SDCMS Report Reveals Looming Physician Shortage in San Diego , -and- CMS Announces Changes to Physician Documentation Requirements

CAL/AAEM News Service pottsbri@yahoo.com
Mon, 23 Dec 2002 00:08:27 -0800 (PST)


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From: Paul Windham [mailto:pcwindham@elite.net] 

Sent: Saturday, December 07, 2002 3:27 AM

Subject: CMA report (San Diego County Medical Society)

SDCMS Report Reveals Looming Physician Shortage in San Diego 



A survey of more than 1,200 San Diego County physicians found that one in three report they will leave the practice of medicine within three to five years. Of those who are staying, one-third plan to reduce patient care hours. Twenty-two percent report that within one to three years they will no longer be participating in the Medicare program, and 26 percent will opt out of California's Medicaid program in the same time period. This is grim news for the nation's fifth-largest county, which-according to the survey-is already experiencing a physician shortage and difficulty recruiting physicians to the area. Physicians surveyed blamed growing pressures and declining reimbursements from HMOs and low Medicare and Medi-Cal rates for their decisions. 

The San Diego County Medical Society mailed the survey in August to all San Diego County physicians, and 24 percent responded. Respondents were evenly spread across the county and represented a full range of ages, specialties, and types of practices.

According to James Grisolia, M.D., a San Diego neurologist and one of the survey's presenters, the results would look even bleaker had the survey 

been mailed today, after the U.S. Senate's recent failure to enact "fix-it" legislation that would have prevented further Medicare cuts for physicians. "The 4.4 percent cut slated to take place in February, on top of the accidental 5.4 percent cut that physicians sustained this year, will drive more doctors out, and sooner," Dr. Grisolia says. 

For more information, including a copy of the report, click here <http://www.calphys.org/html/bb060.asp> .


========================================
AAMC WASHINGTON HIGHLIGHTS

Legislative and Regulatory News

from the Association of American Medical Colleges

December 6, 2002

CMS Announces Changes to Physician Documentation Requirements 



December 6, 2002 - The Centers for Medicare and Medicaid Services (CMS) Nov. 22 published changes to the Carrier Manual Instructions (CMI), Section 15016, Supervising Physicians in Teaching Settings (CR #2290). The revisions were effective on the date they were issued. 

CMS has been examining regulatory burden on physicians and attempting to provide relief when feasible. Over the past year, the Agency has worked with AAMC through the Group on Faculty Practice Steering Committee to identify burdensome aspects of the supervising physician requirements that could be addressed through revisions to the CMI rather than through changes in the regulation. While the teaching physician regulation that was effective on July 1, 1996, remains unchanged, the revised CMI makes important positive changes in the documentation requirements.

The revised CMI should significantly reduce the documentation burden on teaching physicians for E/M services when a resident also is involved in the care of a patient. The revised language makes it clear that for E/M services, teaching physicians need not repeat documentation already provided by a resident. It is important to note that with very limited exceptions, a teaching physician still must write a personal note and, unless the service is provided under the Primary Care Exception, must be present for the "key portion" of the service. Further, the revisions clarify other issues, including the use of documentation by students, and updates regulatory references. Each institution should carefully review the instructions. 

Information:

Denise Dodero, Assistant Vice President

AAMC Division of Health Care Affairs

ddodero@aamc.org

(202) 828-0493 


Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC Irvine
MD/MBA candidate
pottsbri@yahoo.com


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<FONT size=2>
<P></P>
<P>From: Paul Windham [</FONT><A href="mailto:pcwindham@elite.net"><U><FONT color=#0000ff size=2>mailto:pcwindham@elite.net</U></FONT></A><FONT size=2>] </P>
<P>Sent: Saturday, December 07, 2002 3:27 AM</P>
<P>Subject: CMA report (San Diego County Medical Society)</P>
<P>SDCMS Report Reveals Looming Physician Shortage in San Diego </P>
<P></P>
<P>A survey of more than 1,200 San Diego County physicians found that one in three report they will leave the practice of medicine within three to five years. Of those who are staying, one-third plan to reduce patient care hours. Twenty-two percent report that within one to three years they will no longer be participating in the Medicare program, and 26 percent will opt out of California's Medicaid program in the same time period. This is grim news for the nation's fifth-largest county, which-according to the survey-is already experiencing a physician shortage and difficulty recruiting physicians to the area. Physicians surveyed blamed growing pressures and declining reimbursements from HMOs and low Medicare and Medi-Cal rates for their decisions. </P>
<P>The San Diego County Medical Society mailed the survey in August to all San Diego County physicians, and 24 percent responded. Respondents were evenly spread across the county and represented a full range of ages, specialties, and types of practices.</P>
<P>According to James Grisolia, M.D., a San Diego neurologist and one of the survey's presenters, the results would look even bleaker had the survey </P>
<P>been mailed today, after the U.S. Senate's recent failure to enact "fix-it" legislation that would have prevented further Medicare cuts for physicians. "The 4.4 percent cut slated to take place in February, on top of the accidental 5.4 percent cut that physicians sustained this year, will drive more doctors out, and sooner," Dr. Grisolia says. </P>
<P>For more information, including a copy of the report, click here &lt;</FONT><A href="http://www.calphys.org/html/bb060.asp"><U><FONT color=#0000ff size=2>http://www.calphys.org/html/bb060.asp</U></FONT></A><FONT size=2>&gt; .</FONT></P><FONT size=2><FONT size=2>
<P>
<P>========================================</FONT><FONT size=2></P>AAMC WASHINGTON HIGHLIGHTS</P>
<P>Legislative and Regulatory News</P>
<P>from the Association of American Medical Colleges</P>
<P>December 6, 2002</P>
<P>CMS Announces Changes to Physician Documentation Requirements </P>
<P></P>
<P>December 6, 2002 - The Centers for Medicare and Medicaid Services (CMS) Nov. 22 published changes to the Carrier Manual Instructions (CMI), Section 15016, Supervising Physicians in Teaching Settings (CR #2290). The revisions were effective on the date they were issued. </P>
<P>CMS has been examining regulatory burden on physicians and attempting to provide relief when feasible. Over the past year, the Agency has worked with AAMC through the Group on Faculty Practice Steering Committee to identify burdensome aspects of the supervising physician requirements that could be addressed through revisions to the CMI rather than through changes in the regulation. While the teaching physician regulation that was effective on July 1, 1996, remains unchanged, the revised CMI makes important positive changes in the documentation requirements.</P>
<P>The revised CMI should significantly reduce the documentation burden on teaching physicians for E/M services when a resident also is involved in the care of a patient. The revised language makes it clear that for E/M services, teaching physicians need not repeat documentation already provided by a resident. It is important to note that with very limited exceptions, a teaching physician still must write a personal note and, unless the service is provided under the Primary Care Exception, must be present for the "key portion" of the service. Further, the revisions clarify other issues, including the use of documentation by students, and updates regulatory references. Each institution should carefully review the instructions. </P>
<P>Information:</P>
<P>Denise Dodero, Assistant Vice President</P>
<P>AAMC Division of Health Care Affairs</P>
<P>ddodero@aamc.org</P>
<P>(202) 828-0493 </FONT></FONT><FONT size=2></P></FONT><BR><BR>Brian Potts<br>Managing Editor, CAL/AAEM News Service<br>MS-IV, UC Irvine<br>MD/MBA candidate<br>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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