Dear Dr. Clark:

Yesterday, your Louisiana State Medical Society (LSMS) Board of Governors held an emergency meeting to discuss the proposed strategy to transform graduate medical education in the state (GME) and its impact on patients, as well as current and future physicians. Earlier this month, the LSU Board of Supervisors announced its intentions to address the severe budget cuts required by recent reductions in federal funding by implementing drastic reductions in staff, inpatient beds and clinical services. The LSU Health System is depending on the private sector to make up the difference by bearing the cost of training residents and providing care for the poor and uninsured after the cuts take effect.

Dear Dr. Clark:

Yesterday, your Louisiana State Medical Society (LSMS) Board of Governors held an emergency meeting to discuss the proposed strategy to transform graduate medical education in the state (GME) and its impact on patients, as well as current and future physicians. Earlier this month, the LSU Board of Supervisors announced its intentions to address the severe budget cuts required by recent reductions in federal funding by implementing drastic reductions in staff, inpatient beds and clinical services. The LSU Health System is depending on the private sector to make up the difference by bearing the cost of training residents and providing care for the poor and uninsured after the cuts take effect.

Moving forward, LSMS leaders want you to know we are representing your interests on this important matter by contacting major stakeholders, including Louisiana State University System (LSU) Interim President Dr. William Jenkins and the Accreditation Council for Graduate Medical Education (ACGME) to share with them our concerns and offer any support that we can provide. Based on current LSMS policy and the feedback received from our members in a recent poll on the issue, members want to:

• Ensure the future of GME in Louisiana with a commitment to maintaining the best training practices and backed by adequate funding; and
• Maintain patients' access to quality health care, especially for those most affected by the cuts - the poor and uninsured.

CLICK HERE TO DOWNLOAD:  Dr. Andy Blalock, president of the LSMS, addresses the issue in an open letter to all LSMS members.

Louisiana State Medical Society
225.763.8500 | 800.375.9508 | Fax 225.763.6122
6767 Perkins Road, Suite 100 | Baton Rouge LA 70808
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Making Louisiana a Better Place to Practice Medicine Since 1878

LA Docs Push AMA on Medicare Reform

By Andis Robeznieks

Posted: June 14, 2012 - 12:30 pm ET

Tags: American Medical Association (AMA), Healthcare Reform, Medicare, Paul Ryan, Physicians, Policy

Members of the American Medical Association House of Delegates want to discuss transitioning Medicare toward a premium-support system at their upcoming June 16-20 meeting in Chicago, and it doesn't look as if they can be stopped from doing so.

On the delegates' agenda was a report that included a recommendation that the AMA lend its backing to proposals to transition Medicare to a premium support system—a move promoted by U.S. Rep. Paul Ryan (R-Wis.) and other conservative members of Congress. The report was prepared by the AMA Council on Medical Service, which serves as an AMA advisory panel on socio-economic issues, but the council took the report off the agenda.

LA Docs Push AMA on Medicare Reform

By This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Posted: June 14, 2012 - 12:30 pm ET

Tags: American Medical Association (AMA), Healthcare Reform, Medicare, Paul Ryan, Physicians, Policy

Members of the American Medical Association House of Delegates want to discuss transitioning Medicare toward a premium-support system at their upcoming June 16-20 meeting in Chicago, and it doesn't look as if they can be stopped from doing so.

On the delegates' agenda was a report that included a recommendation that the AMA lend its backing to proposals to transition Medicare to a premium support system—a move promoted by U.S. Rep. Paul Ryan (R-Wis.) and other conservative members of Congress. The report was prepared by the AMA Council on Medical Service, which serves as an AMA advisory panel on socio-economic issues, but the council took the report off the agenda.

"The executive committee of the Council on Medical Service unanimously agreed to withdraw Council on Medical Service Report 2," Dr. Tom Sullivan, CMS chairman, said in an e-mail. "The Council believes there is a need to put in additional work on a revised report that addresses a number of complicated policy issues."

This move was blasted by former AMA President Dr. Donald Palmisano, a surgeon and attorney based in the New Orleans area, on his website. This was soon followed by the Louisiana delegation introducing a late resolution (PDF) that included the recommendations from the council's report.

The various reports and resolutions before the delegates are initially heard and discussed in front of eight "reference committees" that make recommendations. Delegates are not obligated to follow the recommendations.

In a preliminary report based on online testimony, the reference committee hearing the Medicare report recommended the resolution's adoption with only a small amendment seeking the assurance that health insurance coverage be "affordable for all beneficiaries." The committee said the report gives the Council on Medical Service "a foundation upon which to move forward with policy development necessary to address the unstable Medicare trajectory."

