Feb. 19, 2015
National UpdateCongressional committee hearing examines ICD-10 implementation
The AMA outlined its concerns with implementing the ICD-10 code set, to be implemented Oct. 1, during a Feb. 11 hearing held by the House Energy & Commerce Subcommittee on Health.
At the hearing, titled "Examining ICD-10 Implementation," the AMA submitted a statement for the record (log in) listing concerns with the new diagnosis code set, including:
- The Centers for Medicare & Medicaid Services' (CMS) and the industry's preparedness to fully process claims
- The potential disruption in reporting data quality programs
- The need for risk mitigation strategies to protect physicians against implementation challenges
Several members of the subcommittee articulated their opposition to further delays in ICD-10 implementation. However, some members expressed reservations with CMS' preparedness and strongly urged thorough end-to-end testing prior to the Oct. 1 implementation deadline.ONC responds to AMA advocacy on EHR certification
Due to continued pressure by the AMA, specialty societies and other stakeholders to improve electronic health records (EHR), the Office of the National Coordinator for Health Information Technology (ONC) held a recent multi-stakeholder workshop on improving the EHR certification process.
Currently, EHR certification focuses too closely on meaningful use measures and not on the needs of physicians and other health care professionals. In January, the AMA, along with 36 other organizations, sent ONC a sign-on letter (log in) outlining improvements to EHR certification, including the need to quickly adjust key aspects of the certification process to improve EHR usability, interoperability and patient safety.
Network adequacy protections in Medicare Advantage need to be strengthened, physicians told the Centers for Medicare & Medicaid Services (CMS) in a joint letter (log in) last week.
The AMA joined the American Academy of Dermatology Association and 26 other organizations in urging CMS to do more in providing potential and existing enrollees with adequate information to make decisions about Medicare Advantage plans. The groups asked the agency to fortify network adequacy and directory accuracy requirements when it issues its 2016 Call Letter, slated to be published in April.
The groups asked CMS to put policies in place to prevent no-cause terminations throughout the plan year and ensure that physician network directories are accurate, up-to-date and provide the information that patients need to make informed choices during the annual open enrollment period.
In addition, the groups recommended:
- Policies to address continuity of care when plans narrow their networks
- Certification of network adequacy for the remaining network, prior to execution of network narrowing plans
- Better patient notification
- Retrospective analysis of previous network narrowing to determine if they had a disproportionate impact on older and sicker patient populations
More supportive and flexible policies for accountable care organizations (ACO) would encourage more physician participation, the AMA and other health care organizations told the Centers for Medicare & Medicaid Services (CMS) earlier this month.
The AMA, the National Association of Accountable Care Organizations and other organizations collaborated to develop a joint response and recommendations (log in) after CMS issued proposed regulations on the future of the Medicare ACO program. Unlike the demonstration projects on new payment models, the ACO program is a permanent part of Medicare, and in just its first three years, has already grown to be half the size of the Medicare Advantage program.
To continue this growth and help ACOs succeed over the long term, the groups recommend that CMS:
- Provide options to give ACOs more predictability in their patient populations and budgets
- Offer an array of savings and loss percentages
- Provide flexibility for specialist physicians who want to participate in more than one ACO and allow physicians to choose, on an individual basis, whether or not to have their primary care services included in ACO patient assignments
- Reward ACOs that improve quality performance
- Waive certain Medicare policies to eliminate barriers to care coordination
Read more at AMA Wire®.AMA to FDA: New proposal would stifle innovation
A new proposal from the Food and Drug Administration (FDA) to impose a regulatory framework for laboratory-developed testing services and procedures would hinder medical innovation and result in reduced patient access to essential testing services and procedures, the AMA told the agency.
The FDA last year proposed a risk-based, phased-in approach to regulating laboratory-developed tests, which are services and procedures that represent the majority of advanced laboratory tests used in patient care. This is a critical part of the practice of medicine supporting physician diagnosis and prognosis and guiding treatment options for patients, the AMA said in comments (log in) to the FDA. Laboratory-developed testing services and procedures are already performed under conditions regulated by an interlocking framework of federal laws, state laws and peer-review deemed authorities, which has allowed for accurate and reliable test design, development and performance to meet patient needs.
If the proposed FDA framework is finalized, physicians will not be able to offer or discuss alternative testing services, also known as off-label use, that often reflect more recent advancements in medical knowledge than commercial, pre-packaged test kits. This could reduce physicians' ability to provide high-quality, personalized care. Further, the framework would increase administrative costs for physicians and clinical laboratories, potentially forcing them to limit the number of testing services and procedures they are able to offer.
