Volume 115, No. 5Top
May 2019 Edition

They Said It...

"My patients made me the doctor I am today." Dr. James Cristol, next president of the Philadelphia County Medical Society. You can read his compelling interview on his experiences as a doctor, and what challenges physicians face today, in our next issue of the PCMS magazine, Philadelphia Medicine, due out next month. You can find the spring issue of our magazine here.

In the News... 
CMS Posts Revised Version of 2020 QIS Issuer List A1

You can find it by going to the Marketplace Quality Initiatives (MQI) website at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/Quality-Improvement-Strategy/QIS-Data-Collection.html. It includes a correction to column G, "Number of Progress Report Submissions Required."

Issuers should submit questions about QIS to CMS's Marketplace Service Desk (MSD) by calling 1-855-CMS-1515, or by email at CMS_FEPS@cms.hhs.gov. When you submit inquiries by email, you should include "MQI-QIS" and your HIOS Issuer ID in the subject line or body of the email.

It Isn't Fun Coming in Second A2

But when it comes to medical malpractice payouts you certainly don't want to come in first, either. Pennsylvania is second only to New York in total medical liability payouts and in payouts per capita in 2018, according to the National Practitioner Data Bank. Here is the list of the top five states paying the most in medical liability payouts in 2018:

New York $685,317,000

Pennsylvania $369,034,250

Florida $346,857,750

California $269,240,200

New Jersey $226,712,000

The Pa. Coalition for Civil Justice Reform writes that while the proposal to allow venue shopping in medical liability cases has garnered much of the attention recently, this new study shows that health care professionals in our state are already getting hit with onerous liability burdens.

The Coalition also cited Zurich's Benchmark Study of Healthcare Professional Liability Claims which found that Pennsylvania is consistently in the top five states with the highest frequency of medical liability claims. The Zurich study found that Philadelphia had the highest severity of malpractice claims of any venue studied in the report. Philadelphia and Chicago had two to three times the national average loss cost for medical liability. "Lost cost" is the portion of an insurance rate used to cover claims and the cost of adjusting those claims.

The Pa. Coalition for Civil Justice Reform concludes that these new studies demonstrate that it is crucial that the proposed medical malpractice venue rule changes not be enacted. You can find more information on this issue by going to paforciviljusticereform.org.

CMS Issues Prospective Payment Systems for Inpatient and Long-term Care A3

The Centers for Medicare & Medicaid Services (CMS) has issued the fiscal year 2020 Prospective Payment System and the Long-term Care Hospital Prospective Payment System Proposed Rule.

The proposed changes include:
  • Establishing an EHR reporting period in 2021 for new and returning participants.
  • Removing the Verify Opioid Treatment Agreement measure beginning in 2020.
  • Changing the Query of Prescription Drug Monitoring Program measure in 2020 from required to optional.
  • Converting the Query of PDMP measure for numerator/denominator response, to yes/no beginning this year.
CMS is asking for feedback on these proposed changes. The deadline for submitting comments is June 2. CMS will provide further instructions on how to submit comments after the rule has been published.

To learn more about the proposed changes go to https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-08330.pdf and https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2020-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-acute

Under the Column, "We All Make Mistakes" A4

When you make a mistake in submitting claims to Novitas, the Medicare Administrative Contractor (MAC) for Jurisdiction H and L, Novitas says it has a few easy fixes. It encourages you to use its appeals-related functionality offered in Novitasphere.

Novitasphere will take you through the clear and concise steps necessary to make a claim correction, resolve an error in billing, appeal requests, appeal development letters, appeal redetermination notices and check appeal status. The appeal status, which was added on May 2, helps you obtain information regarding the status and outcome details of Appeals within Novitasphere.

To find Novitasphere enrollment instructions, visit the Novitasphere Portal Center, at:



Or call the Novitasphere help desk at 1-855-880-8424.

Measles Outbreak in Western Pa. A5

Four more cases of measles have been confirmed in Allegheny County, and one of the infected persons was at Pittsburgh International Airport. The Allegheny County Health Department says the five cases constitute an outbreak of the disease.

Four of the cases involve one family. Three of the cases are visitors from overseas. The fourth member is an Allegheny County resident. That individual was not vaccinated. Philadelphia had a mumps outbreak last month, but so far has been spared a measles outbreak.

