Kiss the SGR Goodbye: Senate Repeals Medicare Payment Formula

Posted in Medicare on April 14th, 2015 by MMS – 1 Comment

US Capitol 1In an historic vote Tuesday night, the U.S. Senate finally repealed the flawed Medicare payment formula that has been plaguing physicians for more than 17 years. The final vote was 92-8. Senators Markey and Warren voted in favor.

To get there, the Senate spent more than two hours trudging through votes on six different amendments from both Republicans and Democrats. Only one vote was close – it would have removed caps on therapy services. If any single amendment had passed, the bill would have returned to the House, whose leaders had already said they would not agree to any more amendments.

The vote came just hours before Medicare would have been forced to cut payments by 21% for all services provided after March 31. But that’s not going to happen – President Obama will sign the bill.

The legislation guarantees physicians a 0.5% rate increase every year through 2019, when a series of quality incentive payments become available. The first 0.5% increase takes effect July 1, 2015, followed by another 0.5% increase on Jan. 1, 2016.

Medicare Initiates Plans to Pay Claims With 21% Cut

Posted in Medicare on April 14th, 2015 by MMS – 1 Comment

Photo by frankleleon, via flickrUPDATE: 10:30 a.m., 4/16/15

The Senate repealed the SGR on the evening of April 14.  However, because the bill has not yet been signed, a small number of claims are being processed at the reduced rate, on a rolling basis.

When the bill is signed, Medicare’s contractors will automatically reprocess those claims at the higher rate.

With the Senate’s vote on the SGR repeal legislation still up in the air,

Medicare’s billing contractor announced that on April 15, it will start processing April claims at reduced rates, on a first-in, first-out basis.

Medicare payment rates were cut by 21% on April 1, following the expiration of the latest SGR payment “patch.” CMS routinely holds claims for 10 business days, so until now, practices’ cash flow was not affected. This “rolling hold” is designed to minimize the impact on practices to greatest extent possible.

There’s still a chance the repeal will pass by April 15. But if Congress acts after April 15, the new rate would be retroactive to April 1.

If there’s any positive news here, it’s that practices will NOT be required to resubmit claims initially paid at the lower rate. National Government Services said it will automatically reprocess those claims and issue checks for the difference.

Claims for services provided before April 1 are not affected by the payment cut.

For more information, visit the National Government Services website.

Mass. Attorney General’s Office: Medical Community Is Part of the Solution

Posted in opioids, Public Health, Public Health Leadership Forum on April 8th, 2015 by MMS – Be the first to comment

Massachusetts Attorney General Maura Healey has made prescription drug abuse a top priority for her office, and First Assistant Attorney General Christopher K. Barry-Smith’s message to Forum attendees was that Ms. Healey views the medical community as a “large part of the solution” to the problem of opioid abuse.

Barry-Smith said Ms. Healey decided on making opioid abuse a priority for her office as a result of her campaign for the office last year. In talking to citizens across the state, Healey discovered a recurring theme of concern from individuals and families: that drug and opioid abuse was a serious problem and something must be done about it.

Establishing opioid abuse as a priority, Barry-Smith said, takes three avenues of approach:  heroin trafficking, prescription drug trafficking, and unlawful prescribing, the last of which he said was a “small part” of the problem. He also noted that the Attorney General’s office would act to ensure that pharmaceutical marketers and dispensers take reasonable steps to reduce the risks of diversion and abuse.

Christopher K. Barry-SmithThe pricing of the anti-overdose drug naloxone and insurance coverage for behavioral health parity are other major concerns of the Attorney General, Barry-Smith said, as is the prescription monitoring program, “to make it as useful as possible.”

Finally, Barry-Smith, reprising the theme that the medical community is seen by the Attorney General as part of the solution, said that prescribing practices must take into account the possibility of overdose and he urged prescribers to “follow best practices.”

– Richard Gulla

Public Health Forum Keynote: Opioid Abuse Is a Public Health Issue

Posted in opioids, Public Health, Public Health Leadership Forum on April 8th, 2015 by MMS – Be the first to comment

Combining raw statistics with the faces of real people who have died from drug overdoses, and at the same time reflecting on his personal experience with substance abuse, Michael Botticelli took a decidedly human approach in his address at the 2015 MMS Public Health Forum, The Opioid Epidemic: Policy and Public Health. 

Botticelli, Director of the Office of National Drug Control Policy and former Director of Substance Abuse Services for the Massachusetts Department of Public Health, provided the keynote speech at the forum, which featured a range of experts discussing the medical, clinical, and legal aspects of opioid abuse.

