MSMS Board Addresses Upcoming House of Delegates, Human Trafficking

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MSMS Board Addresses Upcoming House of Delegates, Human Trafficking

Thursday, March 23, 2017

Earlier this week, the Michigan State Medical Society (MSMS) Board of Directors met to address the upcoming House of Delegates, health care delivery, human trafficking and more. Below are some of the highlights:

  • 2017 House of Delegates: The 152nd meeting of the MSMS House of Delegates will continue a two-day format, beginning on Saturday, May 6. Resolutions debated during the annual MSMS House of Delegates are the vehicles by which MSMS policies, priorities, and direction are determined. The Annual House of Delegates will convene at the Amway Grand Plaza in Grand Rapids. Delegates: Please visit www.MSMS.org/HOD and complete the form indicating your attendance.
     
  • Health Care Delivery: The Health Care Delivery committee discussed the Provider Directory, BCBSM New Precertification Program, BCBSM Quality Initiative on C-Section Rates and Economic Study for SNAF:
    • Provider Directory: CMS has mandated that health plans provide accurate information regarding physicians who are available to new patients/enrollees in their online and printed directories. Plans must communicate with physicians at least quarterly to verify the physician's location and availability. An BCBSM audit found their error rate was between 30-50 percent . This has led to efforts to correct the provider directory data to be compliant with the CMS mandate.
       
      BCBSM contracted with a vendor to collect physician information online. BCBSM has also developed an electronic file exchange with POs to submit their roster directly. Enforcement actions for physicians who are non-compliant will include suppression from the provider directory, suppression of applicable value-based reimbursement for PGIP physicians, and ultimately, termination from BCBSM and BCN networks if compliance issues are not resolved. MSMS is assisting in communicating this messaging through all MSMS communication vehicles. MSMS has also requested monthly updates from BCBSM to assist in monitoring compliance.
    • BCBSM New Precertification Program: BCBSM has three new precertification programs (or prior authorization) for radiation therapy, lumbar spine fusion, and interventional pain. MSMS continues to advocate that BCBSM's history of collaborative quality initiatives to improve quality is a better model than the more short-term and perhaps short-sighted utilization management program like pre¬ authorization. MSMS has facilitated several meetings between specialty societies and BCBSM to share similar concerns. After a temporary postponement of the lumbar fusion program, BCBSM allowed several practices with high quality and favorable outcomes data to opt-out of the program.
    • BCBSM Quality Initiative on C-Section Rates: BCBSM has indicated a strong interest in addressing (-section rates in the stat e. A meeting with representatives from MSMS, MHA, Ml-ACOG and BCBSM took place in January. All organizations concurred that the most appropriate and effective means of implementing a comprehensive, multidisciplinary approach to (-sections rates would be through a Coordinating Quality Initiative (CQI). BCBSM is considering the request.
    • Economic Study for SNAF: Through matching federal funds, Michigan Medicaid offers commercial reimbursement rates to providers affiliated with the six medical schools and Hurley Hospital. This program is referred to as the Specialty Network Access Fee (SNAF). MSMS is working with SNAF facilities to prepare advocacy resources to maintain this special financing. Through the federal managed care plan rules and any pending national health care reform, this funding mechanism is at risk. MSMS is acting as the fiduciary in contracting an economic assessment of the SNAF program. The intent is to gather data regarding access, financial impact, and community benefit to assist in messaging the importance of the program to legislators.
           
  • Human Trafficking: Dena Nazer, MD, Children's Hospital of Michigan and Associate Professor, Pediatrics, Wayne State University gave a presentation on human trafficking highlighting: 1) the types of avenues in human trafficking in Michigan and the United States; 2) how to identify warning signs and victims on human trafficking in the health care seeting; and 3) resources for reporting suspected victims of child and adult human trafficking. Doctor Nazer's "Human Trafficking Overview", an MSMS On-Demand webinar, is available at http://MSMS.org/OnDemandWebinars. This webinar does meet Michigan's new human trafficking one-time training requirement from the Michigan Department of Licensing and Regulatory Affairs.