Provider Relations and Reimbursement Committee Report
Blue Cross /Blue Shield of Michigan (BCBSM) Discussions:
There has been one meeting and a number of emails and phone calls to discuss the upcoming opportunity for pathologists as specialists to participate in an increased compensation (called “fee uplifts) program within the PGIP program of BCBSM. Many of the details of the program regarding metrics and measurements that make pathologists eligible have yet to be defined, but because this program has already included other specialists, pathologists are able to learn some aspects of the program. Below are some important aspects of the program as well as a very important message.
In order to be eligible to participate in the program and benefit from possible increased reimbursement for 2015, you must be a member of a PGIP sponsored Physician Organization (PO) by July 1, 2014.
If you are a member of more than one PO, that is acceptable, however, for purposes of this program, you must be signed up for PGIP with only one PO. This will then be designated as your Member PO. The PO should be one where a majority of your work comes from and for many of you, that PO will be the one that is associated with your hospital medical staff. For Independent pathologists and laboratories, that should be the PO where most of your referral physicians are members. For some, it may be difficult to obtain membership in the local PO for various reasons and you should contact your BCBSM physician consultant to help guide you in your choices. That choice may well be CIPA (Consortium of Independent Physician Associations) which is a statewide provider network consisting of approximately 50 independent physician associations (IPAs), physician hospital organizations (PHOs), health centers and group practices representing about 1,600 physicians. You can find information on all the POs in PGIP through the following link: http://www.bcbsm.com/providers/help/faqs/how-to-participate-in-pgip.html, which includes a link to a list of all the POs and their contact information.
The overall program is based upon the premise that all physicians of various specialties who are responsible for a population will collaborate on aspects of improving patient care and the patient experience and at the same time with an eye towards decreasing cost and eliminating excess. Those physicians associated with populations of patients that do well on measures of cost, quality and/or use will be rewarded by increases to their fees (fee uplifts) for the following year. This is an effort to move from a volume reward system to a value reward system of healthcare.
This program is in its very early stages with pathology and as we all know, pathology is not an easy system to understand and often does not fully apply to the same influences of most physicians. However, BCBSM is making a very positive effort by engaging us early in order to work through the difficulties we encounter. As additional information becomes available, this committee will keep you informed.
Dear MSP Members,
Recently, the Senate Committee on Reforms, Restructuring & Reinventing recently passed SB 2, introduced by Committee Chair Sen. Mark Jansen (R-Grand Rapids). This bill aims to change the Public Health Code to allow APRNs to perform certain medical/surgical procedures and interpretation of laboratory tests, as well as prescribing duties, without any physician supervision or oversight.
Legislators need to know that the best person to lead the health care team is the person with the most extensive education and training who can ensure the highest quality of care and safety for patients—the physician. It’s time to tell them that scope of practice expansions should come through education and training and NOT through legislative means (“Educate, Don’t Legislate”). The bill moved to the Senate floor, and unless senators hear from more physicians—and other friends of medicine—there’s a good chance they will pass it. Urge your colleagues, spouses, office managers, and others to contact senators, too!
Send an electronic message to your senators by clicking here