Benefit for CAFP Members
CAFP is pleased to announce that we have negotiated a reduced subscription price with the editors of Prescriber’s Letter, a very useful monthly drug advisory publication.

Prescriber’s Letter is independent from any drug company and does not accept any advertising or support, and subscriber information is kept strictly confidential. As a CAFP member, your subscription price is reduced and includes complimentary CME credits. Plus, anytime you need more information on any of the topics, you can get a Prescriber’s Letter Detail-Document at no additional cost.

The PDA version for your Palm or Pocket PC is also available free of charge, as is the 2005 Prescriber’s Letter Professional Rejuvenator, to give you the “best of the best” drug info of 2005. As a CAFP member, you will be receiving information about this benefit in the mail in the upcoming weeks.

Of Note...

• Drs. Drew Edwards of Prospect, Craig Czarsty of Oakville and Andrea Needleman of Woodbury will be in the leadership structure of the Waterbury Medical Association in 2006. Dr. Edwards will be serving his second term as President, while Dr. Czarsty will continue to serve as Immediate Past President. Dr. Needleman will serve on the Executive Board.
• Dr. Ayaz Madraswalla, CAFP President, and Mark Schuman, Executive Vice President, will head the Connecticut delegation attending the AAFP Leadership Conference in Kansas City, May 4-6, 2006. Also participating from Connecticut will be: Drs. Dom Casablanca of Shelton; Edmund Kim of West Hartford; Barbara Phillips of Manchester; and Kathleen Viereg of Cheshire.

Letter To The Editor
On Tuesday, January 31, 2006, sanofi pastuer opened Fluzone®, Influenza Virus Vaccine, prebooking for the 2006-07 season. Anticipating a surge in telephone calls and traffic to our e-commerce site, we doubled the capacity of our telephone lines and on-line ordering systems. Despite the increase in capacity, we were unable to accommodate the overwhelming response we experienced throughout the day – more than 400,000 telephone attempts within the first hour of prebooking, and a 500% surge over the daily average of hits to our e-commerce site.

As a result of the unprecedented demand, the company has committed all influenza vaccine doses planned for production for the next season except it’s no-preservative Fluzone vaccine in pediatric doses. Although we do not currently have the capacity to meet all the US influenza vaccine demand, we believe, from publicly available information, that all influenza manufacturers will be delivering a normal supply of influenza vaccine for the upcoming influenza season.

Stephanie Herrera
Deputy Director of Public Health
sanofi pastuer

Leaders Discuss CME and Chapter Issues at 10-State Conference
By Ayaz Madraswalla, M.D., CAFP President

A calm weekend on the shores of Lake Michigan in February found a few members of the CAFP chapter stranded in Chicago, Illinois thanks to the Nor’easter of ’06. CAFP Board member, Dr. Kathy Viereg, Executive Vice President Mark Schuman and I attended the Annual 10 State Conference held this year in Chicago. Little did we know that almost 2 feet of snow would hamper our return to the Nutmeg State.

Nevertheless, we persevered and attended the conference hosted by the Illinois chapter of the AAFP. The attendees came from many states including: Illinois, Pennsylvania, New York, Ohio, New Jersey, Kentucky, Wisconsin, Michigan, and Indiana. Connecticut is a charter member of this group. We were also fortunate to be joined by Dr. Larry Fields, AAFP president and member of the Kentucky chapter.

The 10 State Conference has several goals. Some of them are to help foster better communication between chapters, discuss and review current trends in Medicine both in the Legislative and health arenas, and help to network with our counterparts in the other chapters. The Conference also serves to allow us to share what is strengthening our chapter and discover areas that need improvement.

The year’s agenda consisted of lectures and round table discussions covering various topics, central of which was an update on Medicare Part D. The state and federal preparedness and response to influenza with respect to vaccine distribution and plan to deal with a possible pandemic were also discussed. Assistance from the National Academy in improving advocacy in legislation and suggestions on implementing statewide smoking bans rounded out the agenda items. CAFP has testified repeatedly urging smoking bans and will continue to do so.

