April 2, 2015
National UpdateVA expands eligibility for Veterans Choice Program
The U.S. Department of Veterans Affairs (VA) will change the way it calculates the 40-mile distance threshold used to determine eligibility for the Veterans Choice Program, giving more veterans the chance to be eligible for the program, according to a news release.
The AMA strongly objected to how the VA initially made these determinations, which used the straight-line (or "as the crow flies") distance from a veteran's residence to the nearest VA medical facility. Going forward, the VA will use the driving distance between the two locations to make eligibility determinations, roughly doubling the number of veterans eligible for the program.
This change is consistent with AMA comments (log in) urging the VA to account for the "actual distance that a veteran would have to travel." AMA comments also urged changes in how the distance is calculated as it pertains to specialty care in order to improve access to specialists. Finally, the AMA voiced strong opposition to the VA's decision to retrospectively determine copayment amounts, thereby precluding community-based physicians from collecting copays at the time of service.
More information about the Veterans Choice Program, including eligibility criteria for veterans and how physicians can apply to deliver care, can be found on the AMA's Supporting veterans' health Web page.
AMA President Robert Wah, MD, last week joined President Barack Obama and U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell at the launch of a new Health Care Payment Learning and Action Network, which will provide a forum for public-private partnerships to discuss, track and share best practices on how to transition towards alternative payment models that emphasize value.
The administration in January announced the network as part of its new goals for advancing payment and delivery reforms.
The AMA was one of the first organizations to express support for the network and continues to emphasize that, to be successful and sustainable, new delivery models must have three key components:
- Flexibility in care delivery
- Appropriate accountability for quality, utilization and associated costs
- Adequate payments
All interested individuals and organizations are invited to register and join the network.Back to Top
Issue SpotlightSGR repeal close—Senate to take action after recess
After the U.S. House of Representatives last week overwhelmingly approved a bill to eliminate the flawed Medicare sustainable growth rate (SGR) formula, the U.S. Senate delayed giving its final approval to the bill. Senate leaders said they will vote on the bill promptly after Congress’ two-week April recess.
The current Medicare payment patch expired Wednesday, which means doctors will receive 21 percent cuts in Medicare reimbursements. Here’s what physicians need to know about these cuts:
- The Centers for Medicare & Medicaid Services (CMS) is instructing its carriers to “hold” claims for 10 business days until legislation can be passed and signed into law that reverses the cut.
- The 10-day hold means that claims will be held through April 14. This is not a departure from standard practice.
- By regulation, CMS may not pay electronic claims prior to 14 days (29 days for paper claims).
- It is possible that the situation will be resolved before any claims are actually processed at the reduced rate.
- The AMA anticipates that when Congress passes a bill, the restored payment rates will be applied retroactively.
By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount. For that reason, the AMA is advising against submitting claims with reduced amounts reflecting the 21 percent cut.
The bill, H.R. 2, would set into motion Medicare physician payment reforms that will support physician practices that serve our nation’s seniors and military families enrolled in TRICARE. President Barack Obama said he would sign the legislation into law, intensifying pressure on the Senate to move the bill forward. The Senate is expected to vote when it returns on April 13. Read about the provisions of the bill at AMA Wire®.
AMA President Robert M. Wah, MD, in a statement said he was “extremely disappointed” that the Senate delayed its vote.
“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Wah said. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
Physicians can contact their senators and urge them to support H.R. 2 when they get back from their vacation in any of the following ways:
- Call senators using the AMA’s toll-free Physicians Grassroots Hotline at 1-800-833-6354.
- Send an urgent email to senators reinforcing the need for SGR repeal now.
- Contact senators directly through their own social media channels.
State UpdateThree states join interstate compact for medical licensure
Idaho joined South Dakota and Wyoming in becoming one of the first states to join an interstate compact designed to facilitate a speedier medical licensure process with fewer administrative burdens for physicians seeking licensure in multiple states.
The Interstate Medical Licensure Compact—an initiative of the Federation of State Medical Boards (FSMB)—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, which will be established after seven states join the compact.
The compact 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.
Of the 14 additional states that have introduced legislation to join the compact, two states' laws are close to passage. Bills in Montana and West Virginia have been delivered to those states’ governors for signature. The AMA has submitted letters in support of the compact to legislators in Minnesota, Montana, Nebraska, Nevada, South Dakota and Wyoming.
FSMB has created a 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 supporting the compact.
