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CAPITAL REGION
Proposed cuts worry health care workers
BY SARA FOSS Gazette Reporter
Reach Gazette reporter Sara Foss at 395-3193 or sfoss@dailygazette.net.

    A proposed federal rule would dramatically reduce Medicaid funding for school-based health centers, family planning centers, dialysis clinics, substance abuse counseling and mental health clinics throughout New York, and health care professionals and advocates are warning that the effects would be devastating, with clinics forced to close or reduce staff and services.
    The state estimates that the rule would cut federal support for a wide range of health care organizations by more than $450 million.
    Approximately 120 upstate New York health clinics and hospitals would lose $65 million, with 13 health clinics and hospitals in the Capital Region standing to lose $10.3 million, according to estimates from U.S. Sen. Charles Schumer’s office. Schumer warned that hundreds of thousands of upstate residents would lose access to necessary health services if the funding cuts are implemented.
    “This proposed payment change will slash millions of dollars from hundreds of health clinics across the state, endangering the health of hundreds of thousands of New Yorkers who rely on these clinics’ crucial services,” Schumer said, in a statement.
    Under the proposed change, Planned Parenthood Mohawk Hudson in Schenectady would lose $3 million, about 25 percent of its operating budget, while Upper Hudson Planned Parenthood would lose about $745,000.
    “We’re on a $4.3 million budget,” said Pat McGeown, CEO of Upper Hudson Planned Parenthood. “This isn’t belt-tightening. This is a significant hit, and it’s inevitable that we would have to think in terms of cutting back hours or staff. Certainly we’ve taken hits before, but nothing of this magnitude.” She said the cut would undermine Upper Hudson Planned Parenthood’s ability to provide services, such as pre-natal care, birth control and pap smears, to lowincome women; as a result, low-income women would forego preventive treatment and primary care, resulting in more complicated health problems and trips to hospital emergency rooms down the road.
    “We would be forced to close health centers or reduce vital services,” said Linda Scharf, director of communications for Planned Parenthood Mohawk Hudson. “This is about families who are already struggling to make ends meet. Planned Parenthood is a safety net for low-income people, particularly low-income women.”
    Scharf said it’s too early to say what services Planned Parenthood Mohawk Hudson would cut if the new rule is implemented. “Obviously, if you lose one-fourth of your operating budget you’ll be forced to take draconian measures,” she said.
    Saratoga Hospital runs three family health centers, in Galway, Saratoga Springs and Schuylerville, that would lose about $29,312 if the new rule goes into effect. Gary Foster, the hospital’s vice president and chief financial officer, said he wasn’t sure how the funding cut would impact services at the health centers, but noted that the family health centers already operate at a loss. “Any further reductions would not help us,” he said.
    Other Capital Region organizations would lose money if the proposed rule went into effect, including the Albany Dialysis Center, which would lose about $661,323, the Albany County Health Department, which would lose about $12,496 and the Albany Regional Kidney Center, which would lose about $444,276.
    Last year the Centers for Medicare and Medicaid Services proposed a new regulation, the Medicaid Outpatient Clinic and Hospital Services Rule, that changes the definition of what outpatient medical services Medicaid will pay for. Under the proposed rule, reimbursement for care such as pediatric dental check ups, dialysis and prenatal care and family planning services would be much lower, or nonexistent. It would also reduce Medicaid payments to New York by capping them at the Medicare payment amount — which for most services is less than the Medicaid amount — and prohibits states from paying more than what Medicare pays.
    The proposed rule is one of seven the Bush administration offered last year as part of an effort to cut Medicaid spending. The first six rules were postponed this summer because of opposition from Congress.
    Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the rule will “enhance the integrity of the Medicaid program, ensuring that the services provided our Medicaid recipients are effective and that taxpayers are receiving the full value of the funds spent on Medicaid.” He said that because the regulatory definition of outpatient hospital services is so broad, there is a high possibility of overlap between outpatient hospital services and other covered benefits.
    “This overlap results in circumstances in which payment for services is made at the high levels customary for outpatient hospital services instead of the levels for other covered benefits,” Nelligan wrote, in an e-mail. “There have been instances of claims for payment of physician services as outpatient hospital services, which result in payment far in excess of the rates available in the state for physician services.”
    Earlier this month, more than 150 health care organizations sent a letter asking New York’s Congressional delegation to block the proposed federal rule. They asked Congress to implement a nationwide temporary increase in federal Medicaid assistance to protect and preserve health care services during the current economic downturn.
    If the proposed rule goes into effect, family planning organizations in New York would lose about $22 million, clinics that serve people with developmental disabilities would lose $25 million, renal dialysis clinics would lose $41 million and substance abuse treatment clinics would lose $25 million.