A similar report on Medicaid recommending changing AMA policy "to give states the option to transition nonelderly and nondisabled Medicaid beneficiaries to a system of tax credits for the purchase of coverage" was given a preliminary recommendation for adoption without changes.

The reference committee also made a preliminary recommendation that, instead of adopting a resolution calling on the AMA to "ask politicians who make proposals to reduce healthcare costs to answer more specific questions to detail the potential impact on all Americans," the association should reaffirm its existing policy on evaluating health system reform proposals.

This does not sit well with the author of the resolution, Dr. Michael Kitchell, past president of the Iowa Medical Society and board president for the McFarland Clinic, a physician-owned multispecialty group practice in Ames, Iowa. Kitchell said he plans on calling for discussion of his resolution, which mentions Ryan and Sen. Wyden (D-Ore.) by name in its text.

"Politicians say this is the wave of the future—but these politicians don't get it," Kitchell said, saying that he thinks premium support might be fine for the healthiest 90% of the nation, but won't do anything to reduce costs because it doesn't address what to do with the minority of patients who use the majority of Medicare's resources.

"What do you do with the sickest of the sick?” Kitchell asked. "If they have a well-thought out plan, let's hear it."

Kitchell said he thinks having accountable care organizations focus on these patients may be the best approach to reducing costs.

Cindy Munn
Executive Director, Louisiana Health Care Quality Forum

In December 2011, the state's health information exchange, LaHIE, went “live” with Lafayette General Medical Center and Opelousas General Health System as pilot facilities in the Acadiana region. The go-live marked a milestone toward establishing a web-based medical records exchange that is designed to allow physicians, hospitals, pharmacists and other health care providers to deliver coordinated, cost-effective patient care across the state.

Cindy Munn
Executive Director, Louisiana Health Care Quality Forum

In December 2011, the state's health information exchange, LaHIE, went “live” with Lafayette General Medical Center and Opelousas General Health System as pilot facilities in the Acadiana region. The go-live marked a milestone toward establishing a web-based medical records exchange that is designed to allow physicians, hospitals, pharmacists and other health care providers to deliver coordinated, cost-effective patient care across the state.

LaHIE is the mechanism that allows for the secure exchange of health information among authorized providers and across Louisiana’s health care system to help improve patient safety, quality of care and health outcomes. The hospitals were willing to help work through the process of implementation, identifying best practices and approaches. Additionally, because of their willingness to be on the cutting edge, the Acadiana region now benefits from LaHIE sooner than other communities in the state.

LaHIE is an initiative of the Louisiana Health Care Quality Forum. The Forum is a private, not-for-profit organization dedicated to advancing evidence-based, collaborative initiatives to improve the health of Louisiana residents. It also serves as the state-designated, neutral entity to support providers and critical access/rural hospitals as they adopt and meaningfully use EHRs and to plan and implement the state’s health information exchange.

Brenda Ikerd, the Forum’s Health Information Technology Director, noted that this milestone event was years in the making. “There has been extensive involvement with many stakeholders, and they are excited that it is now a reality,” she shared. “We are one of the first states in the country to be doing it. The successful exchange between the two pilot hospitals created secure, real-time access to information for high quality patient care. LaHIE is the next critical step in Louisiana’s journey to advance health information technology and connectivity.”

The LaHIE team continues to work with the Acadiana pilot region to build valued usage of LaHIE. Core services include a master patient index, provider registry, record locator service, user identity management and authentication, audit trail and consent management. LaHIE is currently adding additional features, such as single sign on; direct secure messaging; additional data flowing through HIE (e.g., medications, procedures); and facilitation of additional functionality with Louisiana Department of Health and Hospitals services (e.g., public health reporting on immunizations, Medicaid eligibility verification, electronic lab reporting and syndromic surveillance). Features to be developed in later phases include case management/analytics, patient access to LaHIE, quality reporting capabilities and interstate exchange capabilities.

For more information about LaHIE and the Forum, please visit www.lhcqf.org or contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

From: Jeff Williams, LSMS Executive Vice President

I can tell you this specific issue is one the LSMS has been heavily involved in from day one, which was  August of 2010.  However, Medicaid as a whole is something we are concerned with and work on every day of every year to ensure patients have access to quality health care and providers are reimbursed at a fair rate.  Below is a condensed timeline of our activities related to Coordinated Care Networks (CCNs), now known as Bayou Health.  However, this in no way summarizes all of our activities on behalf of Louisiana physicians and their patients.

• Letter to DHH RE: Repayment of Reimbursement (September 2010)
• SB 207 Letter(June 2011)
• Updated CNN Document (February 2011)
• Member Notice RE: Physician Plaintiffs

From: Jeff Williams, LSMS Executive Vice President

I can tell you this specific issue is one the LSMS has been heavily involved in from day one, which was  August of 2010.  However, Medicaid as a whole is something we are concerned with and work on every day of every year to ensure patients have access to quality health care and providers are reimbursed at a fair rate.  Below is a condensed timeline of our activities related to Coordinated Care Networks (CCNs), now known as Bayou Health.  However, this in no way summarizes all of our activities on behalf of Louisiana physicians and their patients.

