over the -8.7% change the AMA estimates would have occurred in the absence of S. 610. The AMA estimates most other physician specialties will experience a decrease in their total Medicare allowed charges even with the changes made by S. 610. This represents a big victory for family physicians. And remember, in the previous year, family physicians received a substantial bump from Medicare with E&M codes receiving a higher RVU value.
MEDICAID CHANGES
While NCAFP still supports a broader coverage expansion to provide all North Carolinians access to affordable healthcare, the NC General Assembly did make some additions to Medicaid coverage last year. For example, post-partum mothers can now stay on Medicaid for a full 12 months. Previously, Medicaid coverage for mothers ended six weeks after delivery. Another change involved children of parents in the foster care system. Previously, parents of children in foster care automatically lost coverage. This meant if the reason the parent lost coverage was substance use, the parent also lost the opportunity to seek substance use treatment. Now, those parents will remain on Medicaid, so that they can get access to the appropriate treatment.
Medicaid has also worked to incentivize getting recipients vaccinated for COVID-19. Medicaid recently increased the administrative fee you receive when providing a COVID-19 vaccine to $65 per immunization. That’s up from the $40 previously provided for COVID-vaccine administration. Even better, the administrative fee increase is retroactive to April 1,
2021. As a result, you will automatically receive a payment for the $25 increase for every COVID-19 vaccine you have administered back to April 1st. NC Medicaid hopes this will help incentivize all family physicians to keep or continue to keep COVID-19 vaccine in your office for vaccine-hesitant patients.
Speaking of vaccine hesitancy, NC Medicaid also pays you to counsel your patients about receiving the COVID vaccine using code 99401. As you continue to work to get your patients vaccinated, you can counsel the patient multiple times and add this code to your visit each time you counsel. This is one more way that Medicaid has been acknowledging the work you have been doing throughout the pandemic.
MEDICAID TRANSFORMATION – MOVE TO MANAGED CARE
While we know the move to Medicaid Managed Care in the middle of a global pandemic was certainly not ideal, there were some positives during the process. For example, last year Medicaid temporarily increased the per-member, per-month (PMPM) care management fees in several ways for various primary care practices to help them through the transition. First, practices could receive up to three months of “glide path” payments for working to exchange data with the pre-paid health plans before the go live date. In addition, practices with patients in certain zip codes that had greater poverty levels, received temporary PMPM increases for social determinants of health projects. We continue to work with Medicaid to let them know of issues that arise due to this transition. While it has not been perfect, compared to managed care roll outs in other states, North Carolina was well positioned.
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CONTINUING EDUCATION
The NCAFP has also become more innovative in the educational opportunities we provide with great success. For example, our virtual offerings in 2020 and 2021 were better attended than any live meeting outside of our Annual Meeting. As a result, we have decided to permanently offer virtual meetings where you can learn from anywhere. In 2022, we will have a virtual offering on Saturday, August 6, and will also offer a virtual KSA. See page 12 for more information.
We were also extremely fortunate to bring you back together for the first time in two years in December, 2021. While we had to limit attendance and put many safety measures in place, the energy at the meeting was palpable. It truly showed the “family” of Family Medicine as colleagues and friends came together for our annual reunion. We were fortunate to host the meeting at the end of the “Delta curve” but before we hit the beginning of the “Omicron surge.” We learned how to come together safely, and we are already planning for this year’s Annual Meeting in Asheville.
LOOKING TO THE FUTURE
Over the past year, your NCAFP Board of Directors also updated our strategic plan to truly focus on your needs moving forward. The work won’t be easy, but some of our key areas of focus include:
Administrative Burden: NCAFP staff and leaders will be working to reduce the administrative burden of family physicians in a few key areas. First and foremost, we are meeting with insurance companies to address the burden of Prior Authorizations. But we will also provide greater education on how to use Electronic Health Records more efficiently. We will be holding a webinar (or two) with “Super Users” from various EHR platforms offering tips and tricks. Finally, we are at the table with statewide discussions on minimizing the number of quality metrics you must meet and how to better align those metrics across payers. Again, this will not be easy, but is a key focus for the NCAFP.
Workforce: We continue our efforts to increase the family physician workforce. One focus area is to make it easier for our members to serve as role models for medical students by incentivizing precepting. We will be working with our healthcare systems to discuss the value of teaching medical students and how they should incorporate that value into compensation packages. We also are working on policy levers to try to incentivize community-based teaching.
Professional Development:
As stated above, we are focused on delivering our members the best continuing education out there both in-person and virtually. While we will still focus on clinical topics, we will mix in a few non-clinical issues that could have a significant impact on your specialty, including value-based care.
These are not all our activities but do represent a few of our key priorities. The bottom line, we want to continue to be the bright light for you, even during a global pandemic. While we hope the pandemic eases in the coming weeks and months, know the NCAFP is here for you every day.
Blue Cross NC Reinstates Payment for After Hours Codes
Thanks to the advocacy work of the NCAFP, the NC Pediatric Society, and Community Care of North Carolina, Blue Cross and Blue Shield of NC has reinstated payment for after-hours care. Following what we believe was ill-advised guidance from the Centers for Medicare and Medicaid Services (particularly during a Public Health Emergency), Blue Cross NC had stopped paying for B Codes 99050 (after hours services when office is normally closed) and 99051 (services provided in the office during regularly scheduled evening, weekend, or holiday hours). These are codes that increase the value of the regular office visit when provided after typical office hours.
In responding to our concerns, Blue Cross NC noted that they are “committed to supporting providers, especially during the public health emergency, when access to care is critical,” and they have updated their policy and reinstituted coverage of these codes effective January 21, 2022. The updated Blue Cross NC policies can be found at ncafp.com/ bcbsah22. We appreciate Blue Cross NC responding to the concerns of primary care physicians across our state and reinstating these codes.
