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MSMS Board Talks SB1019, BCBSM, SIM, CPC+ at Meeting

Earlier this week, the Michigan State Medical Society (MSMS) Board of Directors heard from Thomas L. Simmer, MD, regarding Blue Cross Blue Shield of Michigan's activities and priorities for the upcoming year, discussed the State Innovation Model (SIM) and Comprehensive Primary Care Plus (CPC+), discussed legislative issues, and reviewed and approved MSMS's 2017 budget.

  • Senate Bill 1019: Senate Bill 1019 removes the requirement for physician supervision for anesthesia services. In spite of routine mischaracterizations of what this bill would actually do, in spite of numerous concerns brought forward by a number of individual senators, and in spite of significant lobbying efforts on the part of the physician community, the legislation was once again moved through the Senate without any changes. SB 1019 has been referred to House Health Policy, to which Representative Mike Callton chairs. MSMS has met with Representative Mike Callton on this issue, and he is frustrated that this legislation has found its way to his committee without sufficient deliberation in the Senate, and that his committee is now tasked with unraveling this complex issue after the Senate largely ignored their obligations. Furthermore, the Representative has indicated that he does not like addressing issues that are needlessly controversial among groups that he is traditionally aligned with. Chairman Callton has indicated that he may be inclined to hold a hearing on the legislation, but does not support the bills and does not believe that there is support to pass the bills. Physician contact with legislators over the next several months will be crucial >>
     
  • Senate Bill 1104: Introduced by Senator Mike Shirkey (R-Clark Lake), Senate Bill 1104 clarifies the requirements for economic damages in professional liability cases. The MSMS Board of Directors voted to support SB 1104, which is comprehensive in providing a fix to the Greer v. Advantage Health case that will provide the Michigan Court of Appeals with the necessary statutory authority to rule that plaintiffs are only entitled to the actual damages and not the windfall that comes from calculating losses based on hospital charges.
     
  • Blue Cross Blue Shield of Michigan: Thomas L. Simmer, MD, Vice President and Chief Medical Director of Blue Cross Blue Shield of Michigan spent significant time highlighting BCBSM's activities and priorities for the upcoming year. Those include:
    • Patient Centered Medical Home (PCMH) and Physician Group Incentive Plan (PGIP): PGIP now includes more than 20 initiatives with nearly 20,000 primary care physicians and specialists participating. 4,534 physicians and 1,638 practices have been designated as PCMH in 2016
    • Value-based Reimbursement for Primary Care and Specialists: 77 percent of PGIP primary care physicians and 62 percent of PGIP specialists are receiving value-based reimbursement. $57.1 million was paid to primary care physicians, $45.7 million was paid to specialists in 2015 for value-based reimbursement. Ten years ago, MSMS strongly advocated for the adoption of this incentive program, benefiting its members.
    • Hip and Knee Bundled Payment Program: Full scale launch will begin January 1, 2018 with a limited launch date of July 1, 2017. This will be a customer specific offering initially with retired and salaried automotive employees. The program is being offered to all providers within network.
    • New Precertification Program: BCBSM has three new precertification programs (or prior authorization) for radiation therapy, lumbar spine fusion and interventional pain. There was robust discussion around BCBSM's history of collaborative quality initiatives to improve quality in contrast to a more short-term and perhaps short-sided utilization management program like pre-authorization. BCBSM was encouraged to consider using outcomes to allow high-quality performers to be rewarded not monetarily but by "graduating" out of the program.
    • Personal Choice PPO: This new BCBSM product uses the Organized System of Care (OSC) program. The network is tiered into level 1 OSCs, level 2 OSCs, the PPO network, and out-of-network. Tiers were determined by cost. Member cost sharing is also tiered.
       
  • State Innovation Model (SIM) and Comprehensive Primary Care Plus (CPC+): Under SIM, the Michigan Department of Health and Human Services opted for a custom payment model rather than CPC+. MDHHS recommended that all practices previously participating in MiPCT apply for participation in CPC+ as a way to continue much needed funding for chronic care and care coordination services. MSMS continues to work with Physician Organizations, as well as BCBSM and Priority Health, as the commercial plans participating in CPC+.
     
  • MSMS Submits Comments to MDHHS on SIM Custom Payment Option: MSMS, with input from its partners on the Executive Council of Physician Organizations, drafted a number of recommendations to address the challenges and improve the chances for successful SIM implementation. The recommendations centered on the need for greater simplicity and alignment across payment models between Medicare, Medicaid, and commercial payers in Michigan. MDHHS recently announced it would accept the recommendations of MSMS and incorporate a significant portion of these items into its customer payment option design. Read MSMS's full recommendations to MDHHS >>
     
  • Drug Diversion: The MSMS Board of Directors spent a great deal of time discussing the issue of drug diversion. MSMS has a fair amount of policy in this area that exists from a series of House of Delegates resolutions, positions on legislation, as well as ongoing input from the Task Force at MSMS chaired by Pino Colone, MD. MSMS has been very active in being a constructive partner with legislators and law enforcement to take meaningful steps to reduce drug diversion and avoid overly burdensome requirements for physician practices that will not reduce addiction or drug related deaths. Specifically, MSMS has been prioritizing the following areas:
    • Broaden access to naloxone
    • Improve MAPS-Improve functionality and reduce workflow burdens (Read MSMS's testimony to the Michigan House Health Policy Committee >>)
    • Advocate for funding for State of Michigan to offset cost of EHR integration
    • Enhance existing regulatory pathways to address bad actors as opposed to adding more requirements onto physicians that are obeying the law.
    • Improve options and capacity for treatment programs
    • Update and enhance educational offerings to physicians related to pain management and drug diversion issues
    • Only consider MAPS related mandates if uptake is still too low, and limit mandates to only instances where such checks would be clinically indicated. Consider laws similar to Massachusetts for prescriptions that exceed a seven day supply.

Finally, Mark Komorowski, MD, made a plea for all physicians to donate $100 to the Michigan Doctors' Political Action Committee (MDPAC). Supporting MDPAC protects your patients and the medical profession through pro-medicine candidates. In a matter of personal privilege, Doctor Komorowski said "...the APRN bill affects everyone ... the CRNA bill ... these are reasons enough to donate to MDPAC. If everyone gave a one-time $100 donation to MDPAC in 2017, we will stop asking for money for three years. Please donate today."

 

Posted in: State Government News, Medicare, Tort Reform, Board of Directors News, Hot Topics, News for Practices, Advocacy, Scope of Practice, Insurance