AOA President's Blog

As a Dean I have always had two favorite times of the year: Graduation and Orientation. Both are simply joyous occasions of celebration. By now, all our colleges of osteopathic medicine have conducted orientation and you students have moved into the year’s work. I particularly want to welcome all of the new students in your first year in osteopathic medical school. Whether you are entering a college that is over 100 years old or one that is starting its very first class, there is an excitement that you can feel. Every single Dean and every single faculty member wants you to have the very best educational experience possible and will work to provide that. In response, you will be expected to return that level of dedication with an equal measure of hard work. I can assure you that osteopathic medical school will be the most demanding four years of your life to date. Therefore, I have eight recommendations that will guide you towards the best opportunity for success:
1. Study very hard
2. Keep up and review
3. Take advantage of every opportunity to learn
4. Help your classmates; you are part of a team now
5. Don’t even think about cheating; it’s a future patient you are cheating
6. Seek assistance from your faculty at the first sign of a challenge academically
7. Get involved in extra-curricular activities ONLY if your academic performance allows
Every year a few students trip over one or more of these recommendations and their long-hoped-for career disappears. I encourage each of you to take these recommendations to heart.
And what about the eighth recommendation? Join SOMA! It is the introduction to the world of the AOA and the best place to learn about what being an osteopathic physician really means. You will develop friends across the country who share your enthusiasm for your newly-entered profession.
So follow all these recommendations and I hope to be able to congratulate each and every one of you four years from now as you graduate with your degree as a Doctor of Osteopathic Medicine. Welcome to the Osteopathic Family!!

One of the projects we are preparing this year is a student/specialty clearinghouse. Traditionally, the emphasis of the specialty colleges such as Family Practice, Internal Medicine and all the rest has been on connecting with the resident learners. The thought was that most students had not determined their specific areas of interest and would not be ready to connect with the specialty colleges. However, time has shown that students frequently have narrowed their areas of interest to one or two specialties and many are very interested in connecting with their specialties of choice. Some specialty colleges have very robust student programs, but not all have the resources and time to create connections. Therefore the specialty colleges' organization has agreed to have a "one-stop-shop" for all specialty college/student connections through the AOA website. If the specialty college has resources well developed, the website will merely connect to that college. If the specialty college does not yet have a program in place, the AOA will have information for the students to connect to. Examples of the information for the specialty colleges to provide would be "FAQ's," "A Day in the Life of a......," sample club bylaws, student-oriented convention programming, etc. We are also going to establish an organization of the presidents of the various national student specialty organizations to promote sharing of information. The purpose of this project is to improve the connections between all students and the specialty colleges of their choice, and maintain that connection through the coming years, whether they match with osteopathic or allopathic residencies. I would appreciate any feedback on this new project which is nearly ready for launch.

Greetings!

I recently received a question about the ongoing study of the
advisability of allowing MD's to take OGME residency programs. There
were 2 questions that originally led to the idea of doing this study:
1. How to fill unfilled OGME slots
2. How to encourage establishment of new OGME residency programs in
hospitals with predominantly MD staff members who were only interested
in establishing programs if open to MD's and DO's.

A proposed answer to both questions was to consider allowing MD's into
OGME residencies. Rather than continue in partially informed debate,
this study was commissioned by the Medical Education Summit II and
presented to the 2009 and 2010 AOA House of Delegates.

A brief review of the pro's and con's identified in the study follows:

PRO's
1. OGME unfilled slots may have a greater likelihood of filling.
2. New OGME programs may be started in new hospitals.

CON's
1. The increasing number of DO graduates are likely to fill all the currently
unfilled slots.
2. One of the provisions of the ACA law will sweep 65% of MD and DO
unused GME slots in 2011 so there will be many fewer unfilled slots left.
3. Slots that are currently unfilled by DO's may also be considered
undesirable by MD's so these slots may not be filled anyway.
4. If MD's were admitted to OGME, many states' statutes would need to be
changed to recognize this variable training method, all DO credentialing
boards would need to re-craft their standards, and the NBOME would need to
change their policies that currently restrict COMLEX exams to be taken only by DO's.

In summary, the AOA House of Delegates has voted to continue to study
this question through 2015.

Welcome to the 2010-11 AOA President's Blog. I am very honored to have been elected to this office and especially to hold this office as the first woman to do so in the history of our profession.