Read more about the changes the AMA proposed to the FDA's framework.
Issue SpotlightPrescription drug misuse focus turning toward treatment
At least three-quarters of states are expected to introduce legislation this year related to prescription drug misuse, diversion, overdose and death – with an increased focus on treatment and prevention, signaling an issue that is at the forefront for both lawmakers and patients across the country. Here are four facets of the issue that are being addressed in 2015.
The U.S. Centers for Disease Control and Prevention (CDC) reports that deaths involving prescription opioids remain unacceptably high, at more than 16,000 lives lost each year. At the same time, there has been a substantial increase in deaths from heroin. The CDC recently reported that 8,257 people died of heroin-related deaths in 2013—a 39 percent increase from 5,925 deaths in 2012.
These numbers point to the need for informed and focused state and federal efforts to save lives, including:
Increased access to naloxone. Making the opioid overdose-reversal drug naloxone available to first responders and others is a 2015 legislative priority for at least 20 states. Naloxone helps save lives from overdose of opioids, whether a prescription opioid or heroin.
As an early adopter of efforts to expand access to naloxone, Colorado is now seeking to enhance its overdose prevention efforts with "Good Samaritan" provisions that allow others to aid an overdose victim without the fear of being arrested. Colorado's bill would make naloxone available to a family member, friend or other person in a position to assist an individual at risk of experiencing an opioid-related overdose. Other states, including Nevada, North Dakota, South Carolina and Tennessee, also are working to enact legislation focused on saving lives from overdose.
In 2015, the AMA is working to get meaningful naloxone access and Good Samaritan legislation in all 50 states.
Expanding efforts across organizations. As a founding member of the Alliance to Prevent the Abuse of Medicines, the AMA is working with other key industries across the supply chain to address critical issues related to the diversion of prescription drugs, from manufacturing and distribution to coverage and dispensing. This alliance results in a unique and comprehensive perspective to address this epidemic.
Federal efforts to expand treatment. Taking on the prescription drug epidemic isn't just a problem for states. Federal legislation, such as the Recovery Enhancement for Addition Treatment Act (TREAT Act) could expand treatment for opioid addiction. The TREAT Act would increase the number of patients that doctors can prescribe treatment for and would allow certain nurse practitioners and physician assistants to treat patients with substance use disorders by providing access to medication-assisted treatments such as buprenorphine.
Progress was made last year on the state and federal levels. Michael Botticelli, director of the Office of National Drug Control Policy, addressed physicians at the AMA State Legislative Strategy Conference in January, stating that "science and data must guide our work to support all our efforts." The White House also hosted a national summit last June to discuss federal, state and community responses to prescription drug misuse and deaths from overdose, underscoring the enormity and importance of the problem.
Prescription drug monitoring programs (PDMP). Legislation in Missouri would establish a PDMP, making it the last state to enact such a program.
In a letter to the Missouri Legislature, the AMA stressed the importance of long-term, stable funding for the state's PDMP to make sure the program can be maintained and modernized.
"In rare instances when PDMPs have been adequately maintained and funded, are available at the point-of-care with up-to-date information, and integrated into physician workflow, the efficacy of PDMPs is remarkable," the letter said. "On the other hand, when PDMPs have not been adequately funded, states simply are left with outdated, inefficient databases that serve to frustrate the prescriber, dispenser and public health community."
"As the only state without a PDMP, Missouri has become a popular destination for doctor shoppers and pharmacy hoppers from all across the nation," said Missouri State Medical Association Executive Vice President Tom Holloway. "This is not just a criminal justice issue—it's a very serious public health issue. And it must be addressed. A PDMP alone is not the cure-all, but it has the potential to be a powerful tool to help physicians and other health care providers identify prescription drug abuse and diversion problems when they come calling."
Besides Missouri, 30 states will likely see efforts to improve their PDMPs this year.
Learn more at the AMA's Web page on combating prescription drug abuse and diversion.
State UpdateNew physician specialties added to AMA Health Workforce Mapper tool
A mapping tool from the AMA builds customized models that empower policymakers and physicians to make fact-based decisions about their state's health care workforce.
Eleven new specialties have just been added to the AMA's Health Workforce Mapper, which illustrates key geographic, patient population and health care workforce data. New specialties are in bold text, below:
- Addiction medicine
- Emergency physicians
- Family physicians
- General surgeons
- Internal medicine physicians
- Obstetricians and gynecologists
- Orthopaedic surgeons
- Pain medicine physicians
- Physical medicine and rehabilitation physicians
- Physician anesthesiologists
- Plastic surgeons
- Primary care physicians
For medical association advocacy staff, this tool provides visually persuasive data to inform policy and legislative decisions that ensure a proper workforce for our nation's patients. Established physicians and those in training can use the mapper to inform decisions about starting or expanding their practices based on access-to-care needs and other important factors.
A reduced view of this tool is open to anyone who wishes to view basic regional information and data about non-physicians. AMA members and select medical association staff get exclusive access (log in) to layered physician data that drills down to medical specialty and practice type and overlays the other mapping data for a complete picture of the selected location.
The AMA Health Workforce Mapper was developed in collaboration with the American Academy of Family Physicians' Robert Graham Center.
Attorneys from the AMA Advocacy Resource Center have begun a series of weekly state legislative conference calls to highlight key issues, explain the AMA's perspectives, share helpful resources and otherwise provide a forum where medical societies can discuss these issues with their colleagues and expert speakers.
Call topics this year have included telemedicine, biosimilars and immunizations. Future call topics will likely include prescription drug abuse and diversion, Medicaid and managed care contracting.
Information will be shared with medical societies in advance of each call. If you have an idea or issue that you would like to discuss, please email Daniel Blaney-Koen of the AMA.
At least 14 states are considering legislation that would authorize pharmacists to substitute "interchangeable" biologic products if a physician does not indicate a preference, and several more states will likely do so this year.
In Washington, for example, House Bill (H.B.) 1675, would, among other things, further strengthen existing Washington state law by ensuring that physicians retain the discretion to prescribe medications in their patients' best interests. Specifically, the AMA wrote in support (log in), "If the physician—based on medical research and his or her experience—prefers a specific biologic product for his or her patient, then the physician can help protect his or her patients by ensuring that the specific product is prescribed."
H.B. 1675, like most bills being considered this year, limits substitution to only those biologic products the Food and Drug Administration has determined are "interchangeable."
Judicial UpdateProtected patient information at stake in Florida case
Data collected in patient safety systems comes with confidentiality protections under the federal Patient Safety and Quality Improvement Act of 2005 (PSQIA). These protections encourage physicians to share patient safety information without fear of liability—but a Florida case could impede efforts to improve patient safety, jeopardizing these protections.
In Southern Baptist Hospital of Florida, Inc. v. Charles, a Florida court ordered a hospital to produce patient safety work product documents as part of litigation discovery, even though the state had not required these documents to be reported to it and the documents had been submitted to a PSO. This was notwithstanding the hospital's argument that the PSQIA protected the documents from discovery in litigation, and their production to the plaintiffs would undermine the efforts of physicians, government agencies and other health industry participants to improve patient safety.
The hospital has appealed the trial court ruling. The Litigation Center of the AMA and State Medical Societies and the Florida Medical Association earlier this month filed a friend-of-the-court brief in support of the hospital and the patient safety efforts encouraged under the PSQIA.
Read more at AMA Wire.
Other NewsVA program presents an opportunity for community-based physicians
After asking for physicians' help to enhance care for veterans last November, the U.S. Department of Veterans Affairs (VA) has released information for physicians interested in delivering care through the Veterans Choice Program.
A recently released VA fact sheet (log in) offers detailed guidance on how community-based physicians can partner with the VA to deliver care to our nation's disabled veterans. Dubbed the Veterans Choice Program, this new benefit was authorized by Congress as a short-term solution to the VA's workforce shortage and care delivery problems that were exposed last year.
AMA advocacy successfully influenced the legislative language to ensure that physicians in the private sector could provide care to veterans. Members of Health Net's or TriWest's PC3 provider networks are automatically eligible to deliver care through the Veterans Choice Program. More information about the Veterans Choice Program, including the eligibility criteria for veterans and how physicians can apply to deliver care, can be found on the AMA's Supporting Veteran Health Web page.
If a physician or group practice believes they received an incorrect payment penalty letter from the Centers for Medicare & Medicaid Services (CMS), they now have the ability to verify the information and request an informal review by utilizing a new Physician Quality Reporting System (PQRS) Look Up tool. Informal review requests for 2013 will be accepted through Feb. 28.
An informal review may be requested for any of the following reasons:
- A practice's PQRS feedback report indicates 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
- A practice received a notification in error from CMS indicating the physician or group practice 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.
AMPAC will host its 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.
Register to attend the National Summit on Health Care Price, Cost and Quality Transparency in Washington, D.C. The summit is sponsored by the Robert Wood Johnson Foundation and co-sponsored by the AMA. AMA members receive a registration discount (enter the discount code "CoSponsor"): $895 to attend in-person onsite and $495 to attend online via live and archived Internet video broadcast.
Apply today to participate in the AMPAC Campaign School in Arlington, Va.