What I found most worthwhile were state reports on their efforts in the areas of CME, student and resident support, governmental relations, and non-dues revenue generation. Many members were quite impressed with the Core Content Review of Family Medicine Home Study CME program, co-produced by our chapter and the Ohio chapter. It is safe to say this program is the jewel in the crown of the CAFP’s financial strength, and allows us to offer many different CME programs such as the upcoming Practice Management Seminar.

Members will be pleased to know that CAFP has lower dues than most chapters and a higher percentage of membership. We further discovered that our chapter’s Fall Symposium is strong and successful, while other states are having difficulty continuing their Annual Scientific Assemblies.

On the whole this was an interesting and worthwhile forum. Connecticut will host the 10 State Conference in 2008 and the Chicago meeting has given our Board many ideas on holding a meaningful and successful conference in 2 years. This will be the third time CAFP has hosted this meeting.

As far as the snow was concerned, our weekend conference extended into Monday. There were no return flights to Connecticut on Sunday, and some of us were not able to get home until Monday evening.

Credentialing: How to Reduce Hassles
Editor’s Note: The CAFP receives many questions regarding the hassles involved in getting credentialed and/or re-credentialed. The information contained in this article was provided by Trevor Stone of the AAFP.

Question: What can I do to get credentialed and re-credentialed more quickly and with fewer hassles?

Answer: Your best hope is the Council for Affordable Quality Healthcare’s Universal Credentialing DataSource, an online tool that enables physicians to submit a “universal” credentialing application that can be accessed by health plans that the physician authorizes. The service is free to physicians.

The tool vastly simplifies re-credentialing as well, since physicians need only provide updates to their information and fax supporting documents as needed. Currently, more than 250 organizations, including Aetna, Cigna, Humana, United Healthcare and many Blue Cross and Blue Shield plans, participate, and more than 250,000 providers have used the system. If you contract with any health plans that do not participate, encourage them to do so. For more information, including a list of participating health plans, see https://caqh.geoaccess.com/oas/.

If you have no choice but to apply for credentials the old-fashioned way, you may find the following tips helpful:

• Apply early. If you have signed an employment contract but are still finishing residency, it is not too early to start filling out paperwork.
• Consider designating one staff member in your practice to be responsible for completing and tracking the paperwork. This will improve efficiency and compliance.
• Identify a contact person at each health plan who can address your questions and provide updates.
• Seek approval to bill under another physician’s name temporarily. Some private payers will agree to this; Medicare and Medicaid will not.
• Seek approval to temporarily reassign patients to a credentialed physician in your practice. The patients can be moved to your panel when you are credentialed; In the meantime, you can treat them and work out the financial arrangements within your practice.
• Ask if you can bill retroactively for services you provide during the credentialing process. Some payers will agree to do this.

Coding Correctly Improves The Bottom Line of Your Practice
By Arthur Schuman

In reviewing State Chapter publications from throughout the United States, a recurrent theme relating to the frustration of family physicians who feel they are not adequately reimbursed for what they do, especially for cognitive care, is apparent.

Although the unwillingness of third party payers to adequately reimburse primary care physicians for their cognitive knowledge has been well documented, there are things that family physicians can do to improve their bottom line, and this involves coding correctly and documenting diligently.

Dr. Thomas Felger, who will participate in the CAFP 2006 Practice Management Seminar on Coding and Labor Law on Thursday, May 11, 2006 at the Rocky Hill Marriott, says that historically family physicians tend to undervalue their services. Dr. Felger teaches residents about coding as part of a practice management curriculum at the Saint Joseph’s Regional Medical Center Family Medicine Residency Program in South Bend, IN. He often reminds his residents that providing E/M Services – a staple of family medicine – takes time and effort. He goes on to say, "If a patient comes in for high blood pressure and the physician ends up taking off a skin lesion, there are correct ways to get that billed and to be paid for the service."

Susan Callaway, C.P.C., a 23-year veteran of coding education from North Augusta, SC, says that inaccurate coding runs rampant in family physician offices and that about 85% of the practices she visits have some significant problem in one area or another in understanding how to use their codes correctly and that always translates into money problems. She has estimated that if just 25% of physicians evaluation and management visits during the course of the year are undercoded, a 4 physician family medicine practice could lose as much as $100,000.