For more information, visit the AMA Web page on telemedicine.
More than 100 separate pieces of state legislation have been filed this year concerning prescription drug monitoring programs (PDMPs).
The bills include provisions such as:
- Allowing prescriber and dispenser delegates to access the databases
- Streamlining the registration process for prescribers
- Specifying the circumstances under which prescribers must access the database
View the bills to learn more.
The AMA continues to advocate for modernized, fully funded PDMPs that can provide clinically relevant information at the point of care. Learn more about the AMA's advocacy to reduce prescription drug abuse, misuse, overdose and death, and email Daniel Blaney-Koen of the AMA with questions.
Judicial UpdateCase tackles qualifications for expert witness testimony
The subject of expert witness testimony is up for debate in a case before the District of Columbia Court of Appeals.
In Motorola v. Murray, the issue now before the court is the standards for qualifications of expert witnesses who testify on scientific issues. Nearly 30 lawsuits have been filed in the Superior Court for the District of Columbia against cell phone manufacturers, alleging that plaintiffs incurred brain cancer as a result of using their cell phones. To prove their cases, the plaintiffs proffered experts who were prepared to testify “to a reasonable degree of scientific certainty” that cell phones are more likely than not a cause or catalyst of brain cancer.
Based on the information provided, the court determined that, while some scientific data suggest a possible causal connection between cell phone use and brain cancer, there isn’t enough research to date for scientists to determine that connection with the requisite degree of certainty.
The court observed that most jurisdictions other than the District of Columbia courts follow a restrictive standard. Under this standard, the proposed testimony would be inadmissible on account of the insufficiency of supporting data. However, the court went on to find, the District of Columbia rule is that the jury, not the court, should be allowed to determine the credibility of the expert witnesses.
Because of this standard, the plaintiffs’ expert witness testimony was found admissible. The defendants appealed the decision.
In support of Motorola and the other defendants, the Litigation Center of the AMA and State Medical Societies and the Medical Society of the District of Columbia filed a friend-of-the-court brief holding that the trial court should have found the testimony of the plaintiffs’ experts inadmissible. As part of its general effort to curb lawsuit abuse, the Litigation Center supports restrictive standards for the introduction of expert testimony in medical liability litigation.
“By its very nature, expert testimony addresses questions that are beyond the ken of the average lay juror,” the brief said.
Visit the AMA Litigation Center’s Web page to learn more about this case and others related to expert witnesses.
Other NewsHealth spending growth at record low: New report
Health spending grew 3.6 percent in 2013 to a level of $2.9 trillion dollars or $9,255 on a per capita basis—a record low, according to a new Policy Research Perspective (PRP) (log in) for AMA members that provides an in-depth look at U.S. national health expenditures.
The report also shows the types of products and services that health care dollars are spent on and explains how the financing of health spending has changed over time.
Despite an industry shift placing an increased amount of financial responsibility on patients, the majority of revenue for physician practices is still collected directly from health insurers through the claims payment process. Unfortunately, the claims adjudication process is far from perfect, with payments often being improperly reduced or denied. Maximize revenue and maintain financial viability with a new resource that can help identify and appeal issues surrounding health insurer claims payments.
Identifying and Appealing Health Insurance Claim Payment Issues details important steps for practices to take in order to implement an effective and efficient claims review/appeals process. It includes specific examples of some common claims payment issues facing physicians and outlines actions that physicians might consider if their claim appeal is denied. AMA members can also use template appeal letters that address a variety of claim payment issues.
Read about common payment issues—and how to handle them—at AMA Wire. For more information and to access these resources, visit the Appealing claims payment issues Web page.
A new documentary, Rx: The Quiet Revolution, will air on PBS at 9 p.m. Eastern time, beginning April 2. The AMA-supported documentary, directed by David Grubin, will focus on physicians who deliver patient-centered care while improving health outcomes in chronic disease and enriching patient lives. Learn more.
Apply today to participate in the AMPAC Campaign School in Arlington, Virginia.
Apply to participate in ICD-10 end-to-end testing in July. Approximately 850 volunteer submitters will be selected. Submit a volunteer form through your Medicare Administrative Contractor’s Web page by April 17. Read more about recent ICD-10 testing results at AMA Wire.
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.
- Common payment issues—and how to handle them (log in)
- As prediabetes burdens nation, new solution available for physicians (log in)
- Changes in medical liability reform set in motion (log in)
- How to beat burnout: 7 signs physicians should know (log in)