March 5, 2015
National UpdateAMA sees promise in congressional 21st Century Cures initiative
A draft proposal by the U.S. House of Representatives Energy and Commerce Committee seeks to improve the discovery, development and delivery of new medical cures. The proposal includes a number of promising provisions, while other potential elements need refinement before moving forward, the AMA said last week in comments (log in) submitted to the committee.
The 21st Century Cures Act is taking a comprehensive look at the entire cycle of interrelated health activities, from research through adoption into clinical practice. This initiative, spearheaded by Chairman Fred Upton, R-Mich., and Rep. Diana DeGette, D-Colo., would bridge the gap between medical science and legislative action and regulations that slow progress.
The draft legislation is a result of a year-long effort by the committee that included roundtable discussions, listening sessions and hearings, and a series of white papers. In its comments, the AMA outlined reforms in five areas that directly impact the ability of physicians to deliver quality care to patients:
- electronic health records and 21st century technology
- personalized medicine and laboratory-developed testing services and procedures
- antibiotic development
- patient data protections
The AMA strongly supports the committee's efforts and will continue to work with members as the process moves forward. Read more on the 21st Century Cures Act at AMA Wire®.IPAB repeal legislation introduced in the House
A bipartisan measure to repeal the independent payment advisory board (IPAB) was introduced in the U.S. House of Representatives this week. Rep. Phil Roe, MD, R-Tenn., and Rep. Linda Sanchez, D-Calif., introduced "Protecting Seniors' Access to Medicare Act of 2015" (H.R. 1190) with 205 additional cosponsors. Companion legislation (S. 141) was introduced by Sen. John Cornyn, R-Texas, in January.
The yet-to-be-appointed IPAB is an independent panel charged with reducing health care spending and too little accountability. Like the Medicare sustainable growth rate formula, the IPAB would rely solely on provider payment cuts to reduce Medicare spending. The AMA will continue to work with members of the House and Senate to secure passage of this legislation.
Consistent with AMA advocacy on narrow networks, draft 2016 Medicare Advantage (MA) policies just released by the Centers for Medicare & Medicaid Services (CMS) cite patient complaints of MA network directory inaccuracies. These inaccuracy complaints include directories listing physicians who are no longer contracting with the plan because they have retired from practice, moved, or died, as well as listing in-network physicians who are not open and available to new patients.
In the future, such directory inaccuracies may be viewed as an indication that the MA plan is failing established CMS standards. To address these problems, MA plans will need to establish and maintain proactive, structured communications with physicians to assess their true availability, including specifically whether they are accepting new patients, and verify continued compliance with MA network access requirements. Plans will also have to implement protocols to effectively address complaints related to enrollees being denied access to a contracted provider and they will be expected to update online directory information in real-time. The AMA is urging the agency to confirm these requirements in its final notice to be issued in April.
As part of the 2015 Medicare physician payment rule, the Centers for Medicare & Medicaid Services (CMS) outlined plans to expand data posted on the Physician Compare website starting in 2017, based on 2016 Physician Quality Reporting System participation. To seek feedback from stakeholders, CMS held a series of webinars outlining four informal proposals that will be further discussed in the 2016 physician payment rule.
In response to CMS' proposals, the AMA submitted comments (log in) outlining concerns with the proposed benchmarking methodologies and offering operational principles to guide further improvements and modifications to Physician Compare. In particular, the AMA will continue to advocate for public reporting to only be at the group level, not the individual physician level, and to ensure posted information is valid and reliable.
Physicians now have an additional three weeks, until 11:59 p.m. Eastern time on March 20, to attest to meaningful use for the 2014 reporting year.
The Centers for Medicare & Medicaid Services (CMS) extended the deadline to allow physicians extra time to submit their meaningful use data. Physicians must attest to meaningful use every year to receive an incentive payment and avoid a penalty. Note that CMS is only extending the attestation period, not the reporting period, so physicians must have concluded their reporting by Dec. 31, 2014, in order to attest to meeting requirements now.
To attest, physicians should submit their data to the Registration and Attestation System, which includes 2014 Certified EHR Technology Flexibility Rule options. To speed the attestation process, the AMA recommends that physicians attest during off-peak hours, such as evenings and weekends, and start now to check that their information is up-to-date and begin entering 2014 data.
Read more at AMA Wire.
The Centers for Medicare & Medicaid Services (CMS) has announced that the submission of 2014 Physician Quality Reporting System (PQRS) data for eligible professionals who participated via an electronic health record (EHR) or a Qualified Clinical Data Registry (QCDR) that uses QRDA III format has been extended three weeks until 8 p.m. Eastern time on March 20.