Botticelli was clear and direct with two main messages for the 300 in attendance: “Opioid abuse should be regarded as a public health issue” and “we cannot afford to wait as a society to act” in responding to it.

He said five areas must be the focus of efforts by physicians, policymakers, legislators, and law enforcement officials to curb the abuse of drugs: education, prescription monitoring programs, storage and disposal, enforcement, and treatment.

Education: Botticelli noted that physicians receive little training in medical schools on opiates and prescribing and recommended that medical schools begin to establish courses in these subjects and urge, if not require, students to take them.

Michael BotticelliPrescription monitoring: Regarding them as valuable tools for research and to prevent “doctor shopping” by patients, Botticelli said prescription monitoring programs in the states must continue to be modernized and given more funding.  Noting that 49 states now have prescription monitoring programs, with Missouri on the way to becoming the 50th, he urged a nationwide infrastructure for such programs, with interstate data sharing and interoperability among hospitals, clinics, and health centers.

Disposal: Acknowledging data from the Centers for Disease Control that most of those who abuse prescription drugs use drugs that are prescribed to someone else, Botticelli recognized the importance of proper storage and disposal, saying we need to get the drugs “out of the home when no longer needed.”

Enforcement: While prescription drugs constitute a major part of the abuse problem, Botticelli said priority must also be given to the illegal trafficking in heroin.

Treatment: “People can succeed with the right treatment,” he said, and we must make “every effort to reduce the stigma to help people get the care they need.  If we want better outcomes, we need to pay attention to substance abuse disorders.”

Botticelli concluded his remarks with a message for health care providers.  “The medical community must remain engaged,” he said.  “The problem can be cared for by those who can provide the highest levels of care.  We don’t have time to waste.”

The slides for Mr. Botticelli’s presentation are available at

– Richard Gulla

April Physician Focus: The Causes of Cancer

Posted in Health, Physician Focus on April 2nd, 2015 by MMS Communications – Be the first to comment

Cancer is perhaps the diagnosis patients fear the most. Treatments can be long and exhausting, and the disease can bring anxiety and uncertainty for patients and their families. The disease is the second-leading cause of death in the U.S., surpassed only by heart disease, and claims nearly 600,000 lives each year. The American Cancer Society projects more than 1.6 million new cases of the disease will be diagnosed this year.

A recent study indicated that most cancers are the result of just “bad luck” in how our cells multiply and mutate, yet long-standing research shows that genetics, lifestyle issues, and environmental factors play important roles in developing cancer.

Public surveys, however, have shown a lack of understanding and many misperceptions about the causes of cancer. To raise public awareness about this common condition, the April edition of Physician Focus features Robb Friedman, M.D., (photo, right) a board-certified oncologist and hematologist and Director of The Cancer Center at Beth Israel Deaconess Medical Center in Needham, who joins program host Dale Magee, M.D., (left) a past president of the Massachusetts Medical Society.

Among the topics of conversation are how cancer develops and what patients can do not only to reduce their risks of getting the disease, but also to prevent some types of cancer from occurring.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at,, and on YouTube.

The President’s Podium: Doctor’s Day 2015

Posted in Uncategorized on March 27th, 2015 by MMS Communications – 1 Comment

By Richard Pieters, M.D., President, Massachusetts Medical Society

This year marks the 25th anniversary of National Doctor’s Day, annually celebrated on March 30 and first proclaimed by  President George Bush in 1991 to honor physician leadership in the “prevention and treatment of illness and injury.”

On this Doctor’s Day, however, physicians of the Massachusetts Medical Society are not calling attention to ourselves, but to the importance of the physician-patient relationship – the relationship that is at the very heart of health care.

The impetus behind this focus is a 2011 Florida law making it illegal for physicians to ask patients if they own a gun or to record information about gun ownership in a patient’s medical record. Pediatricians sued to block the law, but it was eventually upheld by a panel of the U.S. Court of Appeals who declared the law regulates physician conduct “to protect patient privacy and curtail abuses of the physician-patient relationship.” Florida physicians have asked for a rehearing, which is currently pending.

This appears to be growing trend. Similar laws are pending in several other states, and the latest effort to regulate physician behavior is occurring in Texas.

Regarding this as a bold intrusion into the physician-patient relationship, members of our House of Delegates at the Interim Meeting last December passed a two-part resolution that (1) declared our opposition to any attempt by government to interfere with a physician’s right to free speech as a tool to improve the health and wellness of our patients, and (2) dedicated Doctors Day 2015 to the recognition of the basic principles that the doctor-patient relationship is confidential and sacrosanct.