• Letter to DHH RE: Repayment of Reimbursement (September 2010)
• SB 207 Letter(June 2011)
• Updated CNN Document (February 2011)
• Member Notice RE: Physician Plaintiffs

The LSMS drafted and presented two different plans to DHH that called for the privatization of Medicaid that would decrease public outlays, reduce overall health care costs by eliminating cost-shifting, increase access to care, and empower  the needy to make decisions about their health care needs.  These plans were called:  Access to Care Plan (ABC Plan) and Health Access Louisiana (HAL).  These were plans that were developed by physicians and contained principles that took into account things such as overall program costs, physician reimbursement rates, patient access to care and patient choice.  Unfortunately both of these plans fell on deaf ears with DHH and the administration as Governor Jindal felt he knew more about health care than the physicians providing it, thus the announcement of the coordinated care networks (CCNs) in August 2010. 

August 2010 to February 2011

The LSMS formed the Coalition to Protect Louisiana’s Healthcare, which was a group of provider organizations that represented tens of thousands of direct caregivers and healthcare employees throughout Louisiana. We were deeply concerned about the recent and future cuts to Medicaid and the rapid development of Coordinated Care Networks (CCNs) being implemented by the Department of Health and Hospitals.  Community hospitals and physicians had been the target of massive Medicaid cuts exceeding $250 million collectively over the last two years. These cuts were counterproductive to economic growth and resulted in job losses to Louisiana residents. They also increased cost shifting to businesses and adversely affected access to quality care.  Together this coalition strongly urged DHH and Governor Jindal to support short and long-term strategies to ease cuts to physicians and community hospitals, as well as delaying the implementation of CCNs until our patients, providers and citizens understand how these drastic changes will affect care in their communities.  Some of these included:

§  Entire program needs to be in rule and legislation to ensure appropriate oversight – The initial rule, as released by DHH, was mostly a shell document that referred mainly to the CCN contract and policy/procedure guides.  By not having the contract or guides in rule or statute, any changes to those documents could result in the program being changed absent any oversight. 

§  Medical Loss Ratio – There is no specific requirement for Medical Loss Ratio in the CCN contracts, guides, or any other material.  Absent a threshold, there is no transparency of how dollars in this taxpayer funded program are being spent and if they are being spent on medical care. 

§  Network Adequacy – While an issue on the commercial side, access to care remains an even larger issue in the Medicaid market.  Payers must be required to offer complete networks of contracted providers. 

§  In-state provider requirement – If services are available within the state, the payers should be required to utilize those providers.  Payers should not be allowed to leverage out-of-state providers against in-state providers with Louisiana dollars. 

§  Number of CCNs and critical mass – There is no selection or evaluation process in the model DHH has proposed.  If a CCN meets the contract requirement, it can participate.  Most of the CCNs that offered up an initial letter of intent to participate were targeting all regions.  If there are 12-14 CCNs in a region, then that could severely dilute the market.  If these plans are unable to attain critical mass, they will fail. 

§  Actuarial soundness – DHH has stated on numerous occasions that they are pushing the envelope with regards to actuarially sound rates. 

§  Long-term sustainability and built in adjustments

§  True rate floors inclusive of all add-ons – A true rating floor is absent in the proposed program at present.  CCNs have the ability to contract below prevailing Medicaid rates and, judging from some DHH comments, have the ability to set non-network reimbursements. 

§  Shared Savings requirement – CCNs have the option of developing a provider incentive program in the proposed structure. 

§  Out of Network Services & Payments – There has been no solid answer from DHH on how out-of network services are to be paid.  In provider meetings, DHH stated that the provider would need to coordinate that with the CCN, but eventually conceded that providers could be looking at substantially lower reimbursements for out of network services. 

§  Title 22 Claims Payment and Audit provisions – None of the title 22 prompt pay/audit provisions are included in the CCN program.  These requirements have served the commercial market well and should be mandated in the CCN program. 

In early February 2011 Governor Jindal met with health care organizations and informed us that the CCNs were moving forward and there was nothing that could be done to stop this drastic change as the enabling legislation that gave the authority to DHH to do this without any legislative oversight had been passed during the 2010 legislative session.  It was hidden in an bill and no one within the legislature noticed it until the announcement of CCNs in August of that year.  Therefore efforts were targeted to try and fix the program. 

