MGMA Seeks 5010 Contingency Plan, SGR Repeal

At a press briefing on Tuesday, Oct. 25, at the annual Medical Group Management Association (MGMA) conference that drew more than 3,500 attendees— a 19 percent uptick over last year—the newly appointed President and CEO Susan Turney, M.D., spoke about several of the policy issues, including the HIPAA 5010 compliance date and the looming Sustainable Growth Rate (SGR) cuts, that her organization was actively advocating over on behalf of its medical group practice membership. Turney also announced that MGMA, which has 22,500 members, and sister accrediting body, the 6,750 member American College Medical Practice Executives (ACMPE), would unify to create efficiencies and be better positioned to guide members through the current uncertain landscape of healthcare reform.

“We think about the changing delivery models, the changing payment system, and all the technology that needs to be implemented,” Turney said. “It’s a daunting task, and they’re struggling, and we want to help.

Citing recent MGMA member research, Turney said that 95 percent of respondents were Medicare participants, and of that percentage, only 16 percent said they would maintain current levels of access for new Medicare patients if the projected SGR payment cuts occur. Another sobering statistic cited that 65 percent of practices said uncertainty caused by the threat of cuts has caused them to delay purchase of new clinical equipment and/or facilities.

Other MGMA research found that over the past 10 years both single and multi-specialty practices reported costs outpaced revenue. “We saw that the operating costs actually decreased 2.2 percent, and that tells you that practices are very concerned about the uncertainty in the environment today, and there is a lot of belt tightening and conservatism,” said Turney.

She added that MGMA didn’t support the Affordable Care Act (ACA), as it failed to enact meaningful liability reform by repealing the SGR growth rate. To that end, Anders M. Gilberg, MGMA senior vice president, said that his organization is undertaking grassroots efforts to urge Congress to repeal SGR. “We’ve had members of our organization, who are our legislative liaisons, go and meet with members of the Joint Select Committee for Deficit Reduction to voice concern and our strong belief that repealing SGR is the fiscally responsible thing to do, as part of this overall deficit reduction effort,” he said. “If ignored it’s only going to create a much larger deficit that is going to have to be dealt with.”

Another looming issue stated by MGMA was the concern about practice readiness for the HIPAA 5010 compliance date. MGMA has called on CMS to be flexible and create a contingency plan. “There could be potential disruption of cash flow [for practices], and if that occurs, what are they going to do?” Turney asked. “So they need to have a back-up plan in the event that there is no payment for the claims they are submitting.”

Robert Tennant, MGMA’s senior policy advisor, added that CMS knows that if it doesn’t create some kind of contingency plan, the industry could hit a serious roadblock. “[CMS has] also heard from health plans that they are going to take in claims that may not have all the 5010 data content,” he said. “What we’re asking CMS for is clear indication to clearinghouses, health plans, and providers that it’s OK to send a claim that has enough data to be adjudicated, but may not contain all of the data content required under 5010.”

During the briefing, Turney also announced that members had approved the merger of MGMA and ACMPE. These legally separate but formally aligned organizations will become a new organization effective Jan. 1, 2012, with one united board and the legal name MGMA- ACMPE.

“It will make us more nimble as an organization so that as the marketplace changes, we’ll be able to come in much faster with products and services to meet the professional needs and those trade association needs at the same time,” said ACMPE Board Chair Alan D. Winkler, vice president clinic operations, St. Vincent Health System.

Outgoing board chair Shena Scott, executive director, Brevard Anesthesia Services PA , also said that with the new organizational alignment, new efficiencies could be made with savings redeployed to member benefits. “Our membership is changing as healthcare evolves and more of our members are becoming employed by hospitals and different employment settings,” she said. “This allows us the opportunity to offer products and services to help them through those changes because the skill sets that are required to work in a hospital is different than in a small medical practice.”

Scott said that savings will be passed along to members as well, as past members who have gone through the certification process have had to belong to both organizations and pay two sets of dues. “So anyone who was certified or a fellow will see a reduction in their dues, so we’re hoping that will encourage more people to pursue certification,” she said.