Submission timeframes for other PQRS reporting methods are unchanged. Physicians who fail to meet the 2014 PQRS reporting requirements will be subject to a penalty for all Medicare physician services rendered in 2016. Note that PQRS reporting via an EHR or QCDR is often done by third parties, not physicians themselves, so physicians should follow up with their vendors to ensure successful and timely reporting. Complete information about PQRS is available on the CMS website.
Issue SpotlightHHS secretary says agency needs physician input
With physicians shouldering a tsunami of regulatory burdens, U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell Tuesday told doctors that the agency wants to help restore the "joy of medicine."
Speaking at the AMA National Advocacy Conference last week, Burwell (pictured right) pointed to ways HHS is working to build a better, smarter health care system—which means listening to physicians.
"We know you have some concerns when it comes to electronic health records (EHR), and we know that you often find them to be clunky, and we want to work with you to improve that usability so they can become a valuable tool," Burwell said.
"We have heard you when you said that the meaningful use program was too much, too fast," she said. "This is why we recently announced plans to make meaningful use more straightforward, more flexible and focused on outcomes and interoperability."
Burwell said the agency is aligning its quality measure reporting programs and wants to work with physicians on solutions to make their lives easier.
She also touched on the sustainable growth rate (SGR) formula, a timely topic given that the current Medicare payment patch will expire on March 31.
"We've heard your concerns [about SGR] and we share them," Burwell said. "And so, in the president's FY 2016 budget proposal, the president is asking for the fix… we're hopeful that that's something that can be done in full, and that's why we put [forward] the proposal, not a temporary fix, but the permanent fix that I think we all know is what we need."
Finally, Burwell said HHS is focused on improving the way care is delivered and the way information is distributed. She mentioned the Centers for Medicare & Medicaid's Transforming Clinical Practice Initiative, announced in October. The initiative will award $800 million for the creation of evidence-based, peer-led collaboratives and practice transformation networks to support physicians in providing high-quality care.
"This effort will support an estimated 150,000 physicians and other clinicians as they transform their practices using peer-to-peer experiences and best practices as a guide," Burwell said.
Attendees also heard congressional perspectives on health care from Sen. Ben Cardin, D-Md., and Rep. Tom Price, R-Ga. The conference gave physicians the opportunity to pay house calls to their members of Congress.
The AMA continues to work with HHS to address the regulatory burdens physicians face, including meaningful use and the usability of EHRs.
State UpdateFirst state joins interstate compact to streamline medical licensure
Wyoming has become the first state to join the Interstate Medical Licensure Compact—an initiative of the Federation of State Medical Boards (FSMB) that will create a new pathway to expedite the licensing of physicians seeking to practice medicine in multiple states.
The proposal promises to increase access to health care for individuals in underserved or rural areas and allow patients to more easily consult medical experts through the use of telemedicine technologies. The compact will make it easier for physicians to obtain licenses to practice in multiple states and would strengthen public protection because it would help states share investigative and disciplinary information that they cannot share now. Wyoming Gov. Matt Mead signed the state's compact legislation into law on Feb. 28.
AMA policy adopted in November directs the AMA to support FSMB and the efforts of state medical boards to implement the compact. The policy also directs the AMA to work with interested medical associations, FSMB and other interested stakeholders to ensure expeditious adoption of the compact and creation of the Interstate Medical Licensure Compact Commission, which will be established after seven states join the Compact.
To date, Wyoming has signed this legislation into law, and 16 additional states have introduced legislation to join the compact. Those states are:
- Rhode Island
- South Dakota
- West Virginia
Of these, bills in four states—Idaho, South Dakota, Utah and West Virginia—have passed at least one house. In another four states—Iowa, Idaho, Minnesota and Montana—bills have passed out of committee. The AMA has submitted letters in support of the compact to legislators in Minnesota, Montana, Nebraska, South Dakota and Wyoming.
For more information, email Kristin Schleiter of the AMA or visit the AMA Web page on telemedicine. Read more about the compact at AMA Wire.
As the outbreak of measles continues to spread across the United States, several state legislatures are considering bills to make changes to childhood immunization requirements, and it is likely that more states will follow suit. As of February, at least six states are seeking to tighten or remove personal and philosophical exemptions (California, Maryland, Minnesota, Oregon, Vermont and Washington).
In Washington, for example H.B. 2009 would remove both philosophical and personal exemptions.
Specifically, the AMA wrote in support, "Philosophical and personal exemptions, especially if granted with little or no restrictions, provide a barrier to high immunization rates and work against the establishment of a successful vaccination program. By eliminating philosophical and personal exemptions for immunization as envisioned by H.B. 2009, Washington lawmakers can take positive steps to ensure Washington children receive the necessary vaccinations to protect not only their health, but the health of others. Should you decide to not eliminate philosophical and personal exemptions to immunizations, the AMA strongly urges that such exemptions be tightened and restricted so that they are not easily obtained without oversight."