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If the proposed rule goes into effect, family planning organizations in New York would lose about $22 million, clinics that serve people with developmental disabilities would lose $25 million, renal dialysis clinics would lose $41 million and substance abuse treatment clinics would lose $25 million.

The president makes suggestions - Congress passes laws.  

If this goes into effect, blame the right person/people.

CUTS IN HEALTH CARE?? OH MY, WHAT SHALL WE EVER DO???

And that my web friends is what government, taxpaid, universal health care will bring ya! Get it?

As Senders would say we can't afford ourselves.

2008 Medicare physician payment rates:
What to expect in your practice
Factors affecting 2008 rates
In the waning hours of the 2007 legislative session, the U.S. Congress passed a law that postponed for six months the 10 percent cut in the Medicare conversion factor that was slated to occur on Jan. 1, 2008. This law provides for a 0.5 percent increase in the conversion factor from January through June 2008.
The conversion factor change is not the only change affecting 2008 Medicare payment rates, however. Payment changes will vary by service, specialty and locality based on the following factors:
• This year will be the second of a four-year transition to revised practice expense relative value units.
• A number of services have revised relative value units for physician work. This change particularly affects anesthesiology, home health and eye exam services, which increase significantly.
• The budget neutrality adjustment created last year to adjust for changes from the 5-year review of work values has been increased, which will decrease payments for most services by about one percent.
• The geographic adjustment factors have been updated, as they are every three years. The magnitude of the geographic changes is generally small but it affects many payment localities. In addition, the law just passed by Congress continued the floor on the work GPCI and the physician scarcity area bonuses until June 2008.
• Some services have been added to those that are subject to imaging payment cuts stemming from the Deficit Reduction Act of 2005 which limits payments to no more than the comparable payment in hospital outpatient departments.
The combined impact of these various payment changes on your practice depends on your specialty, location and service mix. When all of the changes are averaged out across all physicians, there should be a slightly positive increase in rates, but many physicians will see net decreases in payments.
Many other payers as well as Medicare Advantage plans link their rates to the Medicare rates in some way. No information is available about how other payers plan to adjust their rates in response to the six-month intervention by Congress. American Medical Association, December 2007
Physician Quality Reporting Initiative (PQRI)
During July through December 2007, physicians who reported on quality measures included in the PQRI became eligible to receive a bonus of 1.5 percent of their total Medicare allowed charges for that six-month period. The bonus payments will be made as a lump sum payment sometime after February 2008.
The law just passed by Congress extends this program for an additional year. Physicians who participate in the PQRI from January through December 2008 will be eligible to receive a bonus of 1.5 percent of their total Medicare allowed charges for the year 2008 as a lump sum payment sometime after February 2009. Visit http://www.ama-assn.org for more information about the measures used in the PQRI program and how to report them.
Participation options
For 45 days at the end of each year, physicians have an opportunity to notify Medicare whether they will be a “participating” or a “non-participating” physician in the coming year. Participating physicians agree to accept assignment on all their Medicare claims. Non-participating physicians can make assignment decisions on a claim-by-claim basis. Medicare payment rates for non-participating physicians are 5 percent lower than payment rates for participating physicians, but non-participating physicians can balance bill patients for more than the Medicare rate, up to a “limiting charge” amount. Physicians also have the ability to “opt out” of Medicare and privately contract with their patients, but neither they nor their patients can submit any claims to Medicare for their services for a two-year period.Because Congress acted very late in the session to prevent a 10 percent Medicare pay cut, Medicare has indicated that it will be reopening the participation decision period for an additional 45 days. With a 10 percent cut looming in the middle of the year, the participation decision is more complicated. While it is possible that the participation period decision will be re-opened at that time, there is no guarantee. Visit http://www.ama-assn.org for a document that describes the various Medicare participation options.
Future outlook
By providing just a temporary six-month reprieve from the 10 percent pay cut, the legislation passed by Congress leaves the outlook beyond the next six months highly uncertain. The AMA will mount an aggressive effort in coming weeks to secure a longer-term solution to this continuing Medicare crisis. Visit http://www.ama-assn.org/grassroots to see how you can help in this effort.
American Medical Association, December 2007

Aren't we all just waiting breathlessly.......