Most physicians will dispute this. But a check of the CMS Medicare physician fee schedule shows a difference in payment of more than 57% between a Medicare visit coded 99213 and a more complex level visit coded 99214. In actual dollars, depending on what part of the United States a physician practices, this could mean a loss of between $20 to $26 for every undercoded 99213 visit.

Most coding consultants agree that it is inappropriate for physicians to undercode because of fear of an audit. Robin Linker, President of a national consulting firm and CEO of the Rocky Mountain Healthcare Institute, advises physicians to lean heavily on the term "correct coding." If you code correctly and document sufficiently, the levels of service will work themselves out, she said. Accurate coding is essential if a physician wants to be paid for all the services provided.

Because of the potential loss of income which many family physicians are experiencing due to inappropriate coding, the Board of Directors of the Connecticut Academy of Family Physicians has authorized that a coding seminar be held in the State on May 11, 2006. The seminar will be highlighted by outstanding lectures on Coding and Labor Law. It will be held at the Rocky Hill Marriott from 12:30 P.M. to 6:00 P.M.

According to Mark Schuman, CAFP Executive Vice President, "Physicians and office billing personnel are urged and encouraged to attend this important meeting. This will be the first in a series of Practice Management Seminars authorized by the CAFP Board."

A full program with registration information will be mailed to the membership in the near future.

CAFP President Testifies On Cooperative Agreements
Editor’s Note: Dr. Ayaz Madraswalla, CAFP President, testified before the Connecticut General Assembly on the need to establish cooperative agreements and unilateral contracts.

Good Morning, I am Dr. Ayaz Madraswalla, President of the Connecticut Academy of Family Physicians. I am here today on behalf of our nearly 600 Family Physician members to speak to you concerning the establishment of cooperative agreements and unilateral contracts. The Family Physicians of Connecticut strongly encourages this Committee to enact legislation during the 2006 legislative session that would add some fairness to the current “all or nothing” contracts that physicians have to negotiate with Managed Care Organizations (MCOs).

As Physicians we are committed to providing the highest quality healthcare to our patients. Unfortunately, caring for our patients no longer just requires a physician’s time to address health concerns. Instead, we must negotiate contracts with MCOs, multibillion-dollar companies, that have dozens of contract attorneys on their side. In contrast, we are usually small practices, sometimes solo physicians, who need to hire an attorney, but usually attempt to negotiate these contracts ourselves. Some physicians utilize their local Physician-Hospital Organization (PHO) or Independent Practice Associations (IPA) to negotiate for them. Unfortunately, some of these organizations are not experienced enough to negotiate on their own or simply do not have enough resources to negotiate. Finally, not only do we have to negotiate contracts, we must also sort through restrictive drug formularies, hire extra staff to resubmit “denied or downcoded” claims, and we must be businessmen and women before we can even begin to doctor.

Of course the days of simple fee service billing are gone. I’m not sure I would like to go back. Unfortunately the current environment fosters animosity between the companies that have the money and the doctors who want to get fair reimbursement for their service. As usual, the patient is caught in the middle.

The MCOs’ executives have told us that if we don’t like the contracts then we should simply not sign them. Given that most if not all of our patients are covered by an MCO through their employer, we have no choice but to sign such agreements. In addition, the strong market hold of the MCO combined with antitrust laws that prohibit physicians from negotiating together leave us powerless.

These contracts usually allow for unilateral contract changes on the MCO’s part, but do not give the financial information that is need to determine the amount of reimbursement, and allow for the downcoding and bundling of claims, and other unfair practices.

Current anti-trust laws that prevent physicians from entering into “cooperative agreements” must be changed. Such agreements would allow physicians to join together in order to provide health care services, negotiate pricing, share patients, personnel, support services, laboratory facilities and/or procedures. As a result, physicians would be able to improve quality of care, help to contain costs, and improve access to health care especially in rural areas. The only way to combat unfair contract provisions and negotiate with an MCO is through the formation of a cooperative health care arrangement. Without changes to current antitrust laws, MCOs will be able to continue dictating the terms and conditions they offer physicians.

We must level the playing field between physicians and MCOs in order to guarantee that our patients are able to receive the health care they deserve. We hope to be able to work together with the legislature in order to bring fairness in contracting between Managed Care Organizations and physicians.