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November 2011

Jim A. Yturri, MD, FACP, Governor
Carrie Reisig, Executive Director

From the Chapter

Welcome to the first edition of our new monthly newsletter! This edition focuses on advocacy and provides some resources that may be of interest to you. If you have topics you would like to see covered in future newsletters, please email Carrie Reisig, the Executive Director of the Montana Chapter, at creisig@bresnan.net


Report to MT ACP Chapter Regarding MMA’s 133rd Annual Meeting Held in Helena September 9-10, 2011

This year’s Montana Medical Association Annual Meeting held September 9 and 10 was one and a half days devoted to Montana health policy issues and Montana physicians’ concerns. All Montana physicians are invited to participate in these semi-annual meetings, even if they are not MMA members. I (Dr. Effertz) attended as Montana ACP’s Trustee on the MMA Board of Trustees.

This year’s meeting pursued the theme of “Charting the Course for Health Care Change.” The MMA itself is pursuing internal change and renewal, with the installation of a new Executive Vice President, Jean Branscum, this July. The organization has a new logo to go with the new energy. The MMA hopes to function as the voice of the State’s physicians and expand physician membership and participation.

This meeting was a very interesting event. Speakers in the fast-moving sessions reviewed the content of the 2011 State legislative actions that affect health care in Montana. Diana Ferriter, Bureau Chief of Montana Department of Labor and Industry, presented the new Workers’ Compensation law and how it will apply. State Auditor Monica Lindeen updated the assembly on attempts to have a Montana influence on the health insurance exchange that will be created to assist uninsured Montanans after the legislature rejected federal funding for a state-run exchange. Mary Dalton, State Medicaid Director, explained the squeeze on decisions in Health and Human Services with 23% of the State’s total budget going to Medicaid. State Senators Jason Priest and Bruce Tutvedt discussed why certain bills failed to become law and listed issues now being discussed in an ongoing interim HHS committee: hunger and obesity in Montana children, psychological and physical trauma in kids, and how to regulate an illegal substance (marijuana). At the evening reception five gubernatorial candidates introduced themselves and their ideas for Montana.

Besides health policy matters, the meeting content pursued “what physicians want,” as they cope with constant metamorphosis in daily professional practice. Presenters and panelists explored the revolution underway with hospitals now employing the majority of Montana physicians, the commercialization of the US health care system, erosion of professionalism, shrinkage of the primary care physician workforce, and new practitioner models, including “doctors of nursing practice.” The discussions were broad and deep, and these interactions brought out clear, and often painful, points that were enlightening and provocative. On the specific issue of the how physicians may avoid self-sabotage when signing a hospital employment contract, MMA is prepared to offer assistance to its members.

This was a friendly meeting well worth the time. In company of a thicket of Montana physicians who participate in these meetings year after year, one feels some reassurance that institutional memory is alive, and that there will be role models to guide us.

- Susan J. Effertz, MD FACP


Check out the newly updated State Health Policy Site and Health Care Reform Guide

State Health Policy/Advocacy Site

ACP’s newly revamped State Health Policy/Advocacy webpage brings you the latest on how implementation of the Affordable Care Act (ACA) is affecting states, and offers a wealth of resources on how to engage in state-level advocacy. The new "hot topics" section provides you with information on current health policy issues and how you can take action at the state level - not only as they relate to the ACA but on other issues as well. Each hot topic is provided in an easy, uniform format that summarizes the issue, identifies specific actions to take on select issues, and includes a list of related resources. The information will be updated regularly to bring you a timely and useful resource. So, please check regularly for the latest information at http://www.acponline.org/advocacy/state_policy.

An Internist’s Practical Guide to Understanding Health System Reform

An Internist’s Practical Guide to Understanding Health System Reform offers an in-depth look at the comprehensive health care reform law that was enacted in March of 2010, known as the Affordable Care Act (ACA). Updated with information about newly completed regulations and recent developments, and broken up into an easy-to-follow format organized by year of implementation, this guide explains the provisions that will affect internists most. Learn more at http://www.acponline.org/advocacy/where_we_stand/access/internists_guide/.

If you have any questions on these or other topics, please contact Shuan Tomlinson at 800-338-2746 ext. 4547 or by email at stomlinson@acponline.org.


Medicare Update

Medicare has a revised version of the Advanced Beneficiary Notice (ABN) that must be used by 1-1-12. The ABN must be signed by the Medicare recipient before a non-covered service can be performed for the provider to be reimbursed by the patient. If the form is not filled out correctly, the patient is not financially responsible for the service provided. Finding if a service is covered can be maddening. To review Local Coverage Determination (LCD), go to https://www.noridianmedicare.com/macj3b/coverage/active.html

To review National Coverage Determination (NCD) go to:

The ABN form can be found at http://www.cms.gov/BNI/02_ABN.asp#TopOfPage

Scroll down the page to: Revised ABN CMS-R-131 Form and Instructions [zip, 58kb]

Medicare will be requiring all providers who have enrolled in Medicare before March 25, 2011, to “revalidate”. There will be a $505 fee with the revalidation process. Providers do not need to do anything until the Medicare contractor contacts them about the revalidation process. With revalidation, Medicare will place providers and suppliers in one of three levels of categorical screening: limited, moderate, or high. The risk levels denote the level of the contractor’s screening of the provider or supplier when it initially enrolls in Medicare, adds a new practice location, or revalidates its enrollment information.

To strengthen primary care, the Center for Medicaid and Medicare Innovation developed the Comprehensive Primary Care (CPC) Initiative. The first phase of the CPC Initiative is to solicit public and private payers to join CMS to test a new payment model. This payment model will help primary care practices transform into a comprehensive “medical home” type practice.

Five comprehensive primary care functions are hoped to be accomplished:

1) Risk stratified care management;

2) Access and continuity;

3) Planned care for chronic conditions and preventative care;

4) Patient and caregiver engagement; and

5) Coordination of care across the medical neighborhood.

Letters of intent from the payers must be received by CMS by 5:00 PM EST on November 15, 2011.

CPC Initiative Solicitation

- Jay L. Larson, MD FACP


New Members

The following members joined the Montana Chapter in the past 6 months:

Nishan Dallakoti, MBBS
Shane A Hill, MD
Megan B Littlefield, MD
Steffan J May, MD

We welcome them to the Chapter and look forward to getting to know them!

New Fellows

The following members became Fellows during the past six months:

Michael T Herring, MD FACP
David A Mark, MD FACP

We congratulate them on this achievement!