During this time period the LSMS also started preparing a lawsuit against Louisiana Medicaid and the Centers for Medicare and Medicaid (CMS) because reimbursement rates were now set so low that Medicaid patients no longer had the same access to care as private insurance patients, which is required by the federal government.  The background work on this lawsuit took approximately 1 year and $100,000 and is currently ready to be filed.  However, there is a similar lawsuit filed in California that has been challenged all the way to the U.S. Supreme Court and we are waiting on their ruling before we file.  A letter regarding the lawsuit is attached.

We also formally protested the recoupment of Medicaid payments by DHH, letter is attached.

March 2011 to present

We have continued to try to make the Bayou Health program more physician friendly by meeting with DHH on a regular basis.  We also have been providing LSMS members with a voice and direct access to DHH officials.   We have done this through email alerts, conference calls, newsletters and other activities.  We also supported Senate Bill 207 during the 2011 legislative session, which would have provided some legislative oversight over the CCNs.  However,. Governor Jindal vetoed that bill after it was passed by the legislature (see attached letter).  We are bringing a similar bill back this year during the 2012 legislative session and will be pushing hard to get it passed. 

Currently, Medicaid providers who are LSMS members have access to DHH officials that other physicians do not.  This is an extremely important effort as problems are expedited to the highest level and addressed immediately.  We are also in the middle of a statewide survey of physicians where we are identifying problems and trends within Bayou Health in an effort to fix them.   

We have an continue to meet on a regular basis with legislators, DHH, Molina, Maximus, CNSI and the 5 Bayou Health providers to address issues as they arise.  In recent weeks we have held meetings to discuss issues related to lab work, newborns, payment delays, etc.  There is a new issue every week and we will continue to address each of them as they arise. 

Again sorry for the length and I apologize for my ramblings but there is a lot of information.  Please let me know if you need anything else.  Lastly, if you can get us an audience at Women's and Children's hospital we would be happy to come and discuss this issue in more detail. 

Sincerely,

MEDICAID UPDATE:  New CCN Implementation Timeline Released
The Louisiana Department of Health and Hospitals (DHH) announced several key dates regarding the implementation of Coordinated Care Networks (CCNs) today in its Making Medicaid Better enewsletter. In lieu of the President's Update, LSMS is sending this vital information to all of its members today. The October President's Update will be forthcoming.

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Non-Profit Healthcare Organizations Can Now Provide In-Depth On-line Information to Their Members on Meaningful Use (MU) and the ARRA stimulus Benefits At No Charge

August 8, 2011—HITECH Answers, a leading provider of educational resources on the HITECH Act, the ARRA stimulus benefits and Meaningful Use (MU) announced today a unique industry outreach program enabling non-profit organizations such as local and regional medical societies to offer its vast library of materials to their members free of charge.

These organizations can now better inform their members on the details of MU and the ARRA stimulus benefits without expending often scarce internal resources. Their members can now be better equipped to implement MU initiatives and be more effective in obtaining stimulus benefits.

Non-Profit Healthcare Organizations Can Now Provide In-Depth On-line Information to Their Members on Meaningful Use (MU) and the ARRA stimulus Benefits At No Charge

August 8, 2011—HITECH Answers, a leading provider of educational resources on the HITECH Act, the ARRA stimulus benefits and Meaningful Use (MU) announced today a unique industry outreach program enabling non-profit organizations such as local and regional medical societies to offer its vast library of materials to their members free of charge.

These organizations can now better inform their members on the details of MU and the ARRA stimulus benefits without expending often scarce internal resources. Their members can now be better equipped to implement MU initiatives and be more effective in obtaining stimulus benefits.

Subject matter experts from leading organizations and institutions help contribute content to HITECH Answers including the Centers for Medicare and Medicaid Services (CMS), the Certification Commission for Health Information Technology (CCHIT), Wellspan Health, The American Academy of Professional Coders (AAPC), Oregon Health and Science University (OHSU), and the Health Story Project. The information is presented in an easy to access, web-based format and is aimed toward working professionals in the field.

Through this educational outreach program, members of non-profit organizations can:

• Learn how to earn EHR Incentives

• Really understand Meaningful Use

• Get full details for Attestation

• Attend live e-learning sessions

Interested non-profits can contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it for more information.

Media Contacts:
Mark Benvegnu                                                       Carol Flagg    
HIT Marketing Solutions                                          HITECH Answers
832.928.1173                                                          623.535.3622
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About HITECH Answers

HITECH Answers is a leading provider of online educational resources for healthcare providers to learn more about EHR adoption. At the forefront of providing independent analysis of the HITECH Act since April of 2009, HITECH Answers has built a substantial virtual library of research, resources and tools for members to access to gain a complete understanding of the process of adopting certified EHR technology and achieving meaningful use. Learn more at: www.HITECHAnswers.net

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