In my inaugural speech, I pointed out the importance of teamwork to accomplish our goals. Specifically, the goals I have outlined are:

1. Obtain fair Medicare reimbursement for physicians so patients have access to medical care.

2. Provide more robust support for our physicians in private practice to enhance their financial stability.

3. Enhance a process to create more osteopathic graduate medical education residency positions

4. Solidify the connection between osteopathic medical students and osteopathic residency programs with an AOA-based student-specialty college clearinghouse

5. Promote collaboration between state associations and specialty colleges to allow more efficient use of resources in the current economic climate.

I will be following the policies of my predecessors as I want a dialogue, not a diatribe. Let's talk!!

K

We are in the midst of the 2010 AOA Annual Business Meeting; when our elected representatives come together to decide on important policy, and when my term as the 113th President of the AOA comes to an end.

It has been a pleasure to share my thoughts with you on this blog, listen to your feedback, and answer your questions. While I have had many opportunities to connect with members of the osteopathic family at events and meetings throughout my term, the blog has been an invaluable tool by which to connect with even more DOs and osteopathic medical students (yes, Chris, but the preferred terminology is osteopathic physician). I hope you have enjoyed reading along during my term and will continue to visit the President’s Blog in the coming year, when Karen J. Nichols, DO, will take office.

In closing, thank you for helping to ensure that the AOA President’s Blog serves its intended purpose. It exists to facilitate communication between the leaders of the AOA and the osteopathic family. Your constructive feedback has been very much appreciated and I hope you continue to take advantage of this unique space in the coming year.

Larry

On Saturday, July 17, at 7:30 p.m. CST, the AOA will feature a broadcast of the entire inaugural ceremony on the homepage of DO-Online. You can watch as 2010-2011 AOA President Karen J. Nichols, DO, is honored by her family and colleagues; as I pass on the presidential baton; and as she gives her inaugural speech as the 114th AOA president and its first female president. It’s going to be a great moment in our osteopathic history, so I hope you tune in to watch.

Larry

With the passage of recent health reform legislation, granting all Americans access to health care, the osteopathic medical profession has an opportunity to educate the public about DOs and osteopathic medicine.
Here’s one way we can join together now to help spread that message.

The AOA has created a 30-second video on the DO option, airing now on network television in Chicago, which can be shared with countless members of the public with just a few clicks of the mouse. If you are a member of Facebook, Twitter, MySpace or other social media sites, you can share this video with all of your contacts by simply viewing the video on the AOA’s YouTube Channel and selecting “Share.” If you are not a member of these sites, or even if you are, you can also just send the link to the video through your e-mail.

Today’s Health Video: DOs

Whether you share the video on social media sites or simply send the link to your friends, you can help spread awareness of the DO option during this time of great change in our health care system. Thank you for taking the time to support the osteopathic medical profession.

Larry

As we head into the holiday weekend, I’d like to remind you/make you aware of some important AOA program information and upcoming events:

• The AOA Intern/Resident Registration Program (the AOA “Match”) is now open for registration. Applicants who wish to register for the Match for positions beginning in 2011 may do so now. To register for the Match, visit the Match website.

• The AOA’s second 2010 Regional Osteopathic Medical Education conference, ROME–Mid-Atlantic, will take place July 29-31 in Chesapeake Bay, Maryland. Online registration is open until July 22. One-day registration is also available. Visit www.do-online.org/ROME.

• Registration for the Unified OMED 2010 Conference and Exposition is also open. Programs are being added daily, so check back to the OMED section of DO-Online often to see what’s new and to create your customized CME conference schedule.

• The AOA will be accepting comments on resolutions to go before the House of Delegates until July 14. To submit your comments, e-mail resolutions@osteopathic.org.

Have a safe and happy holiday weekend! Look for my final post next week as I conclude my term as the 2009-2010 AOA President.

Larry

Dear Osteopathic Family:

As most of you are well aware, physicians participating in the Medicare program had their payments cut 21% on June 1. The Centers for Medicare and Medicaid Services (CMS), after holding claims for several business days, instructed their intermediaries to pay claims reflecting this cut on June 18. This cut and the continued use of the sustainable growth rate (SGR) formula are having a devastating impact upon beneficiaries’ access to health care and your practice. On June 24, Congress once again intervened and reversed this cut through November 30, 2010. This means that physicians and their patients have a total of 158 days until the next cut is implemented – not exactly stability.