You can read the recent Pa. Dept. of Health advisory on the subject by going to https://www.health.pa.gov/topics/Documents/HAN/2019-PAHAN--444-05-03-ADV-Measles-Surveillance%20testing%20recommendation.pdf

Measles Testing Available A6

Testing is being done at the Pa. Dept. of Health's Bureau of Laboratories. The testing requires prior approval from the Pa. Dept. of Health (DOH) at 877-PA-HEALTH or from the county/municipal health department.

If you're testing to determine measles immunity, commercial IgG testing is recommended. Do not order measles IgM if the patient is asymptomatic or recently vaccinated with MMR.

Consider measles in patients with febrile rash illness lasting three days or more, a fever of 101 or higher, and clinically compatible symptoms (cough, coryza and/or conjunctivitis) particularly if the patient was potentially exposed to a case of measles or has recently traveled to an area with an on-going measles outbreak.

To see the DOH's complete measles alert, go to https://www.health.pa.gov/topics/Documents/HAN/2019-PAHAN--446-05-08-ADV-Measles%20Testing%20Guidance.pdf

HHS - Vaccines Protect You, Your Family and Your Community A7

In response to the measles outbreak, the U.S. HHS Region III director, Matt Baker, has called on health care professionals to do everything they can to make sure their patients get the vaccinations recommended. (Region III includes Pennsylvania.)

Baker writes in his op-ed piece on the subject that "vaccines are essential to the health of our youngest and most vulnerable."

Baker goes on to state that vaccinations save lives, protect children from debilitating and deadly diseases, and promote the overall health of the community. "Vaccines are safe and highly effective," he adds, "There's a lot of misinformation swirling around out there suggesting otherwise, so we want to get the facts out there."

Baker recommends that for specific information on measles, you should go to the Centers for Disease Control and Prevention at https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

Calendar of EventsCalendar

23 - Deterring Dementia Through Diet

Date: Thursday, May 23
Time: 6:00 PM - 7:30 PM
Place: The Philadelphia County Medical Society, 2100 Spring Garden Street, Philadelphia, PA 19130

What are the nutritional factors in the dementia epidemic? How much of this disorder is preventable? Learn the surprising data on nutritional factors at this free evening program at PCMS.

5 - Building Healthier Communities Through Medicaid- A Policy Forum

Date: Wednesday, June 5
Time: 1:00 PM - 4:00 PM
Place: The Philadelphia County Medical Society, 2100 Spring Garden Street, Philadelphia, PA 19130

The forum will bring together policymakers, advocates, and national experts to take a closer look at innovative models that address the social determinants of health through Medicaid. Hosted by the Pennsylvania Health Access Network and Maternity Care Coalition. Tickets are free, but registration is required.

Keynote Speaker: Pennsylvania Secretary of Human Services, Therese Miller

Click Here to Register

12 - Block Captain Program

Date: Wednesday, June 12
Time: 5:30 PM - 8:15 PM
Place: The Philadelphia County Medical Society, 2100 Spring Garden Street, Philadelphia, PA 19130

Attention Philadelphia Block Captains and Community Leaders! You're invited to learn about Naloxone, the risk factors for opioid overdose, signs and symptoms of an opioid overdose, the medical protocol for responding to an opioid overdose, and the current state of the opioid crisis in Philadelphia.

RSVP by contacting Eileen Ryan at (215) 563-5343 x 113 or send an email to eryan@philamedsoc.org.

29 - President's Installation and Awards Night

Date: Saturday, June 29
Time: 6:00 PM
Place: The Philadelphia Country Club, 1601 Spring Mill Road, Gladwyne, PA 19035

Save the date! This year we will be celebrating the Inauguration of James L. Cristol, MD, as the 158th President of the Philadelphia County Medical Society.

25 - House of Delegates

Date: October 25-27
Place: The Hershey Lodge, 325 University Dr., Hershey, PA 17033

Join your colleagues for a lively, informative weekend of continuing education, leadership development, advocacy, and networking at the Pennsylvania Medical Society's House of Delegates Meeting and Annual Education Conference.

28 - Pennsylvania Harm Reduction Coalition Statewide Conference

Date: October 28-29
Place: Sheraton Harrisburg, 4650 Lindle Rd, Harrisburg, PA 17111

Advocates, clinicians, professionals, and community leaders will be coming together for a 2-day statewide conference on October 28th and 29th in Harrisburg to discuss cutting edge research and evidence-based solutions to the opioid epidemic.

Philadelphia County Medical Society | stat@philamedsoc.org
215-563-5343 | http://philamedsoc.org