HCFA delays making ICD-9 changes

HCFA recently announced that it will not implement any ICD-9 code changes for fiscal year 2000. The codes will be updated for fiscal year 2001, which begins Oct. 1, 2000.

According to HCFA, undertaking system changes to capture additions, deletions and modifications to ICD-9 codes for fiscal year 2000 would have jeopardized HCFA's efforts to ensure that all Medicare computer systems are ready to function on Jan. 1.

Family Practice Management (FPM) will publish a quick-reference card of diagnosis codes most often used by family physicians after the 2001 codes are released. In the meantime, you can use the card we published in our October 1998 issue, which may be downloaded from the FPM Web site or purchased through the AAFP Order Department by calling 800-944-0000 and asking for item number A-512 (two copies).

E/M documentation guidelines still on HCFA's back burner

HCFA won't begin pilot testing the draft evaluation and management (E/M) documentation guidelines until after January, according to the Sept. 13 issue of Part B News. The delay makes it unlikely that new guidelines will be implemented before 2001.

The newsletter quotes an unnamed HCFA official, who cited several reasons for the delay, including Y2K compliance priorities and the need to issue rules for the Medicare physician fee schedule, the hospital outpatient prospective-payment system and the Health Insurance Portability and Accountability Act.

Physicians working harder to maintain income levels

Average annual compensation for primary care physicians rose 2.5 percent in 1998, to $139,244, according to the Medical Group Management Association's (MGMA) latest Physician Compensation and Production Survey.

The increase in compensation, though slight, comes at a time when overhead costs are growing and reimbursement rates are declining. What's keeping compensation from dropping is that physicians are working longer and harder, said David F. Thomas, a member of the MGMA Survey Advisory Committee and CEO of Midwest Physician Group, Olympia Fields, Ill.

“Physicians, like all people, get used to a certain salary, and they don't want to see their take-home pay go down. So they're working more days and longer hours,” he said.

Average gross charges for primary care physicians increased 4.7 percent last year, according to the report.

Source: Medical Group Management Association, Physician Compensation and Production Survey: 1999 Report Based on 1998 Data.

Y2K Update: Medicare contractors, providers still generally unprepared

Despite extensive efforts by HCFA to promote Y2K readiness, Medicare contractors and providers continue to lag behind, according to the Sept. 27 Washington Post. Draft testimony prepared by the General Accounting Office for a House Government Reform subcommittee revealed that 40 of 69 Medicare contractors have conducted Y2K testing with “less than l percent of the doctors, hospitals and health providers who submit claims for payments,” reports the Post.

“We now see our greatest risk to the program as the uncertainties in the readiness of our partners, namely, our Medicare providers,” said Gary Christoph, HCFA's chief technology officer.

Government computers that handle Medicare transactions will be Y2K-ready, according to Christoph, who reported that Medicare has already successfully received and processed enrollments from the Social Security Administration for beneficiaries entitled to Medicare benefits on Jan. 1, 2000. Medicare is expected to process more than 1 billion claims and pay out $288 billion in benefits in 2000

AMA union won't support strikes

In an effort to promote a professional image and to set itself apart from other unions, the recently formed American Medical Association physician union, Physicians for Responsible Negotiations, says it will not support strikes by physicians and will not encourage physicians to join its ranks. Instead, the AMA considers unionization “the last resort for doctors who cannot settle their grievances any other way,” said Todd Vande Hey, AMA vice president of private sector advocacy and a member of the union's governing body.

According to an Oct. 11 article from the Associated Press, the prospect of increased activism by the AMA has already begun to have an effect. Some observers report that insurers are making greater efforts to alleviate tensions with doctors, for example, by including them on decision- making committees.

Teens seeking STD services place importance on provider traits

When deciding where to seek care for sexually transmitted diseases, black adolescents more frequently base their decisions on the attributes of health care providers rather than on the availability of services or confidentiality.

In a University of California at San Francisco study of 302 black adolescents between 12 and 17 years old, more than 90 percent of the respondents rated provider attributes — giving clear explanations, answering patient questions and having sufficient medical knowledge — as extremely or very important.

Items pertaining to availability, such as convenient hours or short waiting-room times, were rated second in importance. Confidentiality, such as the clinic keeping the visit secret from family, was rated least important.

The study was reported in the August 1999 issue of the Archives of Pediatrics & Adolescent Medicine.

Americans don't know what ‘managed care’ means

Although 87 percent of workers with health insurance are enrolled in a managed care plan, 62 percent of those patients believe they have never been covered by a managed care plan, according to preliminary findings of the 1999 Health Confidence Survey by the Employee Benefit Research Institute (EBRI).

Among persons enrolled in HMOs, 54 percent said they have never been in a managed care plan. Among PPO enrollees, 68 percent said they have never been in a managed care plan. And among people with traditional fee-for-service insurance, 6 percent said they are currently enrolled in a managed care plan.

“The findings of the 1999 Health Confidence Survey make it clear that the American public and their policymakers need better education about the health care system today,” said EBRI president Dallas Salisbury.

EBRI is a private, nonprofit, nonpartisan, public policy research organization based in Washington, D.C.

Patients, physicians support e-mail communication

Seventy percent of patients would like to communicate with their health care providers via e-mail, according to a recent survey of 320 patients and 75 residents at the University of Michigan Health System, Ann Arbor.

Although 27 percent of the physicians said they were currently using e-mail to communicate with their patients, 83 percent indicated that e-mail was a good means for answering patients' nonurgent medical questions.