For more information, email Carrie Armour of the AMA.
More than 150 medical, public health, patient and health care organizations came together this week, using the power of their collective voices to ask the nation's governors for increased emphasis on overdose prevention and treatment as part of the effort to combat prescription drug abuse, misuse, overdose and death.
In a letter (log in) led by the AMA, National Safety Council and Harm Reduction Coalition, these groups urged the National Governors Association to take action to help treat those suffering from substance use disorders and enact other measures to save lives from opioid overdose. Every state medical society joined the letter, along with more than 25 major national specialty societies.
As part of the nation's efforts to reduce prescription drug abuse, misuse, overdose and death, the organizations recommended adoption of the following key policies:
- Enhancing access and utilization of naloxone in every state
- Providing Good Samaritan protections for those who help victims of overdose
- Increasing access to medication-assisted treatment services as well as non-opioid based treatments
Judicial UpdateRuling could restrict access to psychiatric care
Mental health parity is at the center of a case between physicians and Anthem, Inc., one of the largest health insurers in the country.
In American Psychiatric Association v. Anthem Health Plans, Connecticut psychiatrists are challenging the insurer, alleging that Anthem systematically failed to pay proper mental health and substance abuse benefits under beneficiaries' plan documents and under various laws in the state, including the Mental Health Parity and Addiction Equity Act, the Employee Retirement Security Act (ERISA) and Connecticut common law.
The complaint alleged that Anthem reimbursed psychiatrists less than non-psychiatric physicians who provided comparable medical services and imposed unnecessary administrative requirements on psychiatrists. A trial court dismissed the case, finding that physicians and their medical societies lacked the legal standing to sue under ERISA.
"Anthem's unequal treatment of mental health care is a direct attempt to diminish the availability and use of mental health services," the AMA told the appeals court in a friend-of-the-court brief filed by the Litigation Center of the AMA and State Medical Societies and the Connecticut State Medical Society.
The brief calls out Anthem's tactics as restrictive to patients' access to psychiatric care, pointing to the AMA Code of Medical Ethics as the basis for why Connecticut psychiatrists have standing to advocate for their patients.
Read more at AMA Wire.
Other NewsSpread the word on SGR: Use new social media campaign
A new campaign targeting the elimination of the sustainable growth rate (SGR), launched during the AMA National Advocacy Conference, has already reached more than 600,000 Twitter users and achieved more than 1.3 million impressions on Twitter and Facebook.
By using iPad kiosks located at the grassroots booth and their own mobile devices, conference participants were able to easily set up their own, personalized social media cards and send them directly to their legislators via Twitter and Facebook. Even some members of Congress took part, sending tweets from their official accounts that called for SGR elimination using #FixMedicareNow.
The campaign complemented the "shoe leather" grassroots efforts of the physician activists attending the conference who had scheduled close to 150 meetings with their lawmakers. To send your own personalized social media card to legislators, visit action.fixmedicarenow.org.
Physician practices may be losing hundreds of thousands of dollars because of a new insurer tactic that charges physicians a fee to accept electronic payments. Insurers' use of virtual credit cards for claims payments is threatening the financial security of physician practices across the country, AMA Trustee Gerald E. Harmon, MD, told legislators at the National Conference of Insurance Legislators (NCOIL) Winter Meeting in Charleston, South Carolina.
It works like this: The insurer sends credit card information to a physician practice to pay a claim, and the practice processes the card information through its point-of-sale terminal. These "virtual" credit cards are associated with interchange fees of up to five percent of the payment amount, meaning that if the negotiated rate for a particular service is $100, the physician only receives $95 – with credit card companies often splitting the missing $5 with the insurer in the form of a cash-back incentive. "This type of practice unquestionably hurts physician practices," said Dr. Harmon, who urged NCOIL to take up consideration of AMA model legislation to stop the practice.
NCOIL legislators also heard AMA presentations on telemedicine, network adequacy and prescription drug abuse, overdose prevention and treatment.
For more information, email Emily Carroll of the AMA.
The AMA and 13 other provider organizations last month asked the Centers for Medicare & Medicaid Services (CMS) to take action on two important administrative simplification issues: virtual credit cards and the health plan identifier (HPID).
In a Feb. 20 letter (log in) to CMS Administrator Marilyn Tavenner, the groups outlined providers' numerous concerns with health plans' use of virtual credit cards for claims payments, such as high interchange fees, additional administrative burdens for physician practices and coercive implementation techniques. (Learn more about virtual credit cards in the previous story.)
The AMA and other groups urged CMS to issue additional guidance on the use of virtual credit cards that would require insurers to give full upfront disclosure of associated fees and to obtain physician consent prior to implementation of virtual card payments. The providers also requested that CMS prohibit the assessment of percentage-based fees for the standard electronic funds transfer (EFT) transaction through the Automated Clearing House (ACH) network. More information about physicians' rights regarding electronic payments, the effects of virtual credit card payments, and the benefits of ACH EFT is available through the AMA's EFT toolkit.
The second issue raised in the letter is the required use of the HPID, a unique health plan identifier, in standard electronic transactions. Although providers had initially hoped that the HPID would offer additional granularity in health plan identification in electronic transactions, it has become clear that adding the HPID to transactions would create large-scale administrative problems across stakeholders (including the potential for transaction misrouting and privacy breaches) without any offsetting benefit. The AMA joined the other groups in recommending that CMS issue a new rule that would prohibit the inclusion of HPIDs in standard transactions. Visit the AMA's Web page on administrative simplification to learn more about the AMA's advocacy on these and similar issues.
A new report from the AMA examines persons served and the distribution of per-enrollee spending for Medicare physician services. The report also looks at changes in these measures over time to see if they are related to the recent slowdown in Medicare physician spending growth.
The report (log in), for AMA members only, is part of the AMA Policy Research Perspectives series.
Key findings from the analysis:
- For 2012, 92 percent of full-year fee-for-service Medicare enrollees received a physician service, which was up only slightly from 91 percent in 2000.
- However, enrollees made use of a broader range of services in 2012 compared to 2000. The percentage of "persons served" increased substantially for imaging, procedures and tests, particularly from 2000 to 2006.
- In 2012, the top fifth of enrollees ranked by spending accounted for 60 percent of total spending. The bottom fifth accounted for 1 percent.
- Changes in the makeup (entitlement status and age) of the Medicare fee-for-service population had little impact on either persons served or spending per enrollee.
Visit the AMA's policy research Web page for more information.How to maximize value in the health care system
In a new briefing document (log in), the AMA describes its broad-based efforts to promote increased value in the health care system.
There is widespread agreement that the country needs to do a better job of improving the value of health care through the "triple aim" of better population health and better outcomes at lower cost. The concept of value encompasses both the clinical benefits gained from a particular service or treatment and the cost of that treatment.
The AMA believes the following objectives must be accomplished in order to bring health care costs and quality into proper alignment:
- Support streamlined quality improvement programs to help physicians deliver high-quality, efficient care
- Develop better methods of generating and sharing information about comparative practice patterns with physicians
- Expand the functionality of health information technology to help enhance patient care and increase efficiencies
- Encourage the adoption of healthy patient lifestyles
- Support health insurance benefit designs that encourage patients to seek appropriate care
- Reduce administrative and other non-clinical health system costs that do not add value to patient care
- Support physician payment and delivery models that enable physicians to pursue practice innovations that promote high-quality, cost-effective care
This new briefing document on maximizing value in the health care system is available in the right-hand navigation of the AMA Council on Medical Service Web page.In testimony to federal agency, AMA calls for administrative simplification
The AMA collaborated with other national provider organizations in testimony to the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards on Feb. 26.
In one panel, the AMA, the American Hospital Association (AHA) and the Medical Group Management Association (MGMA) recommended enhancements, including addition of data content requirements, to the draft operating rules for the claim and prior authorization electronic transactions. In addition, the three organizations urged the subcommittee to use this opportunity to fully address the multiple process deficiencies that are hindering true automation and simplification of the current burdensome prior authorization system.
During another panel, the AMA partnered with AHA, MGMA, and the American Dental Association in testimony regarding the role of the Review Committee, a body established under the Affordable Care Act, to review existing administrative health care electronic transactions. The provider organizations advocated for the Review Committee to take on major administrative simplification challenges facing the industry, including oversight of the electronic standards development process, responsiveness of the current standards and operating rules to emerging business needs, and industry compliance.
Visit the AMA's administrative simplification Web page to access the February 2015 testimony slides.
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: $895 to attend in-person onsite and $495 to attend online via live and archived Internet video broadcast.
The current sustainable growth rate (SGR) Medicare payment patch expires. Go to FixMedicareNow.org for ways you can reach your lawmakers and tell them to eliminate the SGR once and for all.
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.
- Avoid these mistakes when borrowing money for your practice (log in)
- How the definitions of digital health differ (log in)
- Get insights from a blood pressure champion (log in)
- What to consider when planning a practice exit strategy (log in)