Earlier this year Congress approved, and the President enacted, comprehensive health care reforms that will expand access to affordable health coverage; increase access to physicians – especially primary care physicians; transform our delivery system to promote quality and efficiency; and lower the cost of health care. The AOA supported each of these goals. However, we are both concerned and confused as to why Congress has failed to act on one element of health care reform that is widely acknowledged to be an enormous problem with an identified solution. Reform of the Medicare physician payment formula is health care reform and is sound economic policy. It is a reform that preserves access to health care for millions of our nation’s seniors, the disabled, and military families. Additionally, long-term reforms are essential to preserving millions of jobs in the health care sector, advancing quality improvement, and achieving our goal of transforming our health care system through health information technology.

The AOA recently commissioned an independent poll of our members to determine the true impact current and proposed payment policies have upon their practices. When physicians who have at least some say in what kind of insurance they accept in their practices were asked about the pending 21% cut in Medicare payments, only 42% said they would definitely or probably continue seeing their current Medicare patients if the cut were to occur. Thirty-three percent were undecided as to whether they would continue to see their current Medicare patients, and 24% said they probably or definitely would not continue seeing Medicare patients. Additionally, only 30% of physicians currently accepting new Medicare patients said they would continue to do so if the cut were to be implemented (32% said they might, and 37% said they probably or definitely would not). When we asked these same physicians about their participation in the Medicare program if meaningful and long-term payment reforms were enacted, 94% said they would continue seeing their current Medicare patients and 92% indicated they would continue to accept new Medicare patients. These numbers should be a “wake up” call to policymakers, but they seem to be falling on deaf ears. Since 2002, the flawed SGR formula has plagued the Medicare program. Congress has acted 10 times to prevent cuts from being implemented, including three times in 2010 alone. Each of these actions and their results are outlined in a chart included with this letter.

Despite its willingness to prevent cuts from being implemented, Congress has displayed on a bipartisan and bicameral basis that they are incapable of enacting meaningful, long-term reforms. In short, we are now at a point where the AOA has serious doubts that Congress is capable of ever fulfilling its responsibilities to the Medicare program, Medicare beneficiaries, TRICARE, or physicians with respect to payment issues. While the AOA remains confident that Congress and the Administration will take the necessary steps to prevent further implementation of the current 21% cut or similar future cuts, we do not believe that you or your patients can reasonably expect any type of meaningful payment reform in the near future. We believe that short-term, stopgap measures are the only achievable policies that Congress is capable of approving over the next few years. Based on this belief, we no longer view the Medicare program as a predictable and equitable payer of physician services.

A commitment to providing high quality health care to patients should remain your top priority. The AOA does not promote, nor do we support, physicians abandoning patients regardless of the underlying circumstances. Patients place great trust in you as a physician, and you should honor that trust by ensuring that your patients have the care they need in a timely manner. However, we also recognize that physicians must be compensated equitably for the services they provide and that the current Medicare formula is falling short of this objective.

To this end, we feel it is important that the AOA provide all osteopathic physicians with unbiased, yet factual, information on your options as a practicing physician. The following information is designed to clearly articulate options available to you with respect to your participation in the Medicare program. Prior to taking any action with respect to the Medicare program, we urge all members to carefully evaluate their current practices to determine the impact of any change in participation status. Additionally, we urge you to familiarize yourself with applicable state laws related to participation in Medicare, Medicaid, CHIP, and other public programs. The AOA is not advising our members to take a specific action regarding participation in the Medicare program nor offering legal advice regarding these issues. Participation decisions involve binding legal documents, and all members are strongly encouraged to consult with their own legal advisors and consultants prior to making a decision on these matters. Our goal is to provide you with the necessary information, thus enabling you to make an informed decision.

