Feb. 5, 2015
National UpdateRegulatory relief expected in 2015 with changes to meaningful use
The AMA continues aggressive advocacy with both the Obama administration and Congress to secure major changes to the meaningful use program that will make it more workable for physicians and reduce the level of administrative burdens. In response to this advocacy, the AMA is pleased to report that the administration, in an unusual move, announced in a blog post that it will make several changes to ease meaningful use requirements for 2015, including:
- Shortening the 2015 reporting period to 90 days to address provider concerns about their ability to fully deploy 2014 Edition software
- Realigning hospital reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and better align with other quality programs
- Modifying other aspects of the programs to match long-term goals, reduce complexity and lessen providers' reporting burden
This rulemaking is separate from the Stage 3 rules expected to be published in early March.
While the AMA looks forward to reviewing the new rules once published, physicians need to be aware of an approaching key deadline for the meaningful use program: Feb. 28 at 11:59 p.m. Eastern time is the last date to attest for a 90-day reporting period in 2014.
Note that even physicians who were unable to meet the Oct. 1, 2014, reporting deadline to avoid a penalty are still eligible to attest for an incentive for the last 90 days of 2014 if they do so by Feb. 28.
Physicians participating in the Medicaid meaningful use program should consult their state deadlines for attestation information. Physicians can use these resources from the Centers for Medicare & Medicaid Services (CMS) to help with their attestation:
- CMS Attestation System
- Stage 1 Eligible Professionals Meaningful Use Table of Contents (2014 definition)
- Stage 2 Eligible Professionals Meaningful Use Table of Contents
- 2014 Stage 1 Attestation User Guide for Eligible Professionals
- 2013 Stage 1 Attestation User Guide for Eligible Professionals
- Stage 2 Attestation User Guide for Eligible Professionals
- CEHRT Flexibility Attestation Guide
The AMA, along with 36 other physician groups, drafted and sent a letter (log in) to the Office of the National Coordinator for Health Information Technology (ONC) pertaining to some of the many issues surrounding electronic health records (EHR) and their certification. Certified EHRs are required for physicians to participate in the meaningful use program.
The usability, interoperability and safe use of EHRs can be improved in the short term while helping to guide further efforts by ONC and EHR vendors in the long term. The letter addresses three key issues:
- Usability. The method used to test EHR usability is underdeveloped, and testing often does not mimic real-world medical practice. More rigorous testing to include a variety of different scenarios, including test cases that represent the needs of medical specialists, would help to improve how the technology is used in real-life workflows.
- Interoperability. The act of two computers sending and receiving data does not constitute functional interoperability—the ability for information to be exchanged, incorporated and presented to a physician in a contextual and meaningful manner. Efforts should be placed on ensuring the necessary health information follows patients during transitions of care.
- Security. Protecting the privacy and security of patient information is crucial, yet current methods for accessing data, like passwords and tokens, are cumbersome and can still be compromised. Health IT regulators and EHR vendors should look toward advancements in consumer electronics and develop identification solutions to reduce many of the authentication difficulties medical professionals face.
For more information on the AMA's advocacy on health IT, visit the AMA website. You can also access the 166-page draft Interoperability Roadmap published by ONC on Jan. 30. The AMA will share more information shortly and seek feedback from the Federation. Comments are due to ONC on April 3.Administration's 2016 budget calls for SGR repeal, GME expansion
President Barack Obama released his 2016 budget this week, reiterating calls made in previous budgets to eliminate the sustainable growth rate (SGR).
The budget calls for "reforming Medicare physician payments in a manner consistent with the reforms included in recent bipartisan, bicameral legislation." The budget also repeats the call to create 13,000 graduate medical education residency slots over 10 years in primary care and other high-need specialties, as well as again recommending a reduction in Medicare indirect graduate medical education adjustments.
The budget calls for the Children's Health Insurance Program (CHIP) to be reauthorized for four years through FY 2019. It also provides for $99 million across various agencies within the U.S. Department of Health and Human Services to fight the misuse of prescription drugs and heroin—included in these funds is a proposal to increase funding for state prescription drug monitoring programs.
The budget as presented will not be enacted into law. Its significance lies primarily in highlighting the administration's spending priorities and in offering savings options that could be supported by the president if they were incorporated as budget offsets in other legislation.
The AMA submitted a letter (log in) on Jan. 16 in response to the House Energy & Commerce Committee's request for information on Medicare's graduate medical education (GME) financing system.
