Page 22 - Volume 69 Number 1
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Executive Council Meeting Highlights
Washtenaw County Medical Society
District Director James Mitchiner, MD, MPH reported the following from the last MSMS Board Meeting:
Blue Cross Blue Shield of Michigan: Thomas L. Simmer, MD, Vice President and Chief Medical Director at BCBSM, highlighted BCBSM’s activities and priorities for the upcoming year:
  Physician Group Incentive Plan (PGIP) now includes more than 20 initiatives, with nearly 20,000 primary care physicians and specialists participating. 4,534 physicians and 1,638 practices have been designated as Patient Centered Medical Homes (PCMHs) in 2016.
  Value-based Reimbursement for Primary Care Physicians (PCP) and Specialists: 77% of PGIP PCPs and 62% of PGIP specialists are receiving value-based reimbursement. $57.1 million was paid to PCPs in 2015 for value-based reimbursement; $45.7 million was paid to specialists.
  Hip and Knee Bundled Payment Program: Full scale launch will begin January 1, 2018 with a limited launch date of July 1, 2017. This will be a customer- specific offering initially with retired and salaried automotive employees. The program is being offered to all in-network providers.
  New Precertification Program: BCBSM has 3 new precertification programs (“prior authorization”)
for radiation therapy, lumbar spine fusion, and interventional pain. There was robust discussion around BCBSM’s history of collaborative quality initiatives to improve quality, in contrast to a more short-term and perhaps short-sided utilization management program like pre-authorization. BCBSM was encouraged to consider using outcomes to allow high-quality performers to be rewarded not monetarily but by “graduating” out of the program.
  Personal Choice PPO: This new BCBSM product
utilizes the Organized System of Care (OSC) program. The network is tiered into level 1 OSCs, level 2 OSCs, the PPO network, and out-of-network. Tiers were determined by cost. Member cost sharing is also tiered.
State Innovation Model (SIM) and Comprehensive Primary Care Plus (CPC+): Under the SIM, the Michigan Department of Health and Human Services (MDHHS) opted for a custom payment model rather than CPC+. MDHHS recommended that all practices previously participating in Michigan Primary Care Transformation Project (MiPCT) apply for participation in CPC+ as a way to continue much needed funding for chronic care and care coordination services.
MSMS continues to work with Physician Organizations, as well as BCBSM and Priority Health, as the commercial plans participating in CPC+.
Senate Bill 1019: Senate Bill 1019 removes the require- ment for physician supervision for anesthesia services provided by CRNAs. Despite of numerous concerns expressed by individual senators and physician lobby- ists, the legislation (again) moved through the Senate without any changes in late 2016 and was referred to the House Health Policy Committee, where no action was taken before the session ended. SB 1019 is therefore at least temporarily officially dead and will have to be reintroduced in the next session.
Senate Bill 1104: Introduced by Senator Mike Shirkey (R-Clark Lake), Senate Bill 1104 clarifies the require- ments for economic damages in professional liability cases. The MSMS Board of Directors voted to support
SB 1104, which is comprehensive in providing a fix to the Greer v. Advantage Health case, and will provide the Michigan Court of Appeals with the necessary statutory authority to rule that plaintiffs are only entitled to the actual damages and not the windfall that comes from calculating losses based on hospital charges. This bill was signed by the governor on January 10, 2017 and
will become effective in 90 days.
Drug Diversion: MSMS has policy in this area derived from House of Delegates resolutions, positions on legislation, and ongoing input from the Task Force at MSMS chaired by Pino Colone, MD. Its policy priorities are to:
  Broaden access to naloxone
  Improve MAPS functionality and reduce workflow
  Advocate for state funding to offset the cost of EHR
  Enhance existing regulatory pathways to address bad
actors, as opposed to adding more requirements onto
physicians who are obeying the law
  Improve options and capacity for treatment programs   Update and enhance educational offerings to
physicians related to pain management and drug
diversion issues
  Only consider MAPS-related mandates if uptake is
still too low, and limit mandates to only instances where such checks would be clinically indicated. Consider laws similar to Massachusetts for prescriptions that exceed a 7 day supply.
22 Washtenaw County Medical Society BULLETIN JANUARY / FEBRUARY / MARCH 2017

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