Jan. 22, 2015
National Update2013 PQRS informal review process open until Feb. 28
Physicians, designated support staff/vendors and group practices who submit data for the Physician Quality Reporting System (PQRS) can request an informal review of their PQRS reporting performance through the Centers for Medicare & Medicaid's (CMS) communication support Web page. Informal review requests for 2013 will be accepted through Feb. 28.
An informal review may be requested for the following reasons:
- A practice's PQRS feedback report reveals that the physician or group practice did not earn the PQRS incentive payment when they believe they should have
- A practice believes the PQRS payment amount was incorrect
- CMS incorrectly notifies a physician or group practice that it did not successfully participate in 2013 PQRS and will receive a 2015 PQRS payment adjustment
Learn more about PQRS on the AMA's PQRS Web page.Physicians weigh in on future direction of quality programs
Quality reporting measures should be more "high value," the AMA said in comments (log in) to a multi-stakeholder partnership that guides the U.S. Department of Health and Human Services on the selection of performance measures for federal health programs.
The National Quality Forum Measure Applications Partnership (MAP) also provides recommendations on the construct of the various Centers for Medicare & Medicaid Services (CMS) quality programs. In response to MAP's 2015 draft report, released in December, the AMA said more focus is needed on the challenges to moving to more "high value" measures, including the inability to capture certain patient reported or experience of care measures in the electronic health record (EHR) and poor EHR interoperability.
The AMA was encouraged by MAP's recommendation to offer steady financial support for measure development and the need to provide incentives to physicians so they can invest in the infrastructure needed to report their data and participate in various programs. Last year, the MAP classified many measures as "topped out" and recommended the need for a core set of measures, but did not take into consideration the implementation logistics and the challenges their recommendations are now posing for physicians who want to participate in the 2015 PQRS program.
State UpdateNorth Dakota focuses on overdose prevention efforts
In response to a growing awareness of the need to enhance overdose prevention efforts, North Dakota is one of the first states this year to introduce legislation to increase the availability of naloxone in North Dakota to prevent death from the overdose of opioids.
Senate Bill 2104 allows physicians to prescribe naloxone to an individual patient at risk of experiencing an opioid-related overdose, or to a family member, friend or other individual in a position to assist an individual at risk of experiencing an opioid-related overdose. The bill also includes common sense liability protections for health care professionals and individuals who seek to help another individual at risk for, or who is experiencing, an opioid overdose.
"We are strongly supporting this bill because it has a clear purpose in line with good medical practice," said North Dakota Medical Association President Steven P. Strinden, MD. "Put simply, this bill will help save lives."
The AMA sent a letter in support of S.B. 2014. About one-half of U.S. states now have laws similar to the provisions in S.B. 2104. The AMA will be advocating that all states have such a law by the end of 2015.
Nebraska and South Dakota physicians who wish to practice in multiple states could soon see a speedier process with fewer administrative and financial burdens as they pursue state medical licensure, thanks to two bills introduced in those states.
The model legislation for the interstate compact was developed by the Federation of State Medical Boards.
AMA Executive Vice President and CEO James L. Madara, MD, expressed the AMA's support for the compact in letters to Nebraska and South Dakota. "This expedited process will help facilitate license portability and allow physicians to practice medicine—including telemedicine—in a safe and accountable manner while protecting patients and expanding access to care," the letters said.
In November, the AMA House of Delegates adopted policy supporting the compact and directing the AMA to work with interested states to effectuate the compact.
Judicial UpdateSupreme Court considers Medicaid payment rate adequacy
Just weeks after Medicaid payment rates dropped for many primary care physicians, the Supreme Court of the United States is looking at this important aspect of ensuring vulnerable patients have access to care before their health deteriorates.
The nation's high court heard oral arguments this week in Armstrong v. Exceptional Child Center, weighing in on whether states must comply with the federal Medicaid Act's "equal access" provision that is intended to make sure physicians and other health care providers receive sufficient payment to provide care to low-income and disabled patients.
The Medicaid Act specifically requires states accepting federal funding for Medicaid to set payment rates that are "sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area."
But as the AMA and six other medical and dental associations pointed out in a friend-of-the-court brief (log in) filed Dec. 23, "because states often cut rates for purely budgetary reasons, they often do so without even considering the impact they will have on access to care."