In an open letter to stakeholders, the Committee posed questions about the environment of the current GME program, alternative financing policies and how to ensure an adequate physician workforce across specialties and settings. The AMA recommended the following improvements to secure a more stable and effective program:
- Remove the existing arbitrary cap on publicly funded residency positions
- Increase the number of GME positions to address future physician workforce, regional, and specialty needs
- Promote educational experiences in the broadest possible range of educational settings, so that residents gain experience caring for patients in the settings where they will ultimately practice
- Actively explore additional sources of GME funding, including states and all-payer models, to ensure adequate and stable support for training programs
Read more at AMA Wire®.AMA sends letter of support on IPAB repeal legislation
New legislation that would repeal the Independent Payment Advisory Board (IPAB) has drawn support from the AMA and 35 Republican cosponsors.
The AMA expressed its support for the Protecting Seniors' Access to Medicare Act of 2015 (S. 141) in a Jan. 29 letter. The legislation was introduced by Sen. John Cornyn, R-Texas.
Rep. Phil Roe, MD, R-Tennessee, is expected to introduce the companion bill in the House of Representatives in the near future.
The IPAB is a panel that puts significant health care payment and policy decisions in the hands of an independent body of individuals with far too little accountability, and could adversely affect access to health care for patients. Patients and physicians are still struggling with the frequent threat of drastic cuts from the broken sustainable growth rate formula. The IPAB would be another arbitrary system that relies solely on payment cuts to reduce Medicare spending. The AMA looks forward to working with members of the House and Senate to secure passage of the legislation.
Issue SpotlightStates take up interstate compact to simplify medical licensure
Eleven states have introduced legislation to join an interstate compact designed to facilitate a speedier medical licensure process with fewer administrative burdens for physicians seeking licensure in multiple states.
Developed by the Federation of State Medical Boards (FSMB), the Interstate Medical Licensure Compact will make it easier for physicians to obtain licenses in multiple states while providing access to safe, quality care. The AMA endorsed the compact in November and created new policy to work with interested medical associations, the FSMB and other stakeholders to ensure expeditious adoption of the compact and the creation of an Interstate Medical Licensure Commission.
States began considering the compact for adoption in January, and already, legislators in 11 states—Iowa, Minnesota, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, Vermont, West Virginia and Wyoming—have introduced legislation to effectuate these states' participation in the compact. The AMA sent letters to lawmakers in Minnesota, Nebraska, South Dakota and Wyoming in support of the compact.
Meanwhile, one physician group has come out in opposition to the compact, claiming that it negatively affects maintenance of certification. In response, the FSMB released a fact sheet to refute the misleading claims.
"Participation in the proposed compact is totally optional, and is intended only for those physicians who wish to practice in multiple states and who want to avoid the process of applying for multiple state licenses one at a time," the FSMB said in a Jan. 30 press release. "The compact in no way changes the requirements for licensure for physicians seeking one license within a state or for those who choose to become licensed in multiple states through existing processes. The status quo remains, for any physician who wants to continue to use current licensing processes."
Last month, FSMB released a new map that highlights the growing support in state legislatures for the compact. The interactive map allows physicians to see if their state has introduced legislation to join the compact.
The compact is based on several key principles:
- The practice of medicine is defined as taking place where the patient receives care, requiring the physician to be licensed in that state and under the jurisdiction of that state's medical board. This tenet aligns with the principles for telemedicine that were developed by the AMA Council on Medical Service and adopted at the 2014 AMA Annual Meeting.
- Regulatory authority will remain with the participating state medical boards, rather than being delegated to an entity that would administer the compact.
- Participation in the compact is voluntary for both physicians and state boards of medicine.
Among states that adopt it, the compact would act as an independent law and as a contract among the states to help ensure ongoing cooperation and adaptation.
"The AMA has long supported reform of the state licensure process to reduce costs and expedite applications while protecting patient safety and promoting quality care," AMA President Robert M. Wah, MD, said in a September statement when FSMB introduced the compact. "State-based licensure is an important tenet of accountability, ensuring that physicians are qualified through the review of their education, training, character and professional and disciplinary histories. The interstate compact … aligns with our efforts to modernize state medical licensure, allowing for an expedited licensing pathway in participating states."
The AMA will continue to work with the FSMB and other stakeholders to advance this compact among interested states. Visit the AMA Web page on telemedicine for more information on the Interstate Medical Licensure Compact.
State UpdateIndiana to be 28th state to expand Medicaid
The U.S. Department of Health and Human Services on Jan. 27 approved Indiana's proposal to expand Medicaid eligibility using a demonstration waiver, potentially giving health coverage to an estimated 350,000 low-income residents of the state. In September, the AMA sent a letter to federal officials urging them to approve Indiana's plan.
Under the approved waiver, known as the Healthy Indiana Plan 2.0, newly eligible residents will be enrolled in high-deductible health plans paired with health savings accounts (HSA) that will be jointly funded by the state and the enrollee. Those with incomes above the federal poverty level must pay monthly premiums into HSAs, but otherwise have no copays except for non-emergent use of the emergency department. Enrollees below the federal poverty level may choose to pay premiums into HSAs or pay modest copays. The approved waiver also establishes a wellness incentive program that can offset premium costs and a voluntary work search program.
To date, 28 states and the District of Columbia have expanded Medicaid. Of those, Arkansas, Indiana, Iowa, Michigan, New Hampshire and Pennsylvania are using federal waivers to implement alternative models. Visit the Advocacy Resource Center Medicaid expansion campaign Web page for more information.
As part of a national trend to enhance overdose prevention efforts, more than 20 states are considering legislation to increase access to naloxone. The AMA is supporting many of these state efforts, including a recent bill in Mississippi, which allows for the prescription of naloxone to an individual patient at risk of experiencing an opioid-related overdose by a family member, friend or other individual in a position to assist the individual.
To further assist medical societies in their support of naloxone-related legislation, the AMA has developed a model bill and also a one-page issue brief for your use. Download the issue brief, "Enhancing access to naloxone" (log in) and send an email to Daniel Blaney-Koen of the AMA for a copy of the model bill.
Read the AMA letter of support for MS House Bill 692 (log in), the "Emergency Response and Overdose Prevention Act."
The AMA and California Medical Association (CMA) last week stated their general support for a proposed regulation in California that would establish stronger transparency, oversight and monitoring of provider networks and directories in California.
"The issue of adequacy and transparency in provider networks is a pressing one in almost every state in the nation, and one that needs immediate attention," wrote AMA Executive Vice President and CEO James L. Madara, MD.
"We support the commissioner's determination that an emergency exists with respect to those provisions aimed at enabling the department to monitor and enforce the network adequacy and directory accuracy of health insurers more effectively," the CMA said.
The AMA and CMA also highlighted areas where the proposed regulation could be further strengthened, including applying network adequacy standards to the lowest cost-sharing of tiered networks.
One area of CMA opposition involved a requirement that facilities disclose to patients any likely involvement from out-of-network physicians, as well as an estimate of charges, for an episode of care involving inpatient services. CMA believes the provision was outside of the asserted emergency basis and needed significant revisions to achieve the state's goals without disruption to California's health care delivery system.
On Feb. 3, the emergency regulations were finalized with no changes and made immediately effective. They will be in effect for 180 days, at which time the state can submit them for readoption (another 180 days) or go through the regular rulemaking process.
To obtain a copy of the letters, please contact Emily Carroll of the AMA or Brett Johnson of the CMA.
Other NewsProvide feedback on Physician Compare plans
The Centers for Medicare & Medicaid Services (CMS) is evaluating options for a publicly reported benchmark for the Physician Compare website. Physicians can weigh in on potential benchmarking methodologies on Feb. 18 and 19.
Per the 2015 Physician Fee Schedule Final Rule, the Physician Compare Support Team is facilitating outreach to discuss potential benchmarking methodologies with stakeholders prior to finalizing a future proposal. Comments to inform the 2016 Physician Fee Schedule Proposed Rule are due March 3 and can be submitted by emailing PhysicianCompare@Westat.com.
Six sessions to discuss potential benchmarking methodologies will be conducted via WebEx on Feb. 18 and 19. To register for a session, email PhysicianCompare@Westat.com, use the subject line "Physician Compare Benchmark Discussion Webinar" and include your name, organization, telephone number, email address, and preferred session in the body of the email. All sessions will present the same information and are scheduled as follows:
Session one: 11 a.m. Eastern time, 8 a.m. Pacific time
Session two: 2 p.m. Eastern time, 11 a.m. Pacific time
Session three: 5 p.m. Eastern time, 2 p.m. Pacific time
Session four: 10 a.m. Eastern time, 7 a.m. Pacific time
Session five: Noon Eastern time, 9 a.m. Pacific time
Session six: 4 p.m. Eastern time, 1 p.m. Pacific time
This week, the AMA Advocacy Resource Center (ARC) held its first 2015 call to highlight the key issues you are facing in state legislatures. This will be an opportunity for ARC attorneys and other advocacy staff to discuss the AMA's perspectives and policy on issues, share resources that may be useful and otherwise provide a forum where you can talk about these issues with your colleagues.
The first call, held today, focused on telemedicine. Additional topics will be announced each week, and if there are particular issues you would like to discuss, please send a note to Daniel Blaney-Koen of the AMA. Your active participation on these calls is welcomed and encouraged.
Apply today to attend the AMPAC Candidate Workshop in Arlington, Va. The workshop is currently full, but applications are being accepted on a wait list basis.
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.
- Allopathic, osteopathic GME programs move closer to alignment (log in)
- Motives behind resident transfers mostly unknown (log in)
- Top personal finance tips from experienced physicians (log in)