As a result, we have acted to call attention to this issue through news reports and opinion pieces in local publications across the Commonwealth. I invite you to read the press release here and one of the commentaries here. Several district society presidents have joined me in co-authoring the commentaries for papers in their regions.

While gun safety takes center stage in the effort due to the Florida law, the real issue posed here is outside interference in the physician-patient relationship, which physicians should emphatically resist. Our obligation as health care providers drives us to ask about many subjects that affect health. Banning conversation about gun safety is a slippery slope indeed: if that discussion is off limits, what might be the next topic prohibited?

President Bush’s 1991 proclamation establishing Doctors Day said that “More than the application of science and technology, medicine is a special calling, and those who have chosen this vocation in order to serve their fellow man understand the tremendous responsibility it entails.”

That “tremendous responsibility” of our special calling is rooted in the physician-patient relationship, and any intrusion into that relationship hinders our ability to practice medicine and denies patients from getting proper care.

So on this 25th anniversary of Doctors Day in 2015, we are placing the focus not on the physician, but on the patient – and that’s right where it should be.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine.

Editor’s Note: Read how Worcester physicians are taking the lead in gun safety by targeting gun “gag laws.” 



U.S. House Makes History, Votes to Repeal Medicare SGR Payment Formula

Posted in Medicare on March 26th, 2015 by Erica Noonan – Be the first to comment

IPhoto by wallyg, via flickrn a historic move, the U.S. House of Representatives voted overwhelmingly Thursday in favor of repealing the flawed Medicare physician payment formula by a vote of 392-37. All Massachusetts members voted in favor of the bill.

The $200 billion package, widely embraced by both political parties, calls for a permanent repeal of the Sustainable Growth Rate, or SGR, that has threatened physicians with double-digit reimbursement cuts 17 times over the past decade.

MMS President Richard Pieters, MD, applauded the House’s action, calling it critical to re-establishing a stable environment for physicians and more than 1 million Massachusetts seniors who depend on Medicare.

“We thank the lawmakers on both sides of the aisle who came together on behalf of the nation’s seniors and military families who depend on Medicare and their doctors to stay well,” said Dr. Pieters.

“Thank you to the tens of thousands of physicians and patients who heeded our calls to contact their representative in Congress this week. Your voices were heard,” he said.

The Senate will not consider the measure until it returns from its Easter recess in mid-April. If it is successful there, President Obama has indicated he will sign the measure into law.

The most recent Medicare payment patch expires March 31. The next day, a 21 percent cut is scheduled to take effect. However, CMS doesn’t process claims until two weeks after date of service, so if the Senate acts quickly enough, physicians’ first payments for services provided after April 1 will not reflect the 21 percent cut.

The MMS will update its website and social media channels frequently with news of the bill’s continued progress through the Senate.  Read more on the MMS website about the effort to repeal the SGR.

Gov. Baker Releases Budget; Board of Registration in Medicine and MassHealth Affected

Posted in Board of Medicine, Uncategorized on March 6th, 2015 by Erica Noonan – Comments Off


By William Ryder, Esq

MMS Legislative and Regulatory Counsel

Governor Charlie Baker released his first budget this week. Saddled by deficits from the previous administration, particularly in MassHealth spending due to well-documented problems with the Connector, Gov. Baker was faced with significant challenges.

Overall spending is up in MassHealth for Fiscal Year 2016. This is led by managed care line item increases with fee-for-service appropriations slightly down. Both these amounts are based on anticipated demand and projected to maintain access to covered services and maintain current rates. Chiropractic coverage is eliminated for a projected $300,000 saving.

Gov. Baker’s stated commitment to rein in MassHealth spending by confirming eligibility, rather than through across-the-board cuts to providers and legitimate patients, is a reasonable and fair approach that is also federally mandated. Some physicians have expressed concern about reports  that the state could carry over some payments from this fiscal year in FY16. This is often done in state government late in the fiscal year. It does not mean that there will be no payments until July. The governor’s budget proposal is a proposal which must be acted on by the legislature to become law. Usually final passage occurs in June.  Massachusetts State House

Also in the budget is the prescription monitoring program, funded at approximately $1.2 million, a reduction of about $45,000 from last year. It has only six employees to register prescribers, pharmacists, and delegates. As we try to evolve a better PMP, perhaps more resources should be provided to improve the system, provide support staff to participants with concerns, and strengthen the database.