1. Medicare Participating Physician
Physicians may sign a participation agreement (PAR) and accept Medicare’s allowed charge as payment in full for all of their Medicare patients. Participating physicians agree to accept assignment on all Medicare claims, which means that they must accept Medicare’s approved amount, which is the 80% that Medicare pays plus the 20% patient copayment, as payment in full for all covered services for the duration of the calendar year. The patient or the patient’s secondary insurer is still responsible for the 20% copayment, but the physician cannot bill the patient for amounts in excess of the Medicare allowance. While participating physicians must accept assignment on all Medicare claims, Medicare participation agreements do not require physicians to accept every Medicare patient who seeks treatment from them or their practice.

2. Medicare Non-Participating Physician
Physicians may elect to be a non-participating (Non-PAR) physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims. Non-participating physicians agree to accept 95 percent of the Medicare approved amounts for services provided. Non-participating physicians may charge more than the Medicare approved amount, but are limited to 115 percent of the Medicare approved amount for participating physicians. Since approved amounts for non-participating physicians are 95 percent of the rates for participating physicians, the 15 percent limiting charge is effectively 9.25 percent above the participating approved amount for services provided. Given the projected 21.2 percent cut in Medicare physician payments, many physicians may consider balance billing an extra 9 percent as one means of helping close the gap between 2009 and the new 2010 payment amounts.

3. Private Contracting
Physicians may become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves. Provisions in the Balanced Budget Act of 1997 afford physicians and their Medicare patients the freedom to privately contract for health care services outside the Medicare program. However, private contracting decisions may not be made on a patient-by-patient basis. To become a “private contracting physician,” a physician must first opt-out of the Medicare program. Once a physician has opted out of Medicare, they cannot submit claims to Medicare for services provided to any Medicare patients for a two-year period. To privately contract with a Medicare beneficiary, a physician must enter into a private contract that meets specific requirements. In addition to the private contract, the physician must also file an affidavit that meets certain requirements. There is a 90-day period after the effective date of the first opt-out affidavit during which physicians may revoke the opt-out and return to Medicare as if they had never opted out of the Medicare program.

A physician who has not been excluded under Sections 1128, 1156 or 1892 of the Social Security Act (SSA) may order, certify the need for, or refer a beneficiary for Medicare covered items and services, provided the physician is not paid, directly or indirectly, for such services (except for emergency and urgent care services). For example, if a physician who has opted out of Medicare refers a beneficiary for medically necessary services, such as laboratory, DMEPOS, or inpatient hospitalization, those services would be covered by Medicare.

Physicians who have opted-out of Medicare under the Medicare private contract provisions may furnish emergency care services or urgent care services to a Medicare beneficiary with whom the physician has previously entered into a private contract so long as the physician and beneficiary entered into the private contract before the onset of the emergency medical condition or urgent medical condition. These services would be furnished under the terms of the private contract.

Physicians who have opted-out of Medicare under the Medicare private contract provisions may continue to furnish emergency or urgent care services to a Medicare beneficiary with whom the physician has not previously entered into a private contract, provided the physician submits a claim to Medicare in accordance with both 42 C.F.R. part 424 (relating to conditions for Medicare payment) and Medicare instructions (including but not limited to complying with proper coding of emergency or urgent care services furnished by physicians and practitioners who have opted-out of Medicare) and collects no more than the Medicare limiting charge, in the case of a physician (or the deductible and coinsurance, in the case of a practitioner). A physician who has been excluded from Medicare must comply with Medicare regulations relating to scope and effect of the exclusion (42 C.F.R. § 1001.1901) when the physician furnishes emergency services to beneficiaries, and the physician may not bill and be paid for urgent care services.


In closing, I urge each of you to continue to voice your concerns with current Medicare payment policies to your elected officials. The AOA has numerous vehicles by which you can communicate with your Representatives and Senators on this issue. You may use the AOA’s Legislative Hotline – (877) 262-9400 to call your elected officials or you can send a letter via the AOA’s Advocacy Website – www.capwiz.com/aoa-aoia.

The AOA, through our Department of Government Relations, continues to advocate for fair and equitable payment policies on your behalf. I assure you that we are deploying all available resources to protect your ability to provide quality health care to your patients. Again, I urge you to join our advocacy efforts by expressing your concerns to your elected officials today.

Fraternally,

Larry A. Wickless, DO
President

See table: Summary of the Medicare Physician Payment Updates and Legislative Activity, 2002-2010

The Affordable Care Act (ACA) contains many provisions to help improve preventive care and wellness. The bill actually provides $250 million in new programs to improve public health. Here’s the breakdown:

• Community and Clinical Prevention: $126 million will support federal, state and community prevention initiatives; the integration of primary care services into publicly funded community-based behavioral health settings; obesity prevention and fitness; and tobacco cessation.