In many states, Medicaid rates don't cover the average practice costs, so physicians are left to "pay out of pocket to treat Medicaid patients," the brief notes. Without the two-year bump in payment rates mandated by the Affordable Care Act, the average Medicaid payment was just 66 percent of the Medicare rates, according to the Kaiser Family Foundation Medicaid-to-Medicare fee index. Inadequate payments prevent physicians from taking on greater numbers of Medicaid patients.
The Government Accountability Office found in 2011 that about 80 percent of physicians accepted privately insured children as new patients, while less than 50 percent accepted children enrolled in Medicaid and the Children's Health Insurance Program. These numbers were only slightly better when looking at primary care in 2012 and 2013—84.7 percent for privately insured patients and 57.9 percent for Medicaid patients—as reported in a JAMA Internal Medicine study published in June.
Read more at AMA Wire®.
Other NewsTop tips for providing point-of-care pricing
The adoption of electronic health care eligibility standards and operating rules makes it possible for physicians to let patients know what their financial obligations for their medical care will be while they are in the office, making payment more convenient and transparent for patients. Get your practice off to a healthy start in the new year by using a free point-of-care pricing toolkit.
Make the most of the information that is available through electronic eligibility verification, including determining what your patients owe and receiving payment from patients at the time of service. This can reduce billing and backend costs for you while eliminating uncertainty for your patients and increasing patient satisfaction with their experience.
Read more at AMA Wire.
The AMA last week, along with several state and specialty medical societies, urged the National Association of Insurance Commissioners (NAIC) to focus on the need for quantitative standards to measure network adequacy, increase transparency in provider directories and provider selection standards, and require greater regulatory oversight and enforcement.
The comments, directed to the NAIC subgroup charged with making the revisions, are the most recent opportunity for organized medicine to influence the NAIC model network adequacy revision process. For many months, the AMA has been working closely with state medical societies who have regulators on the network adequacy subgroup to ensure coordination and cooperation.
In the coming months, the AMA will reach out to many more states to help ensure that regulators who sit on NAIC parent committees will have the benefit of hearing from organized medicine about the importance of strong network adequacy requirements. View all comments submitted to NAIC on this model bill.
Contact Emily Carroll or Daniel Blaney-Koen of the AMA for more information.
About 40 physicians and friends of medicine learned the fundamentals of modern advocacy techniques and political campaigns last week at an AMPAC Regional Campaign and Grassroots Seminar, the first of 2015, in Jefferson City, Missouri.
The seminar, held as part of the Missouri State Medical Association's (MSMA) Grassroots Advocacy Training Workshop, included AMA Immediate Past Chair David O. Barbe, MD, and MSMA President Jeffrey Copeland, MD.
The workshop coincided with the opening of Missouri's legislative session. MSMA is working in 2015 to make progress on priority items like restoring a cap on medical liability damage awards and a prescription drug monitoring program. Attendees got tips on making bigger impact as grassroots and campaign advocates and learned about the AMA's grassroots programs that enable physicians to get in direct contact with their federal representatives.
AMPAC's Regional Campaign and Grassroots Seminars, now in their 11th year, are a way to provide physician activists with training for both state and federal advocacy. If you have questions about holding a seminar in 2015, please contact Jim Wilson of the AMA.
Apply today to attend the AMPAC Candidate Workshop in Arlington, Va.
The 2015 AMA National Advocacy Conference will take place in Washington, D.C. Attendees will hear from Department of Health and Human Services Secretary Sylvia Burwell, members of Congress, political insiders and health sector experts regarding current efforts in health system reform. Come share your thoughts and take part in discussions that will help shape the future of the AMA's advocacy efforts and its work to improve the health of the nation. Register now.
Apply today to participate in the AMPAC Campaign School in Arlington, Va.
News You Can Use
Following is suggested content to use in your association's communication vehicles beginning in January. Please email Terri Marchiori of the AMA to let us know if you're placing this material, your distribution channels, the response from your members and any other metrics, such as audience reach.
- How many hours are in the average physician workweek? (log in)
- How to teach medical students to "feel" like physicians (log in)
- 4 tips for patients securing health insurance for 2015 (log in)