News & Media
MSMS Board meets, discuss elections, MDPAC, legislation and heard from BCBSM
Earlier this week, the Michigan State Medical Society (MSMS) Board of Directors met to discuss the upcoming elections, the importance of MSMS’s political action committee, current legislation, and heard a presentation from BCBSM. Below are some of the highlights:
Legislation:
HBs 5592, 5593 – Expanding Definition of Epinephrine Administration in Schools
Introduced by Reps. Howrylak, Canfield, Tedder and Inman on February 20, 2018
To allow prescribers to prescribe and pharmacists to dispense to school boards under certain circumstances, and limit liability.
The MSMS Board of Directors voted unanimously to oppose House Bills 5592 and 5593.
HB 6288 Exempt Anti-Seizure Epilepsy Medication from MAPS Mandate
Introduced by Rep. Vaupel on August 15, 2018
A requirement to obtain and review a report from the Michigan automated prescription system (MAPS); exempt certain controlled substances for the treatment of epilepsy or seizure disorders.
The MSMS Board of Directors voted unanimously to oppose House Bill 6288.
MDPAC: The Board of Directors discussed the importance of the Michigan Doctors’ Political Action Committee and how important it is for the physician community to contribute. Election Day is right around the corner, and MDPAC can make its voice heard by supporting candidates that put the needs of physicians and they patients they serve above those of profiteering trial lawyers. We need your help. Please consider doing your part to amplify that voice by supporting MDPAC today.
Health Care Delivery and Education:
BCBSM Presentation. Thomas L. Simmer, MD, Vice President and Chief Medical Director, Blue Cross Blue Shield of Michigan.
Doctor Simmer began his annual update with an overview of the most recent reorganization of BCBSM and BCN.
- Kevin Klobucar is Executive Vice President for Health Care Value, responsible for clinical programs (including deciding PGIP payments and Value Based Reimbursement), utilization management, prior authorization, facility and pharmacy contracting, and pharmacy management at BCBSM.
- Steve Carrier has replaced David Share, MD, as Senior Vice President responsible for clinical programs and value-based payments. Tom Leyden reports to Mr. Carrier. Amy McKenzie, MD, provides clinical direction and reports to Mr. Leyden.
- Sue Barkell is the Senior Vice President of Hospital Contracting, Provider Engagement, and Pharmacy Services. She is responsible for hospital contracting and pharmacy services.
- Professional payment policy and medical policy remain under Doctor Simmer for the commercial PPO programs. Marc Keshishian, MD, is responsible for professional payment policy and medical policy for BCN. Additionally, Doctor Keshishian oversees utilization management and credentialing policy for both BCBSM and BCN.
Doctor Simmer next shared directional changes occurring that impact physicians.
- "Pathway to Risk" implementation with expansion of contracted provider organizations beyond PGIP.
- Greater focus of PGIP and VBR payments on cost outcomes, less on infrastructure and initiative support.
- "Road Map" to provide greater specialist performance reporting to physician organizations.
- Increased use of custom networks and tiered benefit designs, similar to approach used by General Motors.
Other items of note:
- Within the UAW Trust, BCBSM is implementing a new radiation oncology program that essentially functions as an elaborate prior authorization process. Physicians will be reimbursed for this program.
BCN Down-Coding. MSMS has met several times with BCN on the down-coding or repricing of level 4 and 5 Evaluation and Management (E&M) services without reviewing documentation.
- MSMS has asked that BCN provide an open dialogue with physicians that appear to be outliers in coding higher levels of E&M services amongst their peers, before applying punitive consequences.
- MSMS raised concerns that some electronic medical records (EMR) may be contributing to this problem and believed that physicians should be given the opportunity to learn how their EMR systems can be audited to be sure their systems are not allowing unintentional over coding.
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MSMS also urged BCN to use an independent review organization when the treating physician and the health plan medical director disagree on the level of care.
Ultimately, BCN decided not to change their processes. However, they will not add any new physicians into this program and approximately 500 of 1,200 physicians will be graduated out. MSMS is working with legal counsel on a comprehensive guide to help physicians better understand the issue including documentation guidelines, medical necessity, appeal rights and other potential options available to them. In the meantime, MSMS urges physicians to appeal every claim that is repriced by BCN.
CHAMPS Enrollment. After several delays, the Michigan Department of Health and Human Services (MDHHS) has set a deadline that providers need to be enrolled in CHAMPS by January 1, 2019. For dates of service on or after July 1, 2019, MDHHS Fee for-Service and Medicaid Health Plans will prohibit payment for prescription drug claims written by a prescriber who is not enrolled.