• Public Health Infrastructure: $70 million will support state, local, and tribal public health infrastructure and build state and local capacity to prevent, detect, and respond to infectious disease outbreaks.

• Research and Tracking: $31 million for data collection and analysis; to strengthen CDC’s Community Guide by supporting the Task Force on Community Preventive Services; and to improve transparency and public involvement in the Clinical Preventive Services Task Force.

• Public Health Training: $23 million to expand CDC’s public health workforce programs and public health training centers.

Learn more about these provisions and ACA on DO-Online.

Larry

Now is your opportunity to comment on more than 100 resolutions currently set to go before the AOA’s House of Delegates (HOD) July 16-18. We welcome your comments on both the Sunset policies, of which there are 67, and the 48 new resolutions submitted this year.

I believe that it is vitally important that all voices within the osteopathic family are heard, so please take advantage of this opportunity to comment on any policy issues that are important to you. Once your comments are received and reviewed, they will be made available to the HOD reference committees. Your elected delegates will then vote on these policies to ensure that the osteopathic medical profession continues to move forward with a unified voice and mission.

To view the resolutions, visit the HOD resolutions page on DO-Online. AOA members can comment on resolutions by sending an e-mail to resolutions@osteopathic.org (be sure to reference the number of the resolution on which you are commenting in the body of the e-mail).

Larry

Help your patients and the public understand the numerous provisions in the Affordable Care Act (ACA) that extend and expand coverage for uninsured individuals. Learn what to do in cases for those with pre-existing conditions or if they are an early retiree. Find out more about the health care insurance exchanges that will be implemented in 2014, as well as the new rule prohibiting insurance plans from placing lifetime or unreasonable annual limits on the dollar value of benefits for a beneficiary.

Learn more about these provisions and more at the AOA’s ACA Web page.

Larry

In this age of digital technology, it’s easier than ever to share our unique experiences with others. That’s why the AOA is calling on its members to submit photos about life within the osteopathic medical profession.

Submitted photos can be from osteopathic events, social gatherings, or more abstract depictions of what it means to be a member of the osteopathic medical profession today. These photos can then be used to share our individual experiences as DOs, osteopathic medical students, and supporters of the profession, with the rest of the osteopathic family, or to promote the profession to the general public.

To submit your photos, simply e-mail them to pr@osteopathic.org, along with your name, contact information, photo caption, and a signed photo release form. You can download the form and read the complete submission guidelines in the Multimedia Center of DO-Online.

I hope you consider taking a few moments to share your experience as a member of the osteopathic family. I truly look forward to seeing our profession through your eyes.

Larry

If you’re a director of medical education, a teaching hospital administrator or a medical student, you probably want to know what’s in the Patient Protection and Affordable Care Act (ACA) that might affect you or your hospital.

Learn about the redistribution of residency positions in closed hospitals; how unused residency positions will be redistributed; as well as how more primary care and general surgery residencies will be created or expanded at the AOA’s ACA Web page.

Larry

Registration is now open for OMED 2010, the AOA’s 115th Annual Osteopathic Medical Conference and Exposition. As a unified conference, OMED 2010 incorporates special events and programming from dozens of specialty and nonspecialty affiliates, offering more opportunities to connect and learn with your osteopathic colleagues. In fact, as of now, DOs can earn up to 45 hours of AOA Category 1-A CME credit, with opportunities for bonus CME.

OMED 2010 will take place Oct. 24-28, at the Moscone Center in San Francisco, Calif. As always, AOA members receive a discount on registration; residents and retired DOs receive an even greater discount; and osteopathic medical students enjoy complimentary registration.

You can register today at DO-Online.org/OMED, where you’ll also find more conference and location details. There is even a tool to create your own personalized conference schedule. Remember to check back often to find the latest additions to the conference program and add them to your schedule.

I hope you are able to take advantage of this great opportunity to connect with your osteopathic family and learn about the latest research findings and advancements in medicine. Without a doubt, I am sure you will find OMED 2010 to be among the most valuable and enjoyable educational events you attend.

Larry