March 19, 2015

National Update

Congress unveils bipartisan SGR repeal package

Lawmakers yesterday unveiled a bipartisan bill to eliminate the Medicare sustainable growth rate (SGR) formula, with only days left before the current physician payment patch expires on March 31.

The bill, H.R. 1470 (no number has been assigned yet to the Senate version), is an updated version of the policies set forth in last year's bipartisan, bicameral Medicare payment reform bill. The newly introduced legislation does not provide details on the roughly $70 billion in budget offsets and other policy changes expected to accompany it when floor votes occur. U.S. House of Representatives Speaker John Boehner, R-Ohio, and House Minority Leader Nancy Pelosi, D-Calif., are working together to finalize the offset package. The House is expected to vote on the entire proposal next week, before the March 31 expiration date of the current patch.

Key provisions of H.R. 1470 and the Senate bill include the following:

Sponsors of the bipartisan legislation include Rep. Michael Burgess, MD, R-Texas, Senate Finance Committee Chair Orrin Hatch, R-Utah, House Energy and Commerce Committee Chairman Fred Upton, R-Mich., House Energy and Commerce Committee Ranking Member Frank Pallone, Jr., D-N.J., House Energy and Commerce Health Subcommittee Chairman Joe Pitts, R-Penn., House Energy and Commerce Health Subcommittee Ranking Member Gene Green, D-Texas, House Ways and Means Committee Chairman Paul Ryan, R-Wisc., House Ways and Means Committee Ranking Member Sander Levin, D-Mich., House Ways and Means Health Subcommittee Chairman Kevin Brady, R-Texas, House Ways and Means Health Subcommittee Ranking Member Jim McDermott, D-Wash., and Rep. Charles Boustany, Jr., MD, R-La.

The AMA and physician organizations across the country are urging doctors nationwide to participate in a National Call to Action day on Tuesday. Contact your senators and representatives on that day and urge them to support H.R. 1470 in any of the following ways:

Act now: Visit to contact your lawmakers and urge them to pass permanent legislation that would eliminate the SGR. Call, email or tweet to legislators today.

Organized medicine pressures CMS on ICD-10 transition plans

Physicians are concerned with preparations for transitioning to the ICD-10 diagnosis code set, 100 state medical societies and national specialty organizations, including the AMA, recently told the Centers for Medicare & Medicaid Services (CMS).

The letter (log in) to CMS underscores the significant challenges of implementing ICD-10 and the need to have sound contingency plans in place to minimize claims and payment disruption for physicians. It presses CMS to release the detailed findings of the end-to-end testing conducted in January as soon as possible. 

The AMA will continue urging CMS to address the concerns outlined in the letter and to sensitize the administration to the challenges of moving to the new code set. Read more about the concerns physicians outlined in the letter at AMA Wire®.

CMS publishes updated coverage policies to reflect ICD-10

While the AMA continues its push to reform the Centers for Medicare & Medicaid Services (CMS) ICD-10 implementation plans, physicians are reminded to stay abreast of Medicare coverage policies that are being updated by CMS on a rolling basis.

The most recently changed coverage policies can be accessed through the AMA's ICD-10 Web page under "Medicare Testing and Payment." Physicians are urged to review any policies that may impact them.

Senate committee examines meaningful use program

Witnesses representing physicians, patients and providers testified on the current state and future of health information exchanges, exploring the frustrations with the meaningful use program and the promise that interoperable electronic health records (EHR) hold for improving health care during a Senate hearing this week.

The Senate Health, Education, Labor and Pensions Committee held a hearing, "America's health IT transformation: Translating the promise of electronic health records into better care." The AMA submitted a statement for the record (log in) that highlights barriers to EHR adoption for physicians and provides recommendations to improve interoperability. These include addressing technological barriers, usability concerns, security and privacy issues, and costs. The testimony also stresses that to be successful, the meaningful use program must become more flexible.

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Issue Spotlight

5 things physicians say about the evolution of payment models

Physicians are trying to move to new payment models, but need help successfully managing and responding to the many quality programs and metrics from payers, according to a new joint study by the RAND Corporation and the AMA.

Researchers conducted case studies of 34 physician practices in six diverse geographic markets to determine the effects that alternative health care payment models are having on physicians and practices. The models under investigation included episode-based and bundled payments, shared savings, pay-for-performance, capitation and retainer-based practices. Two other organizational models, accountable care organizations and medical homes, also were examined.

Here are the five things physicians should know about the report:

The report's findings will guide the AMA's work in improving alternative payment models and helping physician practices successfully adapt to changes in the health care environment. The findings also point to the need for payers to make similar investments in managing the information that physicians collect.

Read more about the findings at AMA Wire.

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State Update

Document IDs challenges and "red flags" related to controlled substances

In a new consensus document (log in), the AMA and 16 other organizations representing physicians, pharmacists and supply chains highlighted, among other things, the "red flag" warning signs of prescription drug abuse and diversion.