The governor’s proposed budget also included outside sections that would directly impact the Board of Registration in Medicine by placing it within the Mass. DPH and under the authority of the commissioner. The MMS has always supported a fully funded, independent medical board with oversight by the Division of Administrative Law Appeals, the Supreme Judicial Court and the Commissioner of Public Health with some oversight on new regulations. This change was offered by former Senator Richard Moore and rejected in last year’s budget.  MMS will work to maintain the medical board’s independence.

Physician Focus for March: The Measles Outbreak and The Value of Vaccines

Posted in Physician Focus, Public Health on February 27th, 2015 by MMS Communications – Comments Off

The current measles outbreak, which began last December in Disney World and has since led to more than 150 cases in 17 states, is a stark reminder that diseases once declared eliminated can, without vigilance, return easily and spread quickly.

To remind patients about the benefits of immunization, the March episode of Physician Focus examines the current outbreak, how it came about, and why vaccines merit its place on the list of the top ten greatest public health achievements of the 20th century.

Guests are George Abraham, M.D., (photo, center) a board-certified infectious disease specialist, Associate Chief of Medicine at Saint Vincent Hospital in Worcester, Professor of Medicine at UMass Medical School, and Governor of the Massachusetts Chapter of the American College of Physicians, and Sean Palfrey, M.D., (right) a pediatrician at Boston Medical Center, Clinical Professor of Pediatrics and Public Health at Boston University School of Medicine and the founder and director of the Immunization Initiative of the Massachusetts Chapter of the American Academy of Pediatrics. Hosting this edition is primary care physician Bruce Karlin, M.D. (left).

Among the topics of discussion are how once-eradicated diseases like measles can return and spread, how dangerous childhood diseases can be and why people tend to discount their severity, the risks of not getting vaccinated, how herd immunity to protect the public’s health is determined, how misinformation about medicines can spread quickly, how physicians may deal with patients and their parents who have questions or reservations about vaccines, and the importance of immunization for adults as well as children.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at,, and on YouTube.

The President’s Podium: Reducing Opiate Abuse

Posted in Department of Public Health, Health Policy, Medicine, opioids on February 18th, 2015 by MMS Communications – Comments Off

By Richard Pieters, M.D., President, Massachusetts Medical Society

Governor Charlie Baker and Attorney General Maura Healey have each made opiate abuse one of their top priorities, and this week they will announce steps they will take to fight this public health crisis. That the state’s top elected official and top law enforcement officer have put this issue at the forefront of their agendas is good news, because even as Massachusetts ranks as one of the top four states in adopting strategies to curb prescription drug abuse by the Trust for America’s Health, prescription and opiate abuse remains a crisis in the Commonwealth.

MMS has reached out to both the Governor and Attorney General to offer our assistance as they address the problem. Their initial responses have been encouraging, and we look forward to hearing the specifics of their plans and working with them.

One of the keys to reducing the abuse, however, is a sustained effort in raising public awareness about the issue, and the Massachusetts Medical Society has long recognized the importance of communicating to both physicians and patients about prescription drug abuse.

We highlighted the topic in 2011 with our patient education television program that reaches communities across the state, and in subsequent shows addressed the topic of substance abuse in young people and how they can be treated.

Our current program revisits the subject of prescription abuse with experts in addiction medicine. Additionally, we have distributed articles to local media, to outline what both physicians and patients can do to prevent prescription abuse. This is especially important, as more than three out of four people who misuse prescription pain medicines use drugs prescribed to someone else.

My predecessor Dr. Ronald Dunlap last year outlined the physician’s perspective on prescription drug abuse and recommended additional steps that can be taken to reduce the abuse.

I have since provided my views and recommended improvements in the state’s prescription monitoring program, which the Society helped to create more than 20 years ago. We believe a well-run, real-time, robust monitoring program is a key element in the fight against prescription abuse and one in which every physician should participate.

MMS will continue its educational effort on opioids and prescription abuse on April 8 with our Annual Public Health Leadership Forum for physicians and health care providers. The Opioid Epidemic: Policy and Public Health, featuring local and national leaders in substance abuse and addiction medicine, will discuss a range of issues, including the basics of pain management, alternatives to opioids, communicating with patients about pain management and treatment, and advocacy for treatment programs for those with addictions. This forum will offer important information for those who prescribed opioids and treat pain and addiction, and I urge those who do so to attend.  Also, the MMS Ethics Forum at our annual meeting in May will explore the ethical and legal considerations in pain management by physicians.

As government and public health officials seek remedies to the opiate crisis, we urge them to recognize that physicians and their patients – the ones who treat the pain and take the medicines – can play critical roles in reducing the abuse.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine.