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CMS Medical Staff regulation changes

CMS hospital Conditions of Participation (CoPs) final rule makes significant changes to the hospital governance structure and for the relationship between the medical staff and its individual members. The final rule which became effective July 11, 2014 essentially does the following:

  • Permits a multi-hospital health system to have a unified, system-wide medical staff, rather than a separate medical staff at each hospital, provided that the medical staff at each hospital votes to accept a unified staff structure.
  • Eliminates a requirement that the hospital governing body include a member of the medical staff. The governing body must now consult at least two times per year with the medical staff.

The AMA Organized Medical Staff Section has developed a guide and is available here. The Kansas Medical Society, along with the AMA and other associations sent a letter to CMS objecting to these changes and requested a delay of the implementation, arguing additional time to prepare and the CMS must provide guidance on a number of issues before the rule can be implemented. Unfortunately CMS declined the request for delayed implementation, and hospital systems may immediately begin to seek a unified medical staff structure.

KMS wishes to thank Arthur D. Snow, Jr., M.D., Shawnee Mission State Chair and OMSS Chairman for his leadership and commitment to this and other issues facing the practice of medicine. Contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance, if you have any questions.

BCBS amends 2015 policy memo

Blue Cross Blue Shield of Kansas, after receiving feedback from providers regarding the upcoming changes to their Quality-Based Reimbursement Program (QBRP), made adjustments to the Kansas Health Information Exchange (KHIE) query count for the first quarter measurement period for 2015 and additional connectivity options. Details about the changes can be found here.

KMS offers education on new work comp guidelines

Ruth Cornwall; Director of Health Care Finance

The Kansas workers' compensation program will adopt the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition on January 1, 2015. Physicians who provide impairment ratings for workers' compensation will need to use the new Guides for injuries that happen on or after January 1.

KMS will be hosting a webinar, Musculoskeletal Impairment – An Introduction to the Sixth Edition of the AMA Guides to Permanent Physical Impairment on Wednesday, December 17 from noon-1:15pm. The webinar will focus on understanding the new guideline format and will include an opportunity for questions to be asked. Our presenter will be Dr. Mark Melhorn of Wichita. Dr. Melhorn is an occupational orthopedic physician who specializes in the hands and upper extremities and was the lead author for the Upper Extremity Chapter in the Sixth Edition of the AMA Guides to Impairment.

This is a free program but registration is required. As a reminder, your confirmation will suggest that you test your computer for compatibility prior to the event. Please contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance with any questions or concerns.

Medicare open payments data online

If you have received a payment from a device or drug company you should know about a new CMS Open Payments database. Companies participating in Medicare are required to report physician payments or "transfer of value" greater than ten dollars. For additional information, access the AMA's Sunshine Act toolkit. This includes information on how to contest incorrect database entries and tips for answering questions you might get from patients or the news media.

Contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance, with any questions or concerns.

CMS releases ICD-10 clinical documentation and coding webcast

The implementation date for ICD-10 is October 1, 2015 and will change the way coding is done and will require a significant effort to implement. CMS has released a new webcast with information on clinical documentation and coding from the "Road to 10" tool, which was designed to help small physician practices transition to ICD-10. Accessible through the "Road to 10" link on the CMS website, the webcast discusses how transitioning to ICD-10 will impact documentation and coding in small physician practices. Visit the CMS ICD-10 website to get started on the "Road to 10" today. Keep up to date on ICD-10 Visit the CMS ICD-10 website for the latest news and resources to help you prepare.

Editorial: Dr. Moser leaving KDHE; Dr. Mosier taking over

Jerry Slaughter; Executive Director

No, it's not a typo. The first physician to lead the sprawling Kansas Department of Health and Environment full-time in nearly four decades, Robert Moser, MD, has resigned his position as Secretary and is headed to the KU School of Medicine and KU Hospital. It is expected that his role at KU will focus on graduate medical education and rural health initiatives.

Susan Mosier, MD (same pronunciation), the current Director of the KDHE Division of Health Care Finance and the state Medicaid Director since 2012, has been named by Governor Brownback to be the Interim Secretary of the agency. She is an ophthalmologist and former state representative from Manhattan. Dr. Mosier is a graduate of KSU and the KU School of Medicine, and completed her residency training at the University of Iowa.

Read more ...

KMS seeks nominations for Board of Trustees

As members may recall, in 2013 KMS established a new nominations and elections process for KMS officers. Under the new process, the Nominating Committee will seek and consider recommendations for nominees from the general membership, component/county societies and specialty societies.

The Committee is charged with the task of nominating candidates who possess the integrity, skills and commitment necessary to enable the Board to properly exercise its governance and oversight role in the best interests of the Society. In making its nominations the Committee is directed to work towards a Board composition that is broadly representative of the Society membership, particularly in experience, geographic location, specialty and practice type. Physicians nominated to serve on the Board of Trustees must be members-in-good standing of KMS and their county medical society.

The online nomination form is available here. KMS members may be nominated by a colleague, component/county medical society or state specialty society; self-nominations will also be accepted. 

If you have questions or would like additional information, please contact Allison Peterson via email at This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at the KMS office (800.332.0156). Paper nomination forms are also available by request.

Projected ICD-10 costs higher than expected

The costs for practices to implement the federally mandated transition to ICD-10 are higher than earlier estimates, according to a new AMA study. The study, conducted by Nachimson Advisors, compared current estimates of ICD-10 conversion with Nachimson’s widely reported 2008 report. According to the AMA the previous estimate did not account for the costs to upgrade to certified electronic health record (EHR) software since Congress had not yet enacted the Meaningful Use Program. In addition the study reports, estimating that 2 to 6 percent of all claims filed under the new coding system will be denied by payers.

The AMA House of Delegates adopted a policy calling for repealing ICD-10 for the simple reason that it is not expected to improve the care physicians provide their patients and could disrupt efforts to transition to new delivery models. The AMA expressed their concerns in a letter to Kathleen Sebelius, U.S. Health and Human Services Secretary.

KMS encourages its members to be ready for ICD-10 and not to count on any respite from Congress or CMS. KMS has an ICD-10 resource page that can be found here.

CMS extends Medicare EHR attestation deadline

CMS is extending the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from February 28, 2014 to March 31, 2014. This extension will allow additional time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment.

If you are an eligible professional, you may use the registration and attestation system to submit your attestation for meaningful use for the 2013 reporting year. You must attest by March 31, 2014 to meet the new 2013 program deadline.

The EHR information Center is open to assist you with all of your registration and attestation system inquiries. The EHR Information Center is open Monday through Friday from 7:30 a.m. – 6:30 p.m. and may be reached at 888.734.6433.

PQRS: participate in 2014, avoid 2016 penalty

CMS has announced that 2014 will be the performance period for the 2016 PQRS penalties. If CMS determines that an eligible professional or group practice has not satisfactorily reported through one of the finalized reporting options for January 1 through December 31, 2014, the Medicare fee schedule amount for services furnished during 2016 will be at 98 percent of the fee schedule.

CMS has established different reporting requirements for individual physicians and non-physician providers, as well as group practices for participating in 2014 PQRS program. Participation requirements to qualify for a payment incentive differ from the requirements for avoiding a payment penalty. However, qualifying for an incentive allows the individual or group practice to avoid the payment adjustment. More information about PQRS can be found at the CMS website, the AMA or by contacting This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

APRN scope bill carries over from 2013 session

The bill which would allow APRNs to practice independent of physicians has carried over into the 2014 session. Readers may recall the proposal which would dissolve the collaborative practice arrangement between APRNs and physicians, and establish APRNs as primary care providers without any statutory practice limitations. HB 2251 was introduced in the House Health and Human Services committee last year and has not yet received a committee hearing.

Some outside groups have begun to advocate for HB 2251 under the guise of "economic freedom," deregulation and as a "pro-jobs" issue. The training gap between nurses and physicians is deep and wide and threatens to pull quality of care for Kansas patients downward. The bill's proponents, the APRN Task Force, state that they want APRNs to practice to the full extent of their training, while other advocates like Americans for Prosperity say nursing limitations restrict access to APRNs and impede small business growth.

As written, HB 2251 would allow APRNs to practice well beyond the extent of their training without regard for adequate protection of Kansas patients and no arguments about business growth are appropriate when considering the health and safety of Kansans.

Many more issues are sure to emerge as the session progresses. Communicating with your legislators about this issue and other issues is effective and remains very important. If you have questions about legislative issues, or would like assistance preparing to contact your legislator on the APRN issue, please email KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

KHC program generates quality improvement

In December, Kansas hospitals celebrated two years of quality improvement work through the Kansas Hospital Engagement Network (HEN), a program administered by the Kansas Healthcare Collaborative. Hospitals continue to implement changes in their efforts to deliver quality health care that is safe and affordable.

KHC is an organization founded jointly by KMS and the Kansas Hospital Assoication. Since their founding nearly five years ago, they have worked in partnership with the American Hospital Association's Health Research and Educational Trust (HRET) HEN, to improve quality and reduce patient harm in Kansas hospitals across the state.

The national HEN goal of 40 percent reduction in health care-acquired conditions (HACs) and 20 percent reduction in readmissions is a challenging one. As the HEN moves into year three, the focus will remain on: engagement, maintaining front-line participation and support from leadership; sustaining improvement through customer and technical support including site visits to reinforce hospitals' work in quality improvement; and assistance with data collection, data analysis, and identify solutions to barriers for improved outcomes.

Hospital administrators are now in the process of renewing facility participation commitments to the HEN for the 2014 extension year. Commitment forms were emailed to hospital CEOs in December. In addition, Kansas hospitals not currently affiliated with a HEN received an invitation to join the Kansas HEN and work together to achieve shared patient safety goals. Forms are due to KHC by January 31. For more information, contact KHC at This email address is being protected from spambots. You need JavaScript enabled to view it.

Medicare: standing orders, physician payment data

Medical necessity is the driving force for payment of any Medicare service. Physicians need to be cognizant of the various meanings presented by used of the term "standing orders." WPS has released an article designed to help you understand the various terms associated with "standing orders," including routine orders, recurring orders, and treatment protocols.

Physician payment data to be released

CMS has announced they will respond to Freedom of Information Act (FOIA) requests about how much money individual doctors earn from treating Medicare patients. Historically physicians have been protected from this, but that changed in May 2013 when a federal judge in Florida ruled that doctors' privacy concerns did not trump the public interest in disclosing the information, which can be used for detecting trends in healthcare utilization and fraud, among other things. CMS did not guarantee that every FOIA request would be filled, but said they would begin using a "balancing test" to determine which information should be released.

Last year, in response to CMS' request for public comment, KMS joined other medical societies and raised concerns that the release of claims data to the public "can have unintentional, adverse consequences for patients, providers, and the health care system" if not done correctly.

We will continue to monitor this issue and provide updates when available. If you have any questions or concerns please contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance at 785.235.2383

Legislative session begins; tort reform bill introduced

columnsThe 2014 Legislative Session is off and running, picking up as though they never left off. Eagerness to conclude legislative matters before the summer months begin and the House stands for re-election has prompted a rapid pace as legislators get back to business. Though we are just rounding out the end of the first week, we have a clear view of many of the issues that will define the 2014 session for Kansas physicians.

In response to the Supreme Court's concerns about the adequacy of the cap on non-economic damage, KMS has introduced a bill in Senate Judiciary to increase the $250,000 cap over the next eight years. There is no question that the cap on non-economic damages has been essential in stabilizing the medical malpractice environment over the last 25 years. Before its establishment as part of the 1988 tort reform package, Kansas physicians faced an untenable malpractice climate which drove liability insurance premiums too high and many doctors out of state. For these reasons, preserving the integrity of the cap on non-economic damages has been a central focus of the Kansas Medical Society and remains so today.

KMS's legislative proposal responds to the Supreme Court's concerns in a way that is meaningful for patients, and will not de-stabilize the liability insurance system. We are committed to protecting this key component of the malpractice environment for present and future Kansas physicians.

For questions about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Resources to prepare for ICD-10

The Kansas Medical Society, in collaboration with the Missouri State Medical Association and KaMMCO will be hosting an ICD-10 educational series by conference call. The sessions will be from Noon-1pm on February 27, March 6, and March 13. Brenda Edwards, CPC with KaMMCO will discuss what you need to be doing in the months leading up to October when use of ICD-10 is mandated.

KMS has collected a series of resources which may be helpful as you prepare to transition to ICD-10; you can find them by clicking here.

Further details about the educational calls are available here; registration is not required.

Clear legislative priorities advance

columnsThe Kansas Supreme Court's ruling on the cap on non-economic damages was fairly clear: the constitutionality of the cap was preserved based on the adequate source of recovery, or the quid pro quo, established through the mandatory professional liability insurance that participating providers purchase through the Health Care Stabilization Fund (the Fund).

The court's ruling signaled two necessary actions for those seeking to preserve the cap and the protection it provides: to increase the amount of the cap and to participate in purchasing professional liability insurance from the Fund as a defined health care provider. As such, the Kansas Medical Society has introduced legislation aimed at those two objectives.

The Fund bill has been introduced in the House Insurance committee as a companion to the KMS cap bill previously introduced in Senate Judiciary. The Fund bill, which has not yet been assigned a number, adds three groups to the list of defined health care providers participating in the Fund and thereby benefitting from the cap on non-economic damages. The added providers are the nursing homes, APRNs and physician assistants. Additionally, the bill increases the amount of tail coverage providers will receive when they retire from active practice. The Fund bill is scheduled for a hearing on Monday, January 27 in the House Insurance committee. A hearing on the cap bill has not yet been scheduled.

In addition to these proactive legislative proposals, KMS remains engaged on the APRN bid for independent practice. Though we have not yet seen their new proposal, the APRNs have indicated they will introduce a new bill, modified only in the length of time required for a transition from collaborative to independent practice. Much like former proposals, the APRNs seek to dissolve the collaborative practice agreement and to establish APRNs as primary care providers on the premise that doing so provides access to care. They maintain that as currently written, the Nurse Practice Act is a barrier to care and economic growth. Rather than discuss the profound gap in training between APRNs and physicians, they focus instead on studies in states with independent practice that show no discernible decline in quality of care. It is important to note that Kansas is one of the states contributing to such studies because of the broad authority APRNs already have to practice without the direct, on-site supervision of a physician. Despite their claims to the contrary, their bid for an unlimited scope of practice unnecessarily puts business pursuits ahead of patient safety and quality care. APRNs can practice in rural, underserved areas now, if they choose. KMS will continue to advocate for the right of all Kansans to have access to high quality care.

Along those lines, KMS will be watching HB 2375, the School Sports Head Injury Prevention Act, which seeks to allow chiropractors, optometrists, advanced practice registered nurses and physician assistants to provide clearance to "return to play" after a player sustains a head injury. As new information on the nature and impact of head injuries becomes available, it is clear that students must be evaluated by a trained physician familiar with the presenting factors and ongoing risks of these types of injuries. KMS opposes efforts to allow inadequately trained non-physicians to provide clearance to players. HB 2375 has not been scheduled for a hearing.

As the session continues, KMS will remain focused on issues affecting the practice of medicine and safety of patients in Kansas. For questions about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

KMS tracking issues of import to medicine

columnsAs January comes to close, we are beginning to have a sense of those issues which will define the session for physicians. Though it is still early in the process, the time for individuals to request new bill introductions is drawing to a close, causing a flurry of activity this week. There are dozens of bills we are monitoring for their positive and negative potential if enacted, but only a few will make it through the full process of a legislative session. These are the ones to watch.

Bills on the move

SB 251 – Real Time Explanation of Benefits: would mandate that insurers provide a real time explanation of benefits in advance of any medical procedure via an electronic interface. The goal is to equip providers and patients with a better estimation of what the out of pocket costs are for patients, and what the insurance company will pay for the care provided. KMS supports the concept, as long as it doesn't mandate additional technology costs on practices. The bill has been sent to a special subcommittee of Senate Insurance for further study.

SB 311 – Increasing the cap on non-economic damages: this KMS sponsored bill aimed at preserving the constitutionality of the cap on damages awarded for pain and suffering will have a hearing in Senate Judiciary next Thursday. In response to the Kansas Supreme Court's recent decision on the $250,000 cap on pain and suffering damages enacted 25 years ago, KMS is supporting a $100,000 increase spread over eight years to maintain the balance of providing an adequate source of recovery for patients against the need for a stable medical-legal environment for physicians to practice. The Court signaled that the cap's constitutionality could be threatened if it wasn't adjusted.

SB 316/HB 2520 – Changes to the Podiatry Act: these bills with identical language would allow residency-trained podiatrists to perform surgery on the ankle. A number of states have expanded podiatry laws in recent years to allow ankle surgery to the group of podiatrists who have completed foot and ankle surgery residencies accredited by the American Board of Podiatric Surgery. KMS, the Kansas Orthopaedic Society, and a group representing the residency-trained podiatrists are discussing the proposal. SB 316 has been scheduled for a hearing in Senate Public Health and Welfare on Monday, February 10th.

SB 326 - APRN Independent Practice: this is a new version of the APRN's proposal from last year to expand their scope of practice, and eliminate the collaborative practice requirement with a physician. The major difference between this bill and the original is a lengthened "transition to practice" period for prescribing privileges. This bill contains the "global signature authority" provision which allows an APRN to order or authorize anything under law that a physician is licensed or authorized to approve. It also specifically designates APRNs as primary care providers and authorizes them to lead health care teams. Though the transition to practice requirement is expanded, there remains a significant difference in the training of APRNs and physicians, yet the bill would grant APRNs virtually an unrestricted scope of practice. KMS opposes this bill and encourages you to call your legislator and explain the disparity in quality care this proposal would create. Contact information for your legislator can be found here. A hearing has not yet been scheduled in the House or Senate.

HB 2435 – Tanning Bed Ban for Minors: this bill would prohibit minors from tanning at an indoor tanning facility and would penalize businesses in violation of the ban. KMS testified in support of the bill before the House Health and Human Services committee. Many conferees testified to the fact that people who begin tanning younger than age 35 increase their risk of developing melanoma by 75 percent. Health risks and the growing incidence of melanoma in a younger population set notwithstanding, there are many opposed to the government establishing "nanny-state" regulations intended to protect the public.

HB 2516 – Health Care Provider Liability Insurance Availability Act: this KMS initiative and companion to the cap bill (SB 311) adds to the list of defined health care providers participating in the Health Care Stabilization Fund and receiving the benefit of the cap on non-economic damages. The bill was heard in House Insurance and passed out of committee favorably. It is expected to run in the Kansas House early next week.

Bills to watch

HB 2375 – School Sports Head Injury Prevention Act: this carryover bill from last year would expand the list of health care providers who are authorized to determine when a student athlete is cleared to return to play or practice following a sports related head injury. The push comes mainly from chiropractors and has not yet been met with a scheduled hearing.

HB 2376 – Disclosure of unanticipated medical errors: another carryover bill from 2013, this bill attempts to marry the issue of mandatory disclosure of unanticipated outcomes with the concept of "I'm sorry" legislation. Though intended to encourage conversation between patients and physicians about adverse outcomes, this complex bill would actually complicate that process and the legal implications of expressions of sympathy or apology made by health care providers. KMS opposes the bill; it has not yet been scheduled for a hearing.

HB 2523 – Apology Bill: introduced last week by the House Health Committee, this bill allows expressions of sympathy or apology by health care providers and establishes that such statements are not admissible as evidence in a malpractice case. Many states have established apology laws in an attempt to encourage such expressions while providing legal protection for physicians. KMS is supportive of an apology law if it is consistent with or very similar to this bill. The bill has not yet been scheduled for a hearing.

As the session continues, KMS will remain focused on issues affecting the practice of medicine and safety of patients in Kansas. For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

ICD-10 testing, support available March 3-7

In preparation for the October 1 deadline for adopting the ICD-10 code set, CMS will conduct a week of limited ICD-10 testing March 3-7. During this testing, Medicare Administrative Contractors will offer real-time help desk support for physicians and other health care professionals. CMS expects an increased call volume during this time. Additional information and registration can be found at the WPS website.

KMS has a number of ICD-10 resources available online to assist members or contact Ruth Cornwall, KMS Director of Health Care Finance with any questions.

KaMMCO insureds: earn CME, premium credit

New this year, KaMMCO has partnered with ELM Exchange, Inc. (ELM) to offer a convenient online curriculum, which allows eligible members to take one course to earn an additional 2 percent premium credit toward policy renewal, as well as CME.

ELM courses are case study based and represent actual redacted medical professional liability claims. The user-friendly ELM system allows you to stop and start the courses at your convenience. Courses can be accessed 24/7 from any computer (or mobile device) with internet capability. The following courses are available in 2014:

  • Transitions of Care: Documentation, Coordination, and Communication
  • Controlled Substance Prescribing: Risks in Managing and Terminating the Physician-Patient Relationship
  • Deposition and Trial Guidelines for the Physician Defendant
  • Managing Difficult Patients: Duty and Documentation
  • Physician Liability for Midlevel Providers
  • Risks in Transitioning to Electronic Medical Records
  • Disruptive Clinician
  • EMTALA
  • Informed Consent
  • Chain of Command
  • Communication: Adverse Outcome & Event Disclosures
  • Managing Lab & Test Results

Visit www.KaMMCO.com to get started or call KaMMCO at 800.232.2259 with questions.

Winter storm brings flurry of activity to Statehouse

columnsDespite a mid-week winter storm that forced a two-day legislative shutdown, there has been a flurry of activity on KMS priorities in the past week.

SB 311, the cap bill, was heard in Senate Judiciary on Thursday, allowing KMS the first opportunity to discuss the Miller v. Johnson ruling upholding the cap on non-economic damages as constitutional. Though the Supreme Court did not strike down the cap, they were clear that their decision hinged on the right to recovery assured to patients injured by medical malpractice. The law requiring physicians to carry professional liability insurance establishes this right to recovery for patients. Many would ask why, in light of the Court's decision to uphold the current $250,000 cap, the Kansas Medical Society would offer to increase the cap by $100,000 over the next eight years. It is a valid question, and one that we were able to testify to before the committee this week.

For many, the simple fact that the Court upheld the cap is enough. And though it is true enough that the cap is in place for today, we would be foolish to ignore the Court's instruction for how to preserve it for the future. The Court expressed reservations about the adequacy of a cap that had not been adjusted for twenty-five years; reservations that could become central to a future challenge to the cap. There is no question that the balance between requiring physicians to carry professional liability insurance and capping that liability on non-economic damages has been key to establishing the stable medical malpractice environment our state enjoys today. As SB 311 is worked in the Senate Judiciary committee next week, we will continue to impress upon the Legislature the importance of preserving that stability for the future by making this reasonable, incremental increase.

HB 2516 addresses the remainder of the Court's basis for upholding the cap - the right to recovery established through the Health Care Stabilization Fund (the fund). Since 1976, the fund has been providing professional liability insurance for all Kansas physicians as well as other participating health care providers. HB 2516 was introduced by KMS to expand the list of health care providers who participate in purchasing liability insurance from the fund. The expanded list includes physician assistants, advanced practice registered nurses, and nursing home facilities. The bill was heard by the full House on Friday and was passed without opposition.

With just two weeks until the first Legislative deadline, "turnaround" which requires all non-exempt bills to have been heard and passed from their house of origin to remain active, the APRNs continue to push aggressively for independent practice. They have a carryover bill from last year, HB 2251; SB 326 introduced two weeks ago which would minimally expand their transition to practice, and an identical bill introduced in House Health and Human Services last Thursday. With three bills addressing their proposal, it is clear that the APRN Task Force will not back away from their bid for independent practice in favor of compromise language. They continue to assert that allowing APRNs to serve as primary care providers is the best solution for rural access to care. Additionally, outside groups such as Americans for Prosperity are actively messaging that differentiating between nurses and physicians is an unnecessary boundary to free enterprise and "equal" care.

Though many legislators understand the danger of such assertions and are not moved by these arguments, others are less acquainted with the vast gap in training between physicians and APRNs. For those who live in rural areas and don't have a physician in their home town or who are more frequently seen by a nurse practitioner than a doctor, these arguments can be compelling. Some fail to realize that the APRN they currently see regularly is working under the collaborative practice agreement or supervision of a physician, even if they as the patient don't observe that oversight during their visit. It is critical that your legislator hears from you about the collaborative relationship between you and your nurse practitioner and how the current construct carefully balances independence and oversight that benefits the patient by ensuring quality care. Ensuring that diagnosis and development of treatment plans are determined by licensed physicians with necessary training and experience is not a distinction made to impinge upon the free market. APRNs simply are not equipped with the necessary training to initiate and deliver unrestricted treatment independently. Contrary to claims by the advocates of this proposal, protecting the collaborative relationship between physicians and APRNs as well as other members of the health care team is precisely what ensures access to equal care for all Kansans. If you have not already, please consider contacting your legislator to discuss this issue today. Legislative contact information can be found here.

SB 251 would require insurers to provide an explanation of benefits and associated out-of-pocket costs in "real time" in advance of any medical procedure. The bill has been sent to a subcommittee of Senate Insurance where members are studying the cost of implementing such an interface for both insurers and providers as well as trying to estimate utilization of such an interface by providers. KMS supports the concept of encouraging insurers to provide accurate information about benefits and associated costs for patients and continues to monitor this bill as the details are discussed.

SB 316 amends the podiatry act to authorize podiatrists who have completed an accredited residency in foot and ankle surgery to perform surgery on the ankle. Under current Kansas law, podiatrists are limited to performing surgery on the foot and toes, and may not operate on the ankle. KMS is taking no position on SB 316 at this time, pending the results of a working group of orthopedic surgeons and podiatrists which has been meeting for the past few months. Although the group has not agreed on any legislation yet, a draft proposal is under consideration, and the group has agreed to continue working on the proposal which has been circulated.

HB 2435 prohibits minors from utilizing tanning beds unless they have a doctor's prescription for a medical condition such as psoriasis. Though the House Health committee agreed that such an instance was likely rare, they agreed on making just this one exception to the ban for minors. The committee heard testimony from the American Cancer Society, KMS and several physicians about the detrimental effects of ultraviolet radiation and the resulting increased occurrence of melanoma in a younger population set. Some members of the committee expressed reservations about imposing further business regulations rather than relying on parents to remain informed and restrict minors from accessing tanning facilities. Despite those objections, the bill was advanced from the committee to the full House for further debate.

As the session continues, KMS will remain focused on issues affecting the practice of medicine and safety of patients in Kansas. For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

"Turnaround" deadline approaches

columnsCommittees have until a week from tomorrow to hear and work bills before non-exempt bills will be subjected to the first legislative deadline, "turnaround." By the end of next week, non-exempt bills failing to have been advanced by a vote of the full House or Senate will be considered "dead" for the Session. As a result, this week will be full of hearings and committee action to determine the course of which issues will advance. Below is a summary of priority and emerging issues on which the Kansas Medical Society has taken a position.

The following issues are currently working through the Kansas Senate:

SB 311, which increases the cap on noneconomic damages by $100,000 over the next eight years, was favorably passed out of Senate Judiciary and now goes to the full Senate for consideration. KMS introduced this bill in response to the Kansas Supreme Court's 2012 ruling in Miller v. Johnson with the intention of preserving the integrity of the cap on noneconomic damages well into the future.

HB 2516, the Health Care Stabilization Fund bill which serves as a companion to the cap bill, was introduced by KMS to add three provider groups to the list of those purchasing professional liability insurance from the Fund and thereby receiving the protection of the cap on noneconomic damages. The bill was passed without opposition by the full House of Representatives and has now moved to the Senate, where it will be heard by the Financial Institutions and Insurance Committee this Wednesday.

SB 350 was introduced last week by the Chiropractor's Association to allow them, physicians assistants and APRNs to evaluate students after a sports related head injury and determine when the student can "return to play." Though these types of injuries are nothing new, they are becoming increasingly common and relevant medical information about their long term impact is growing. As research develops around these types of injuries children are sustaining, physicians are best equipped to determine a child's readiness to re-engage in regular and sport-related activity. Neither SB 350 or an identical bill, HB 2375, have yet been scheduled for a hearing; KMS opposes the proposal.

SB 251 would require insurers to provide an explanation of benefits to providers in "real time" via an electronic interface. KMS supports making information about out-of-pocket costs more readily available to providers in advance of service. As a growing number of individuals are moving to high deductible plans and are having to pay higher amounts for covered services, providers are seeing growth in their accounts receivable. SB 251 would allow interested practices with the necessary technology to make and receive electronic predetermination requests to help avoid this problem. The bill has been heard by Senate Insurance and is now being further considered by a subcommittee, but is expected to have a vote of the full committee later this week.

KMS appeared before the Senate Health committee last week to discuss SB 316, which amends the podiatry act to authorize podiatrists who have completed an accredited residency in foot and ankle surgery to perform surgery on the ankle. Under current Kansas law, podiatrists are limited to performing surgery on the foot and toes, and may not operate on the ankle. KMS is taking no position on SB 316 at this time, pending the results of a working group of orthopedic surgeons and podiatrists which has been meeting for the past few months. Although the group has not agreed on any legislation yet, a draft proposal is under consideration, and the group has agreed to continue working on the proposal which has been circulated.

Today, KMS will testify before Senate Public Health and Welfare in support of SB 317, which would establish prompt pay requirements for the managed care organizations contracting with KanCare, the state's medicaid program. The bill was introduced by the Kansas Hospital Association to make private payors contracting with the state subject to the same prompt pay rules as other private insurers. Under the bill, the MCOs would be given thirty days to pay clean claims, and ninety days to adjudicate all claims or be subject to a 12 percent annual late payment penalty.

Several issues are also working through the Kansas House of Representatives. Recent years have also brought several discussions and proposals to establish an apology law. The most recent version, HB 2523 would protect a physician's expression of sympathy in the event of an adverse or unanticipated outcome from being admitted as evidence in a court proceeding. KMS testified in support of the bill when it was heard in House Judiciary last week. Previous versions of this proposal would have allowed the presiding judge to determine whether the expression could be admitted into evidence after the fact. If physicians are to be encouraged to make sincere expressions of sympathy in the event of an adverse outcome, they must be assured their expressions will not be used against them. The bill has not yet been scheduled for a committee vote.

The House Judiciary committee held hearings on a related bill, HB 2376, when it considered the apology bill. HB 2376, which KMS opposed, would require providers to disclose to the patient any unanticipated or adverse outcome within seven days of the event. The bill also dictated how all subsequent conversations between patients and providers would be required to proceed. Though KMS supports informing patients about their care and disclosing unanticipated outcomes, mandating these conversations in this fashion is not the best approach. The number of providers participating in patient care, the required reporting timeline and the penalties for failure to disclose all create unworkable barriers to the implementation of this bill. It has not been scheduled for further action at this time.

KMS testified before the House Corrections and Juvenile Justice Committee in support of HB 2526, which would increase penalties for assault and aggravated battery on a health care provider. The bill was brought in response to the increased incidence of violence in health care facilities. According to the Bureau of Labor Statistics, the rate for violence against health care workers is more than triple the rate for all of private industry. For this reason, it is appropriate that those who would assault health care providers are penalized at the same level as those who assault law enforcement as stipulated in HB 2526. The bill will likely be voted on by the full committee this week.

HB 2685, identical to SB 326, was introduced last week by the APRN task force. These bills seek to dissolve the collaborative practice agreement and establish APRNs as primary care providers. The bills have been referred to Health committees in the House and Senate and neither chamber has scheduled hearings on the proposal as of yet. Though the APRNs continue to assert that they would like to practice to the full extent of their training, it is clear to many that this legislative proposal would allow them to practice far beyond their training. Rural access is often cited as the need for this bill despite the fact that Kansas law already allows for APRNs to practice quasi-independently anywhere they choose in the state, as long as they collaborate with a physician to ensure that patients are effectively diagnosed and treated. Five weeks into session, the arguments in favor of APRN independent practice are the same, but the pressure to consider their proposal increases with each additional bill introduced to force the subject. If you have no done so already, please contact your legislator today to discuss the benefits of collaborative practice and your opposition to these bills. As health care moves toward better integration of providers and a team-based approach, it would be counter-intuitive and unproductive to further fragment care as the APRNs have suggested. Thanks to the time you have spent communicating with your legislators, most of them understand that this bill simply goes too far to ensure the best care for patients. Legislative contact information can be found here.

Though these are some of the higher priority items for the Kansas Medical Society right now, there are several other relevant bills moving through the process. For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

KMS and KaMMCO partner to host ICD-10 education calls

The Kansas Medical Society, in collaboration with KaMMCO and the Missouri State Medical Association, is hosting an ICD-10 educational series by conference call. The remaining sessions will be from Noon-1pm on March 6 and March 13. Brenda Edwards, CPC with KaMMCO will discuss what you need to be doing in the months leading up to October when use of ICD-10 is mandated. Registration is not required. More information about this week's call can be found here.

KMS also has a number of ICD-10 resources available online to assist members or contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance with any questions.

Received eRx penalty in error? Request a review

Some practices report receiving a 2 percent e-prescribing penalty on their Medicare payments even though they successfully participated in the EHR incentive program and should be exempt from the penalty. If you are affected by this, you must request a review.

The deadline to submit these informal review requests is February 28, 2014. You must email them to This email address is being protected from spambots. You need JavaScript enabled to view it..gov.';document.getElementById('cloaka0098bced4f5a5e0aee16dc2a7715089').innerHTML += ''+addy_texta0098bced4f5a5e0aee16dc2a7715089+'<\/a>'; CMS is expected to make the review decision within 90-days of the original request. The decision will be final as there are no appeal rights. 

Instructions on how to submit an informal review request can be found at CMS’ 2014 eRx Payment Adjustment Informal Review Made Simple. Questions about the eRx incentive program may be directed to the CMS QualityNet Help Desk at: 866.288.8912 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it.

Major legislative deadline looms; important issues moving

columnsThis Friday marks "turnaround", the first major legislative deadline. Committees have just two more days to hold hearings and take action on non-exempt bills. The rest of the week, both the full House and Senate will take action on those bills which have passed out of committees. Non-exempt bills failing to pass out of the chamber where they were introduced by turnaround will be considered "dead" for the rest of the session.

We expect action on the following issues this week by the Senate and House, respectively:

SB 311, introduced by KMS in response to the recent Kansas Supreme Court decision. The bill would increase the cap on noneconomic damages by $100,000 over the next eight years, and will be considered by the full Senate mid-week. The bill was passed out of the Senate Judiciary committee without changes to the cap provision and has broad support from the Legislature. Many understand that by addressing the Court's concern about the adequacy of the cap this bill will preserve the cap's integrity well into the future. SB 311 is aimed at continuing to balance the rights of individuals with maintaining a stable malpractice climate for physicians.

HB 2526, which would increase penalties for assault and aggravated battery on health care providers will likely face a vote of the full House this week. The bill was brought in response to the increased incidence of violence in health care facilities and was passed out of the House Corrections committee with KMS support.

Potential committee action this week determines the fate of the following non-exempt bills:

HB 2552 establishes prompt pay requirements for managed care organizations contracting with the state on Medicaid services. The bill would require payment of clean claims in thirty days and the payment or denial of all claims within 90 days or subject the payor to a late payment penalty of 1 percent per month. KMS supports the measure to make private insurers contracting with the state through KanCare subject to requirements similar to those governing private, commercial lines of business. The bill has broad support and will likely be favorably passed out of committee this week.

HB 2673 addresses the Board of Healing Arts and the Physician Assistant Licensure Act. The bill modernizes language in the healing arts act and also includes language to allow the board of healing arts to develop rules and regulations about the appropriate number of physician assistants a physician may supervise in a variety of practice settings. KMS testified in support of the bill and expects committee action on the bill this week.

HB 2523 would protect a physician's expression of sympathy in the event of an adverse or unanticipated outcome from being admitted as evidence in a court proceeding. KMS testified in support of the bill when it was heard in House Judiciary two weeks ago. Previous versions of this proposal would have allowed the presiding judge to determine whether the expression could be admitted into evidence after the fact. If physicians are to be encouraged to make sincere expressions of sympathy in the event of an adverse outcome, they must be assured their expressions will not be used against them. The bill has not yet been scheduled for a committee vote. It must be acted upon today or Tuesday or be considered dead for the remainder of the session.

HB 2609 would allow for collaborative practice agreements between pharmacists and prescribers. The bill was heard in the House Health committee last week and could be voted out of committee and worked on the House floor in the coming week. Though many physicians are currently engaged in collaborative practice agreements with pharmacists, KMS has concerns about the bill's drafting and is seeking an amendment that would limit the agreements exclusively to physicians and pharmacists, rather than to mid-levels with prescribing abilities under physician supervision. Though collaborative practice agreements can streamline patient care and improve efficiency, diagnosis and treatment plans should be initiated by physicians with the appropriate training and experience.

Exempt Bills, Not Subject to the deadline:

SB 326, the APRN independent practice proposal will remain alive throughout the entire session. The bill must have hearings and receive favorable consideration by both the House and Senate to advance in the coming days. Hearings have not been scheduled and many legislators have expressed their desire for the APRN task force to meet with members of the Kansas Medical Society to discuss the bill's intent and to better address the practice limitations, if any, facing APRNs. Though the APRNs continue to push for a public forum to discuss their claims that allowing independent practice will improve rural patient's access to care, KMS has maintained that quality care is the primary concern that must be considered.

SB 350 would amend the School Sports Head Injury Prevention Act to allow chiropractors, physician assistants and advanced practice registered nurses to join physicians in making the call on "return to play" for students after an injury. Sports related head injuries and concussions have become increasingly common and the body of information about severity, diagnosis and long-term impact is growing rapidly. Students affected by head injuries may face future consequences and should be evaluated by those best equipped with the most recent relevant training and information. KMS opposes this bill which has not yet been scheduled for a hearing.

SB 251, which would require insurers to provide physicians with a real time explanation of benefits via an electronic interface prior to a patient procedure, has been sent to a subcommittee of Senate Insurance and Financial Institutions to further evaluate the cost to insurers and the demand and potential utilization from providers. KMS supports the bill's effort to equip providers with a good faith estimate of out-of-pocket patient costs.

SB 316 would allow certain board certified podiatrists to perform rearfoot and ankle surgery. KMS has been involved in discussions between the orthopaedic physicians and members of the podiatric society about the proposed language and the development of tiered licensure for podiatrists. If agreement is reached among all parties, the bill will likely advance.

By the end of the week, the turnaround deadline will have filtered out issues without legislative support and momentum and will focus the remaining weeks on those issues which have already passed the full House or Senate or those issues deemed important enough to exempt from regular deadlines. For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Medicare appeals backlog: more than 2 years

One of the biggest challenges facing practices is the increasing demand of audits which can result in entering the payers appeal process. It can be a daunting task, requiring production of medical records, often multiple times at various levels of appeal, meeting deadlines, filing a succession of appeals and tracking.

The Medicare program has five levels of appeals. The third level, Administrative Law Judge (ALJ) hearing, is experiencing a backlog of more than 2 years. The Office of Medicare Hearings and Appeals announced assignment for hearings could be delayed for up to 28 months, citing a 184 percent increase in claims and the expansion of Medicare’s audit programs. Because the Medicare contractors often get it wrong, the appeals process is of utmost importance. The most recent CMS report to Congress stated the 43.6 percent of provider-appealed RAC determinations are overturned. KMS, the American Medical Association and nearly 100 other physician organizations voiced concerns in a letter to OMHA calling for an immediate solution to the backlogs. Additional information about the Medicare appeals process can be found here.

If you have questions or concerns about the appeal process contact This email address is being protected from spambots. You need JavaScript enabled to view it. KMS Director of Health Care Finance.

"Turnaround" marks session midpoint

columnsFriday marked "turnaround," the deadline that is the halfway point in the legislative session. All bills must have passed their house of origin or have been "blessed" to remain alive for further legislative consideration.

Active Bills

SB 311, introduced by KMS to respond to the Miller v. Johnson case upholding the cap on non economic damages, passed the full Senate last week. The bill increases the $250,000 cap to $350,000 over eight years, to respond to the Court's warning that the cap could be invalidated in the future if it wasn't increased somewhat. Though an attempt was made to increase the cap to $500,000, the Senate forwarded the bill to the House without changes.

HB 2673 addresses the Board of Healing Arts and the Physician Assistant licensure act. The bill modernizes language in the healing arts act and also includes language to allow the board of healing arts to develop rules and regulations about the appropriate number of physician assistants a physician may supervise in a variety of practice settings. KMS testified in support of the measure which was passed out of committee and by the full House last week. The bill now moves to the Senate Health committee.

HB 2609 was introduced and heard very close to the deadline. The bill, as amended by the House Health committee, allows for collaborative practice agreements for drug therapy management between pharmacists and physicians. Though this is already allowed under existing law, the bill adds some implementing definitions and formalizes the structure of such arrangements. KMS offered several amendments to the bill which were adopted.

HB 2552 establishes prompt pay requirements for the three managed care organizations contracting with the state through KanCare. The bill, passed unanimously by the full House, would require payment of all clean claims within 30 days and payment or denial of all claims within 90 days. Failure to comply would carry at late payment penalty of 1 percent per month. The bill now moves to the Senate Health committee for consideration.

Blessed Bills

SB 316 allowing board certified podiatrists to perform ankle surgery was "blessed", exempting it from the turnaround deadline. KMS has been involved in discussions between the orthopedic physicians and members of the podiatric society, all of which agreed to the proposed language with amendments detailing the development of tiered licensure for podiatrists. The Senate Health committee plans to work the bill next week.

SB 251 requires insurers to provide a real-time explanation of benefits to providers via an electronic interface. The bill is aimed at providing an estimate of the patient's out of pocket costs to both patient and physician prior to medical care being rendered. The bill was sent to a subcommittee where potential costs to insurers of building the necessary framework and estimated provider utilization where further studied and discussed. KMS supported the legislation, so long as physicians would not be charged additional fees for accessing the information or required to purchase technology to do so. Because insurers projected multimillion dollar costs associated with implementing the necessary technology, the bill was sent back to the full committee with the recommendation for further study. The bill remains alive for the remainder of the session.

HB 2435 which would prohibit minors' access from tanning devices was not heard by the full House prior to the deadline. The measure was blessed and could be brought up for a vote at a later time.

HB 2526 which established higher penalties for assault and battery of a health care provider was also blessed. The bill was passed favorably out of committee but was not considered by the full House.

SB 326, the APRN independent practice bill, has not yet had a hearing. The bill remains alive the entire session. The APRNs have been very active, with an almost constant grassroots presence in the statehouse. Despite their desire for a hearing, legislators have asked that the APRNs meet with physicians and seek an agreement about appropriate scope of practice. KMS has agreed to begin meetings, perhaps beginning over the legislative break in April.

Measures failing to advance

HB 2523 prohibited any expression of sympathy or fault from a physician to a patient from being admissible as evidence in a future proceeding. KMS supported the bill as drafted on the premise that it would provide adequate assurance to physicians that their sincere expressions of sympathy would not be used against them in court. However, after lengthy discussion, the Judiciary Committee agreed that the issue was too confusing to be practical and the committee tabled the bill. Though the intent of the bill is good, it demonstrates that this is a difficult area to legislate in a meaningful, practical way.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

March madness hits the Statehouse

columnsFor college basketball fans, March promises the potential for greatness–hopes for championship titles and bragging rights along the way. For participants in the legislative process, a light at the end of the tunnel is starting to shine and there is palpable hope that in fact, the end is near.

Most committees must complete their work by this coming Friday, and the few "exempt" committees are given three additional days to consider bills before the Legislature's first adjournment. Though the deadlines are fast approaching, KMS' priorities are steadily progressing.

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KanCare health homes launch in July 2014

KDHE will launch a new Medicaid program, Health Homes, for beneficiaries who have certain chronic conditions on July 1, 2014. Health Homes provide coordination of physical and behavioral health care with long term services and support for people with chronic conditions. Health Homes expand upon medical home models to include links to community and social support. Health Homes focus on the whole person and all the patient's needs to manage their conditions and be as healthy as possible. All caregivers in a health home communicate with one another so that all of the patient's needs are addressed in a comprehensive manner. There will be two types of Health Homes servicing people with serious mental illness and people with asthma or diabetes, respectively.

Health Homes will be provided through a partnership among Lead Entities, the KanCare managed care organizations (MCO) and Health Homes Partners (HHP), community providers who meet certain requirements and contract with the MCOs. Some Health Homes services may be provided by the MCOs and some by the Health Homes Partner. The division of services, as well as payment between the MCO and the HHP, will be spelled out in contracts between the MCO and HHP. The state has not announced what the per-member per-month (PMPM) payment will be for the chronic conditions Health Home. Once they do, some physicians will begin to see contracts from the MCOs. As with any contract, KMS encourages you to review it carefully.

KDHE will be hosting webinars on the last two Tuesdays of every month until July from noon to 1:00 p.m. You may register by contacting Vanessa Lohf at 316.978.5380 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it.. KDHE will also be hosting regional meetings from April 2-9, 2014. Information about these events including registration can be found here.

New CMS-1500 claim form updated, use mandated

The CMS-1500 form has been updated and its use is mandated by April 1, 2014. You may begin using the form now, but beginning April 1, payers will no longer accept the old version. The revised CMS-1500 claim form, version 02/12, accommodates reporting needs for the ICD-10 code set and aligns with current standards for electronic health care transaction. See the CMS MLN Matters document for more information about using the revised form for Medicare claims.

The National Uniform Claim Committee, which maintains the CMS-1500 claim form has online instructions. Contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance with any questions or concerns.

KMS to consider changes to Annual Meeting, county societies

At the upcoming Annual Meeting, delegates will consider approving some changes to the KMS' Annual Meeting, the future of the House of Delegates, and our relationship with county medical societies. The recommendations are the work product of the Future Directions Task Force which has been working for the past two years to evaluate how to ensure KMS remains viable and relevant into the future. If adopted, the bylaws amendments would establish a new structure for the KMS Annual Meeting, vest policy-making authority with the Board of Trustees and clarify KMS' relationship with county medical societies. Members can access the task force's report here. If you have questions, please contact Allison Peterson at This email address is being protected from spambots. You need JavaScript enabled to view it. or 800.332.0156.

Congress acts to postpone Medicare pay cut, ICD-10

On March 27, the House of Representative passed H.R. 4302, The "Protecting Access to Medicare Act of 2014," postponing the 24 percent Medicare physician payment cut for 12 months. The Senate followed suit on March 31, passing H.R. 4302 and President Obama is expected to sign the legislation into law. This marks the17th time, Congress has applied a band-aid to the flawed Medicare Sustainable Growth Rate, kicking the issue to the next cliff of April 1, 2015.

Under the bill, the geographic adjustment (GPCI) "floor" of 1.0 for physician work in the Medicare fee schedule would be extended for 12 months. Also the secretary of HHS would have discretion to continue suspending recovery audit contractor post payment audits under the "2-Midnight" policy through June 2015.

Other provisions include:

  • Establishes targets of 0.5 percent in savings from "misvalued" physician payment schedule services from 2017 through 2020, for an estimated savings of $4 billion

  • Delay of ICD-10 implementation for at least one year

  • Creates new Medicare policies for clinical diagnostic laboratory tests

  • Puts in place "appropriate use" criteria for certain imaging services

CMS has ordered Medicare contractors like WPS to hold physicians' claims for 2 weeks after the April 1 deadline. The March 28 email notice stated the hold would only affect the 2014 Medicare Physician Fee Schedule claims with dates of service of April 1, 2014 and later, and "should have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt."

As previously reported, the CMS 1500 claim form has been updated to accommodate ICD-10 and CMS has mandated its use effective April 1, 2014. Given the recent legislative changes a number of KMS members have inquired about the potential delay of this. KMS has reached out to Senior CMS staff and they have indicated they will be getting instructions out soon.

Contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance with any questions or concerns.

Registration opens for 2014 KMS Annual Meeting

Join your colleagues from across the state for the 2014 KMS and KMS Alliance Annual Meeting being held at the DoubleTree Hotel in Overland Park on May 2-3. The KMS Future Directions Task Force has been working for the past several months in its review of the KMS Annual Meeting, House of Delegates and KMS' relationship with our county medical societies; the task force will present some of its recommendations to the House of Delegates. Additionally, members will have the opportunity to hear from Jay Kaplan, MD. Kaplan, a physician with the Studer Group, will share his perspectives on physician engagement and the importance of physician leadership.

Go to www.kmsonline.org for complete meeting details and to register for the meeting. Contact This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it. if you have questions.

Cast your vote today for KMS' next leaders

This year, for the first time in our history, all KMS members will have the opportunity to vote on the election of the physicians who will lead our organization. Previously, only those physicians who attended the House of Delegates meeting as a delegate had the opportunity to vote. We are excited about this change and look forward to enhanced member engagement in this most-important process.

Ballots for the 2014 KMS Board of Trustees election were mailed last month to all members. If you did not receive yours and have not cast your vote, we urge you to do so today. You may visit our website at www.kmsonline.org/election to learn about the candidates and to cast your vote electronically. If you have questions, contact Allison Peterson at This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at 800.332.0156.

Non-economic damages bill passes

columnsNearly two years ago the Kansas Supreme Court upheld the constitutionality of the $250,000 cap on non-economic damages. The cap is the cornerstone of Kansas' tort reform structure, and the main reason liability insurance costs for physicians have remained stable and favorable for many years. However, the Court's opinion contained a clear warning that the cap must be increased by the legislature to remain constitutionally adequate in the future. In order to preserve the cap, KMS introduced SB 311 to respond to the Court's opinion. The bill gradually increases the cap to $350,000 over an eight-year span.

Despite broad support for SB 311, a coalition of business groups led by the Kansas Chamber threatened to kill the bill unless it included a tort reform provision modifying a rule of evidence called the collateral source rule. This provision proved to be very controversial, and was rejected by the House of Representatives three times by very strong votes. Failing to convince the House to include the collateral source provision, the business groups then tried to kill the bill in the Senate, arguing that there wasn't any urgency to pass the bill.

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KMS task force meets with APRNs

Ten physicians representing KMS, the Kansas Academy of Family Physicians and the Kansas Association of Osteopathic Medicine met this week with a group of nurse practitioners that has introduced legislation to dissolve the APRN collaborative practice requirement to allow independent advanced practice nursing. The legislation, SB 326, has not been acted on by the legislature, but remains alive for consideration. The bill is based on a model developed by the National Council of State Boards of Nursing, and is part of a national effort to standardize and align states' regulation of nurse practitioners, around the core elements of independent practice and prescribing.

The group discussed the proposed legislation in detail, and heard from the APRNs about what they believed were deficiencies or problems with the current statutory and regulatory structure in Kansas. The group plans to continue the discussions this year and will focus much of the next meeting on learning more about the education, clinical training and certification processes for the four categories of nurse practitioners. For questions about the work of the task force, contact Rachelle Colombo (This email address is being protected from spambots. You need JavaScript enabled to view it.).

Registration still open for 2014 KMS Annual Meeting

Join your colleagues from across the state for the 2014 KMS Annual Meeting being held at the DoubleTree Hotel in Overland Park on May 2-3. A highlight of the meeting will be the Saturday luncheon sponsored by KaMMCO, where attendees will hear from nationally recognized speaker, Jay Kaplan, MD. Dr. Kaplan is an engaging speaker, very entertaining, with a timely message about physician leadership, service excellence and delivering high quality care in these changing times. The KMS House of Delegates will consider the second installment of comprehensive recommendations by the Future Directions Task Force on changing KMS' governance structure. In addition, the results of KMS' first-ever election of Trustees by the entire membership will be announced.

Go to www.kmsonline.org for complete meeting details and to register for the meeting. Contact This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it. if you have questions.

KMS election results announced; commendations adopted

Eplee JohnJohn Eplee MDIn addition to adopting significant changes to KMS' governance structure, attendees at the KMS Annual Meeting also heard the results of our first-ever membership-wide election for the Board of Trustees. More than 1400 physicians cast ballots to elect the officers and other trustees on the 2014-2015 Board. John Eplee, MD (Family Medicine-Atchison) was elected President and Jay Gilbaugh, MD (Urology-Wichita) will serve as President-elect. Other members of the Board include:

Immediate Past President: Michael Machen, MD (Family Medicine-Quinter)
Central District Trustee I: LaDona Schmidt, MD (Family Medicine-Salina)
Central District Trustee II: Jennifer Koontz, MD (Sports Medicine-Newton)
Eastern District Trustee I: Jim Longabaugh, DO (Family Medicine-Sabetha)
Eastern District Trustee II: Jim Barnett, MD (Internal Medicine-Topeka)
Western District Trustee I: Lynn Fisher, MD (Family Medicine-Plainville)
Western District Trustee II: Jim Zauche, MD (Pediatrics-Garden City)
Wichita District Trustee: Joe Davison, MD (Family Medicine-Wichita)
Kansas City District Trustee: Mark Brady, MD (Anesthesiology-Kansas City)
Chair, KMS Legislative Committee: Kevin Hoppock, MD (Family Medicine-Wichita)
Chair, KaMMCO: Don Hatton, MD (Internal Medicine-Lawrence)
Chair, Annual Members Meeting: Lambert Wu, MD (Cardiology-Topeka)
Vice Chair, Annual Members Meeting: Steen Mortensen, MD (Rheumatology-Wichita)
AMA Delegate: Terry Poling, MD (Family Medicine-Wichita)
AMA Delegate: Art Snow, MD (Family Medicine-Shawnee Mission)
AMA Delegate: Richard Warner, MD (Psychiatry-Shawnee Mission)
AMA Alternate Delegate: Rob Gibbs, MD (Radiology-Parsons)
Gleason Fellow: Aron Fast, MD (Family Medicine-Hesston)
EVC, KUMC: Doug Girod, MD (Otolaryngology-Kansas City)

The delegates also adopted several resolutions of commendation including resolutions recognizing KaMMCO's 25th anniversary, Carolyn Gaughan for her 25 years of service to the Kansas Academy of Family Physicians, Gary Caruthers, KMS Director of Administrative Services, for his retirement after 39 years of service and other employment milestones for KMS staff.

Physicians targeted in IRS scam

There have been a number of reports nationally, regarding physicians who have been the victim of tax refund identity fraud for this year's tax filing period. Several associations report that the fraudulent federal income tax returns have been filed using physician names, addresses and social security numbers. In some cases the fraudulent tax return includes the name of an unknown person listed as the physician's spouse. Those affected are likely to learn of the scam by receiving a 5071C letter from the IRS alerting them of possible fraud. Physicians may also have received a rejection notification when attempting to electronically file their taxes because a return has already been filed using that social security number.

The FBI is working to identify how the intrusion occurred, the IRS is working to identify perpetrators through the financials process and the United States Secret Service is the lead investigating agency. At this time, the Secret Service is encouraging physicians to go to www.experian.com/fraud and place themselves on a 90-day credit fraud alert. This could potentially slow or halt further attempted identity theft activities. This is only suggested out of caution as we have no reason to believe that every physician is at risk. Experian will feed this information and fraud alerts to the other two credit reporting agencies. If you remain concerned, you may go back to that same website after 89 days to initiate subsequent 90-day credit fraud alerts.

KMS has not received reports from members affected by this scam. If you are a victim of this scam, please notify This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance. Below are additional recommendations:

  • IRS – If you received an IRS 5071C letter it provides instructions about contacting the IRS through its identity theft website guide or by phone at 800.830.5084
  • Federal Trade Commission (FTC) – File a complaint with the FTC here.
  • Police report – Consider filing a report with the local police where you reside. This will likely be necessary if there is a financial account as a result of the identity theft.
  • Social Security – Call the Social Security Administration's fraud hotline at 800.269.0271
  • Contact a fraud unit at one of the three credit bureaus: Equifax, Transunion, Experian
  • Office of the Kansas Attorney General website has a list of resources
  • If you have not received a notification from the IRS and are concerned about whether you may have been victimized, call the IRS Identity Protection Specialized Unit at 800.908.4490

Additional information about this scam can be found here.

Legislature approves key issues for medicine

After 79 legislative days, the Kansas Legislature has officially adjourned, marking this as the shortest session in 40 years. But before adjourning and kicking off campaign season for statewide office-holders and members of the Kansas House, the legislature and Governor approved several key issues of critical importance for Kansas physicians.

On April 17, Governor Sam Brownback signed into law SB 311, introduced by KMS to respond to the Supreme Court's ruling on the cap on non-economic damages. The bill addresses the Court's warning that the cap's future constitutionality hinged on the legislature's willingness to increase the limit on these "pain and suffering" damages awarded to plaintiffs. Since its enactment in 1988, the cap has remained at $250,000. SB 311 moves the cap to $300,000 this year and then adjusts it two more times in the coming eight years, bringing it to $350,000 in the year 2022. As a general rule, the legislature is very resistant to being forced to act by the Court, and physicians are understandably wary about even modest increases to professional liability premiums. But the importance of the cap and its impact on our malpractice environment is so great, that failing to act would have most certainly risked losing the cap altogether. The passage of SB 311 ensures the next generation of Kansas physicians will have the benefit of practicing with a cap in place, securing a stable tort environment for the foreseeable future.

HB 2516, the Health Care Stabilization Fund bill which serves as a companion to the cap bill, was introduced by KMS to add three provider groups to the list of those purchasing professional liability insurance from the Fund and thereby receiving the protection of the cap on non-economic damages. The bill also amended the KaMMCO enabling statutes to make it clear that any change in control of the company, such as sale or merger, also requires the approval of the sponsoring organization's (KMS) Board of Trustees. It was passed without opposition by the full House of Representatives and the Senate and was also signed by the Governor.

The legislature also took action on HB 2673, which addresses the Board of Healing Arts and the Physician Assistant Licensure Act. The bill modernizes language in the Healing Arts Act and also includes language to allow the board of healing arts to develop rules and regulations about the appropriate number of physician assistants a physician may supervise in a variety of practice settings. KMS testified in support of the bill, which passed both the House and Senate and was amended in conference committee to include KMS-supported provisions from SB 316. The amended language from SB 316 authorizes podiatrists who have completed an accredited three-year residency in foot and ankle surgery to perform surgery on the ankle. Under current Kansas law, podiatrists are limited to performing surgery on the foot and toes and may not operate on the ankle. The legislation was the culmination of a working group of KMS, the Kansas Orthopaedic Society and several podiatrists that worked together to craft this proposal. The bill passed both chambers in its final form, providing modernization and uniformity for the healing arts act and agreed upon changes to the physicians assistant and podiatry practice acts.

These three pieces of legislation in particular were carefully crafted and designed to responsibly address important issues affecting the practice of medicine. Proposals for mandatory disclosure of unanticipated clinical outcomes that would weaken our tort environment and broad initiatives allowing APRNs to practice medicine as primary care providers were aggressively pushed, but did not advance over KMS' objections.

Another bill that was presented to the legislature clarifies that pharmacists and physicians may develop collaborative practice agreements for drug therapy management. HB 2609 largely codified current practice but also more clearly defined the limitations of drug therapy management and the parameters of collaborative pharmacy practice agreements. Additionally, at the request of KMS, the bill was amended to include language establishing a joint advisory committee to promote consistent regulations and enhance coordination between the Board of Pharmacy and the Kansas Board of Healing Arts. If you would be interested in serving on this committee, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Though the summer and fall elections will likely yield many new faces in Topeka, several of the issues before the 2015 legislature are sure to be familiar. But for now, the legislature has adjourned, and the work of 2014 has been decidedly responsible and respectful of the vital leadership role Kansas physicians play in providing the highest quality care for patients.

For more information about legislative matters, please contact Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Historic governance change adopted by KMS

At the KMS annual meeting on May 3, delegates overwhelmingly approved a plan to eliminate the House of Delegates and consolidate policy-making with the newly restructured Board of Trustees. The change was recommended by the 20-member Future Directions Task Force, which has been working for over two years to ensure KMS remains a viable and relevant advocate for physicians into the future. KMS becomes the fourteenth state to eliminate its House of Delegates structure in recent years.

The action this year follows several changes adopted in 2013 which restructured KMS' governing board, and allowed direct election of trustees by the membership for the first time in the organization's history. Eight new trustees representing the three KMS districts were elected this year, with over 1400 members casting ballots.

The task force will conclude its work later this year, once it completes a complete comprehensive revision of the Bylaws necessitated by the recent governance changes, and studies issues related to membership categories and dues costs. If you have any questions about the new governance model or other changes adopted, please contact This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it..

Open payments data: register by July 1

Starting June 1, physicians may register to review and potentially dispute their data reported by manufacturers of drugs and medical devices under Open Payments, previously known as the Sunshine Act. CMS has indicated that physicians will be able to review disclosure data sometime in July. You will have 45-days to review and dispute the data.

Open Payments is a federal transparency program enacted by Congress in 2010. Under this program, CMS collects and publicly reports data about payments ("transfers of value"), ownership, or investment interests between drug and device manufacturers and physicians. CMS will collect this data annually from the industry and make it publicly available. CMS plans to release the data to the public by September 30, 2014. If you would like to review and potentially dispute any reported data you must complete the two-phase registration process with CMS to access their data. The two-step registration process requires you to first register in June for CMS' Enterprise Portal, then in July for the agency's Open Payments system.

The AMA has created an online "Physician Sunshine Action Tool Kit" that provides a variety of resources for physicians to help navigate the Sunshine Act changes. Additional information about this program can be found at the CMS' Open Payments Physician website and a fact sheet is also available.

Contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance with any questions or concerns.

Certifying Medicare home health

Beginning July 1, 2014, the certifying physician reported on a Medicare home health agency (HHA) claim must be enrolled in Medicare. If not, the claim will be denied under Medicare's ordering and referring edits.

Historically, these edits have applied only to the attending physician on a HHA claims. For health home episodes that begin on or after July 1, 2014, the certifying physician and the attending physician must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System, or have validly opted out, as of the date of service. According to CMS instruction if the certifying and attending physicians are different, both physicians are subject to the ordering and referring denial edits. If they are the same, the edits will only be applied to the "Attending" field.

You can verify if a physician is listed in PECOS here. Additional information about this change can be found in CMS MLN Matters SE 1413 and MLN Matters 8441. Contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance, if you have questions.

KaMMCO celebrates 25 years of service, advocacy

kammco logoIt was in the depths of the decade-long medical malpractice crisis that the KMS House of Delegates made the decision to form a professional liability insurance company to ensure that Kansas physicians would always have a trusted source of insurance protection. Twenty-five years later, that company has established itself as the market leader in our state, known for its strengths in advocacy, protection and service to its member physicians. It has also been recognized as one of the best run and innovative professional liability insurers in the nation, consistently ranked as a best-in-class performer among its peers.

As the health care system changes, KaMMCO will continue to evolve to meet the changing insurance needs of its members. It will be at the forefront with products and services that help the provider community manage risk in an uncertain world. Even as the health care landscape changes, KaMMCO will remain focused and true to its core mission of protection, advocacy and service to physicians.

KMS is extremely proud of KaMMCO's record of achievement since its founding in 1989. We are grateful to the loyal and highly competent staff, and the many physician leaders who have served as directors, officers and committee members over the years. Their support, leadership and vision have been instrumental to KaMMCO's remarkable growth and success.

Meaningful use deadline: July 1

Physicians who are not participating in the Medicare electronic health records (EHR) incentive program, also known as meaningful use, will see a reduction in Medicare reimbursement starting January 1, 2015. In 2015, the reduction will start increasing by 1 percent every year until it reaches 5 percent.

Physicians who wish to stave off next year's financial penalties for not meeting electronic health record (EHR) meaningful use requirements have until July 1 to apply for a hardship exemption. The AMA offers a new tip sheet (AMA login required) to help physicians avoid the 2015 penalty. Please note that even if physicians don't fit neatly into one of the hardship categories, the AMA strongly recommends that they file for the vendor category CMS has termed "Lack of control over the availability of Certified EHR Technology," which may be broadly interpreted. Physicians who are attempting to attest and are concerned they won't be successful are also urged to file for a hardship exemption under the vendor software category.

Additional information about the EHR incentive program including the latest news and updates may be found here. If you have questions or concerns about the EHR program, you may contact Ruth Cornwall, KMS Director of Health Care Finance.

BOHA: MD renewal cycle ends June 30

The Kansas State Board of Healing Arts reminds physicians that June 30 is end of the license renewal cycle. Physicians are encouraged to renew their license online at www.ksbha.org. The web-based system being utilized for this year's renewal cycle is different from that used in past years, so members are encouraged to read all directions before populating the form. Physicians may still choose to renew by paper and may access all necessary forms at the Board's website.

KanCare continues to make progress

It's been eighteen months since the transition to KanCare began, and as expected, there have been some problems with the implementation. For some, the initial pains of the transition have been ironed out while a number of others report ongoing issues. The majority of concerns reported by KMS members are getting claims paid correctly and the additional administrative burden in dealing with the complexities of the program. The MCOs may get an issue resolved but it could be several months before historical claims are reprocessed.

According to information in the first Annual Report on KanCare, the MCOs report losses. It's not clear exactly how much each MCO lost but reports filed with the National Association of Insurance Commissioners show a collective net operating loss of more than $110 million. Each plan's parent company contributed adequate capital to ensure they met or exceeded capital requirements as outlined in the Kansas solvency statutes. The report shows UHC having the most providers in network at; 18,010. Amerigroup 17,352 and Sunflower with 15,404. The number of children enrolled increased nearly 4 percent during 2013. The state reports the program saved an estimated $200 million, federal and state dollars combined.

The state continues to work with and monitor the MCOs. A legislative oversight committee is also engaged and heard from a number of providers at its recent meeting. The Kansas Health Institute published an article about the meeting and may be found here.

There's no doubt that the MCOs continue to experience issues - some more than others. But there have been some improvements. Sunflower has brought in additional staff to help with the work load. Amerigroup continues to work to reduce their issues and UHC has provided some much needed relief for its participating providers by removing their prior authorization requirement for PT, OT, speech, high tech radiology (MRI and MRAs). The requirements were not providing the intended benefit for UHC members, and relaxing these requirements would result in less work for providers. UHC has indicated there are no plans to reinstate these requirements and expects the change to be permanent. They will however, continue to monitor utilization to look for outliers or issues, and will address concerns as they arise. Clearly, this was the right thing to do, and hopefully the other MCOs will follow their lead.

The KMAP website has a KanCare Open Claims Resolution Log and may be accessed here. KMS will continue to work with the MCOs and you are encouraged to contact This email address is being protected from spambots. You need JavaScript enabled to view it., Director of Health Care Finance if you are experiencing issues.

BCBS announces contract changes for 2015

BCBSKSBlue Cross Blue Shield of Kansas (BCBSKS) recently mailed their Competitive Allowance Program (CAP) changes for 2015 to contracting providers. The document provides notice of changes to reimbursement or Maximum Allowance Payment (MAP) and policies for the upcoming year. KMS encourages its members to carefully review this and all contracts.

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CMS announces new ICD-10 compliance date

CMS has issued its final rule officially setting the ICD-10 compliance date for October 1, 2015 for providers, health plans, and health care clearinghouses to transition to ICD-10. Congress forced the one-year delay when it passed H.R. 4302 "Protecting Access to Medicare Act of 2014" in March. President Obama signed the bill April 1.

CMS encourages providers to continue their initiatives to ensure they are prepared to transition to ICD-10 by the compliance date. CMS, in a related article, indicated they plan to offer three separate end-to-end testing opportunities in 2015. This testing will be open to only 2,550 providers, suppliers and other voluntary submitters.

Additional information about ICD-10 can be found at the following websites: CMS, AAPC, AMA.

Deadline nears for PQRS group registration

Group practices, those of two or more, have until September 30, 2014 to register for the group practice reporting option or GPRO. Solo physicians and group practices that plan to report individually don't need to sign-up or register; they simply report their PQRS data via one of the available methods as outlined on the CMS website.

Under the GPRO option, practices may report one set of quality measures on behalf of all physicians in the group rather than reporting each individual physician. There's also a potential for earning a larger incentive.

Group practices participating in the GPRO that satisfactorily report data on PQRS measures during the 2014 reporting period (January 1- December 31) are eligible to earn the 0.5 percent incentive payment and will avoid the -2 percent 2016 PQRS payment adjustment.

Additional information regarding CMS PQRS, Value-Based Payment Modifier, is available online or members may contact Ruth Cornwall, KMS Director of Health Care Finance at 785.235.2383 with any questions.

Keeping the practice of medicine in physician hands

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

For the past several years, various non-physician practitioners across the country have pushed legislation to expand their scope of practice. Kansas APRNs have gone a step further, seeking to abolish all legal limitations on their scope of practice, and any requirements to collaborate with a supervising physician. APRNs wanting authority to practice independently as primary care providers argue that the collaborative practice agreement is meaningless and that supervision is both non-existent and unnecessary.

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Kansas work comp to adopt AMA guides

Effective January 1, 2015, the Kansas workers' compensation program will adopt the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. The AMA Guides, as it's often referred to, were adopted by the 2013 legislature  to be used for the impairment of injuries that happen on or after January 1, 2015. The Kansas Department of Labor Division of Workers Compensation will be hosting a workers' compensation seminar, where there will be additional information about the Guides. Registration is required, and space is limited.

KaMMCO announces loyalty award program

kammco logoIn conjunction with the KaMMCO 25th Anniversary, the KaMMCO Board of Directors wishes to acknowledge the commitment of members who have remained loyal over the years by way of establishing the KaMMCO Loyalty Award. Recognizing and rewarding loyal members is not only a sound business decision, which encourages continued loyalty and member retention, it also recognizes the contribution KaMMCO members have made to the financial success of their mutual insurance company.

The Board has authorized the inaugural KaMMCO Loyalty Award be paid in 2014 as a one-time, 20-year look back payment. This payment will be made to eligible members based upon years of continuous membership, determined as of June 26, 2014. Then, beginning with the January 1, 2015 renewals, eligible KaMMCO members will receive $500 for each five-year increment of continuous membership with the company. In accordance with the program as established by the KaMMCO Board of Directors, an eligible member must be insured by KaMMCO and be an active or affiliate member of the Kansas Medical Society or the Kansas Hospital Association.

To view the company announcement, CLICK HERE or visit www.KaMMCO.com/KaMMCOLoyaltyAward for full program details.

Please call 800.232.2259 and ask to speak to the Underwriting department if you have questions.

Wrap-up of 2014 elections & legislative preview

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

Pollsters, politicos, candidates, campaigners and everyday citizens had one thing in common this election cycle: no one could predict the final outcome and everyone wanted the cycle to end. In a deeply red state that boasts solid Republican registration, no one expected races for the Governor and one of the state's U.S. Senate seats to be competitive. Though Governor Brownback and Senator Roberts faced challenges based on wholly different issues, pre-election polling suggested that both would have difficult campaigns, and neither was assured of a victory. But, even as their opponents surged in Kansas polls, a different tone was affecting races nationwide – one that reflected the President's remarks that though he was not on the ballot, his policies were, and that this midterm election would be in essence a referendum on those policies.

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