By illuminating the challenges of prescribing and dispensing medicines such as opioids, the groups aim to prevent the misuse and diversion of controlled substances while ensuring access to the medications for patients with legitimate needs. This collaboration is just one part of the AMA's efforts to curb prescription drug abuse and diversion, including state and federal advocacy efforts in support of a multipronged public health approach to address the problem. That approach includes increased access to treatment and prevention programs and lifesaving overdose prevention medications like naloxone, enhanced education for physicians and patients and modernized and fully funded prescription drug monitoring programs. 

Learn more about related AMA advocacy and work with other organizations.

New Hampshire set to expand Medicaid

Earlier this month, New Hampshire became the sixth state to receive federal approval to launch its own version of Medicaid expansion under the Affordable Care Act. An estimated 50,000 low-income residents could gain coverage under the program.

Under the program, called the New Hampshire Health Protection Program, newly eligible residents will receive premium assistance to purchase private health plans through Enrollment will begin on Nov. 1 and coverage will become effective on Jan. 1. Cost-sharing for enrollees will remain consistent with New Hampshire's existing state Medicaid plan. Prior to approval of this program, New Hampshire operated a bridge program for the newly eligible population.

To date, 28 states and the District of Columbia have expanded Medicaid. Of those, Arkansas, Indiana, Iowa, Michigan, New Hampshire and Pennsylvania sought federal waivers to implement alternative models. Read more about the Advocacy Resource Center Medicaid expansion campaign.

Telemedicine bills continue to advance in state legislatures

Legislation addressing various aspects of telemedicine gained steam in early March.

Bills that promote coverage of and payment for telemedicine advanced in states including Arkansas, Connecticut, Idaho, Minnesota, Missouri, New Hampshire, Oregon, Rhode Island, Virginia and Washington. In Colorado, a telemedicine reimbursement bill awaits the governor's signature.

Many of these bills are based on the AMA model state Telemedicine Reimbursement Act, one of a series of AMA model state bills related to telemedicine. The AMA Advocacy Resource Center (ARC) has the tools, availability and resources to work with any state medical association interested in pursuing telemedicine legislation or regulation. Visit the ARC telemedicine Web page for more information.

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Judicial Update

State high court to rule on physicians' duty of care

Do physicians owe a duty of care to someone other than their patients? This question is at the center of a case before the New York Court of Appeals after a bus driver was injured in a head-on collision with a car driven by a recently discharged patient.

A patient was treated in the emergency room of South Nassau Communities Hospital, examined by a physician and given several medications, including a narcotic medication. After the patient was discharged, she allegedly became unconscious as a result of the medications she took and crashed into a bus.

The bus driver filed a medical liability claim alleging the physician's duty of care extends to third parties who might be potentially at risk. A lower court found the bus driver's claims were insufficient, since he had no patient-physician relationship with the physician. The bus driver has appealed.

The Litigation Center of the AMA and State Medical Societies and the Medical Society of the State of New York last month filed an amicus brief in support of the physician who treated the patient and South Nassau Communities Hospital.

"A physician's duty of care is ordinarily owed to the patient and does not extend to the community at large," the brief said. "A critical reason underlying the court's reluctance to expand a doctor's duty of care is the recognition of the potential profound harm to society that would result and that expanding a duty of care to non-patients would render doctors liable to a prohibitive number of possible plaintiffs."

Such a precedent would be economically and socially burdensome, the brief said.

Further, with physicians already practicing in a costly medical liability system, a decision for the bus driver could have a chilling effect, potentially leading physicians "to hesitate providing patients with treatments that have inherent risks and potential side effects," the brief said.

Visit the AMA Litigation Center's Web page to learn more about this case and others related to medical liability.

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Other News

Get an in-depth look at practice integration options

The reasons physicians consider practice integration are varied, and an AMA resource can help you understand your options when it comes to integration.

Why might a physician integrate? Some physicians may be motivated to create the collaborative environment needed to make significant quality and cost-effectiveness improvements or to develop economies of scale and raise capital sufficient to implement health information technology. Other physicians may want to take advantage of participating in performance-based reimbursement programs and lawfully bargain collectively with payers. "Competing in the marketplace," which covers practice integrations ranging from mergers to a wide variety of other contractual arrangements, is written to help you understand these and other topics associated with a rapidly changing market and regulatory environment that encourages practice integration.

Physicians in solo or small group practice may think integration is prohibitively expensive and time consuming, which is not necessarily true. Many physicians may simply be unaware of the flexibility permitted by available integrative options.

In many cases physicians will be able to enjoy the benefits of integration and still:

For additional information regarding "Competing in the marketplace," please contact Wes Cleveland or Henry Allen of the AMA, or call (312) 464-5000.

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Upcoming Events

March 20:
Physicians participating in the meaningful use program have until March 20 to attest to any 90-day reporting period in 2014. Learn more about meaningful use.

March 23-27:
The U.S. House of Representatives are expected to vote on the repeal of SGR.  A Senate floor vote may also occur.  Keep your attention on AMA Wire® for updates on Congressional actions.

March 31:
The current sustainable growth rate (SGR) Medicare payment patch expires. Go to for ways you can reach your lawmakers and tell them to eliminate the SGR once and for all.

April 15-19:
Apply today to participate in the AMPAC Campaign School in Arlington, Virginia.

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