Sustainable Growth Rate Legislation AKA "The Doc Fix"

Sustainable Growth Rate Legislation AKA "The Doc Fix"

As a preface, the SGR has been an ongoing problem for providers serving Medicare patients and their beneficiaries. In the past, a "doc fix" has been applied to prevent massive Medicare reimbursement rate cuts, which ultimately would end up in fewer physicians available to treat Medicare patients. Congress is attempting to pass a comprehensive bill that will "fix" the problem (one that rewards quantity of services rather than quality of care) rather than doing an annual patch, which has been the practice for the last ten years.

This is a huge deal for our profession, but also the future of healthcare. Many professional PAs believe that this bill could make or break the profession, which is why it is so important that you are active in pursuing its passage. The SGR bills were both recently passed out of the House and Senate committees and will move to the floor of both chambers sometime in the first few months of 2014. AAPA has been HEAVILY engaged in the development of the bills, as well as some of the amendments which were included in the bills. PAs in the states of the relevant senators have been interviewed and have conveyed personal stories to their senators to help garner support.

Once AAPA finds out early this year what the next steps are for the SGR legislation, they will put out a call to action to AAPA members asking for their support and for them to contact members of Congress to ask them to support these PA provisions. PAFT (PAs for Tomorrow) and their many members are the best advocates they have for the profession. Additionally, other healthcare organizations with aligned interests and Congress are working with them directly on this matter.

What You Need to Know:

Physician Assistants and Medical Scribes

Physician Assistants and Medical Scribes

The word scribe is Latin for scribere, which means "to write." A scribe has been known historically for recording events, making written copies of documents, and more recently, "transcribing" word for word. Medical scribes have emerged most recently in response to the extensive use of EMR into clinical practice from widely used handwritten and dictation methods. 

What Role do Medical Scribes Have in Healthcare?

Medical practices, hospitals, and typically lots of emergency departments hire medical scribes to relieve the providers unequipped with rapid typing skills or who cannot simply find their way around on EMR software. A medical scribe serves to record the actions and words spoken as they occur. Scribes cannot implement their own observations into the medical record. The scribe documents the activities of the provider as they occur and must include the name and signature of the provider who performed the encounter. The provider is required to attest of his/her presence during the encounter, verifying they have reviewed the scribe's documentation and the accuracy. The provider must also sign and date the encounter. 

What are the Benefits of Medical Scribes? 

Reimbursement for Your Performance

Reimbursement for Your Performance 

In the past, PAs have not been given much attention to reimbursement, specifically the requirements of of coding, documentation, and the rules of reimbursement affecting whether YOU are going to get reimbursed for your services as a PA. This is IMPORTANT!

How Is Our Healthcare Reimbursement System Structured?

Medicare sets the standard policy - the rules of the game which everyone should follow. There are then 14 Medicare Administrative Contractors (MACs), which basically function as individual branches that enforce policy around the country, by state or region. This system is sort of like how our government works, with a few differences. The rules come from the capital in D.C. and then each state is responsible for enforcing the rules, but here, the MACs are responsible for enforcing the rules in a way they interpret them. Medicare HMO (health maintenance organization) products are written by private carriers - they basically follow the rules of Medicare with a few changes to the policy as they see fit. Private insurance companies like Blue Cross/Blue Shield, UnitedHealthcare, Cigna, Aetna, and Humana, provide policies with various combinations of benefits, and are not required to follow Medicare policies, which is the practice of "free enterprise" we have in the US. This also means they're not required to follow the coding practices for the Current Procedural Terminology (CPT) or the International Classification of Diseases, 9th Clinical Modification Edition (also known as ICD-9). If you know anything about healthcare, these codes are used to say, "okay, this procedure is for excision of the sigmoid colon due to diverticulitis." There is a corresponding CPT and ICD-9 code that represents medical, surgical, and diagnostic services to communicate with everyone - clinical, financial, administrative, etc.

What's the big deal?

The problem is that PAs can encounter different codes from different carriers, especially private carriers who do not have to use the same coding systems as everyone else. That's what makes reimbursement a "moving target." In addition, on OCTOBER 1, 2014, the entire US will make the largest change diagnostic coding will see in our careers. We will switch over from ICD-9 to ICD-10. This can only mean better healthcare outcomes for our patients. For example, with ICD-10, more diagnoses are going to be implemented into the current system of codes, but also, more descriptive diagnoses. This means that when you go to choose a code matching your diagnosis, it should be less likely to be shot back from the carrier reimbursing your services. In addition, also means that YOU as a PA need to learn the required documentation requirements and stay up-to-date on your responsibilities, especially changes in policy in your area. Your salary, bonuses, and eventually, the ability to provide valuable, quality healthcare to your patients could be affected. This could be huge for the practice of medicine, and not for just PAs!