Medicare Deadline for PECOS
The deadline for Medicare providers to enroll in PECOS (Provider Enrollment, Chain and Ownership System) is January 3, 2011. Claims for items or services will be denied if providers are not enrolled in the system by this date. (This applies to Medicare claims only.) The deadline for enrollment is subject to change; however, providers should rely on January 3, 2011 as the official deadline unless otherwise notified.    For more information about the Internet-based PECOS system, visit the CMS website.

Medical Loss Ratios
As a requirement of the Patient Protection and Affordable Care Act (PPACA), the federal health care reform law, the National Association of Insurance Commissioners (NAIC) has adopted a model regulation for calculating medical loss ratios. Medical loss ratio requirements are designed to ensure that insurance companies are using top dollars for health care. Under the PPACA, minimum medical loss ratios are set at 80 percent for individual and small group markets and 85 percent for large group markets. State governments may impose higher medical loss ratio requirements. To learn more about the model regulation, visit the NAIC website.

CMS Freezes Coding Updates
The Centers for Medicare and Medicaid Services (CMS) recently announced a partial freeze on coding updates for ICD-9-CM, ICD-10-CM and ICD-10-PCS codes prior to implementing ICD-10 on October 1, 2013. On October 1, 2011, the last annual update to ICD-9 and ICD-10 codes will occur. Limited updates to both of these code sets to capture new technology and diseases will occur on October 1, 2012. Regular updates to ICD-10 codes will begin October 1, 2014.

Legislative Update
The Senate is not expected to return to session for the remainder of the year. The House is expected to be back in session on November 8, 2010 to “clean up” and finish concurrence on some legislation from the Senate. At this time, the PAFP does not expect that any substantive legislation will be discussed and that no action will be taken on healthcare legislation in particular.

Just in case you haven’t been watching, reading or listening to anything--Election Day is Tuesday, November 2, 2010.

Flu Shots Covered for Children in Foster Care
Children in foster care can receive a flu shot as part of general well care. According to the Department of Public Welfare, providing flu shots for children and youth in placement is part of normal medical care and covered by a general release from the parent/guardian and or a general medical court order. State law and regulations do not require a special release/court order.

What Should Parents Really Worry About?
A new book states that parents worry about, in order: kidnapping, school snipers, terrorists, dangerous strangers and drugs. But statistics show that these are ways children actually get hurt or killed (in the U.S. and Pennsylvania):  car accidents; homicide (usually committed by a person who knows the child, not a stranger); abuse; suicide; and drowning.

Physicians can help by encouraging the use of seat belts and bike helmets. The PAFP Foundation is offering CME specific to abuse and suicide prevention:

Check out the Fall Keystone Physician magazine (due for release in late October/early November) for an article on the requirements for mandated reporters (note: physicians are mandated).

A lecture on child sexual abuse will be offered at the Pittsburgh Breakaway (Nov. 5-7 – register at www.pafp.com). A tip sheet from that lecture will be published in the December issue of Keystone Physician.

Visit www.pafp.com and click on “online CME” to watch two CME webcasts on helping adolescents with mental health disorders. (Hurry: “Pharmacological Management of Adolescent Depression in Primary Care” expires Dec. 1.)

If You Don’t Like Change, Try Irrelevance
Family physician Edward Zurad, MD, uses that quote to drive home the point that family practices need to adopt continuous quality improvement into everyday practice or risk being left behind. Dr. Zurad and internist Dr. Jorge Scheirer presented at an AAFP Scientific Assembly Satellite Symposium in Denver Oct. 1 about the evidence-based tools family practices can use to make changes that can significantly improve care for patients, including those with uncontrolled type 2 diabetes.

The presentation will be available in November as a CME webcast (a CME monograph will be published this winter). Meanwhile, take advantage of other CME from the PAFP Foundation about quality improvement.

CME monograph.  PDSAs: the Heart of Quality Improvement. Up to 2 Prescribed credits. Qualifies as risk management CME.

CME webcasts. 5 webcasts, 1 Prescribed credit each. Hurry – they expire Nov. 1. Qualifies as risk management CME.

Check out new webcasts; earn free CME credits
Colorectal Cancer is the second leading cause of cancer yet is highly preventable. Check out these 3 supporting webcasts to learn more and improve your screening rates: 
-- CRC Screening Guidelines
-- CRC Screening Toolkit
-- Systems Change to Improve CRC screening rates

To register for these CME webcasts, click here. You also will find supporting tip sheets to download for quick and easy reference.

QI Work by PAFP Member Practices in Philly Inspires Payment Change at IBC
About 30 primary care practices in southeast Pennsylvania have worked for more than two years with the state’s Chronic Care Initiative and the PAFP Foundation program called PA IPIP to make huge changes in the way they deliver care. The change worked – data they’ve been collecting clearly shows that their patients are healthier. These practices are enjoying their work again and now their success as inspired Independence Blue Cross to change the way it pays primary care physicians. This is a PA IPIP goal: improve care, bring joy back to medicine and improve payment – for all primary care practices. Check out the front page story from the Philadelphia Inquirer: http://www.philly.com/inquirer/front_page/20100430_Insurance_firm_has_incentive_for_primary_care_doctors.html.

Learn How to Change the Way You Deliver Care
 The Chronic Care Initiative works with selected practices, but PA IPIP will soon have opportunities for all primary practices to begin this type of work (the first of which will work in the context of colorectal cancer screening). Meanwhile, check out www.pafp.com/IPIP for links to various CME events, webcasts and monographs on quality improvement based on the work being done in the Chronic Care Initiative.

Keep Checking Your Email
The next issue of Keystone Physician is due out really soon. This issue features a Q&A on child sexual abuse and your requirements as mandated reporters; a list of ways the healthcare reform law can pay you more; a personal essay from a resident on becoming a doctor; and plenty of information about live and online CME opportunities.

If you are receiving this newsletter, but not the digital magazine, please contact me at dschumaker@pafp.com.