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April 30, 2015

National Update

New legislation could cover diabetes prevention program

A newly introduced Medicare bill could help reduce the incidence of diabetes by more than one-third.

Yesterday, Sens. Al Franken, D-Minn., and Susan Collins, R-Maine, and Reps. Susan Davis, D-Calif., and Reid Ribble, R-Wisc., introduced S. 1131/H.R. 2102, the Medicare Diabetes Prevention Act.  The bill would require Medicare to cover services provided under the evidence-based National Diabetes Prevention Program.

A study released last year on the bill estimated the legislation would help reduce the cumulative rate of diabetes in the Medicare population by an estimated 37 percent after a decade.

In 2012, the Centers for Disease Control and Prevention (CDC) launched the National Diabetes Prevention Program, a community-based, year-long program to prevent the onset of type 2 diabetes. It includes 16 sessions of nutrition and exercise training. As part of its Improving Health Outcomes initiative, the AMA spent the past year working with the YMCA of the USA and 11 physician practice pilot sites in four states to increase physician screening for prediabetes and referral of patients with prediabetes to diabetes prevention programs offered by local YMCAs, which use the CDC’s program.

Learn more about diabetes prevention programs and the AMA’s Improving Health Outcomes initiative at AMA Wire®.

Opioid abuse crisis should be addressed medically

The prescription drug abuse epidemic is a major public health concern, and policies to address this abuse should be “medicalized,” Patrice A. Harris, MD, secretary of the AMA Board of Trustees, told a congressional subcommittee earlier this month.

Dr. Harris testified before the U.S. House of Representatives Energy & Commerce Oversight and Investigations Subcommittee at a hearing on “Combatting the Opioid Abuse Epidemic: Professional and Academic Perspectives.”

In her testimony (log in), Dr. Harris discussed the AMA’s six prevention and treatment recommendations:

  1. Promoting physician and patient education
  2. Recognizing pain as a medical condition to avert stigmatization of opioid use
  3. Coverage of opioid abuse disorder by health plans
  4. Increasing access to naloxone
  5. Modernizing and fully funding prescription drug monitoring programs (PDMP)
  6. Ensuring collaboration among stakeholders and state and federal policy makers

Dr. Harris highlighted the work of the AMA Task Force to Reduce Opioid Abuse, an AMA-convened working group of representatives from more than 40 specialty and state medical associations, and other collaborative efforts to address the prescription drug abuse epidemic. This was the second of a hearing series that the subcommittee is holding on the topic.

New report explores medical device safety surveillance systems

A new report from the National Medical Device Postmarket Surveillance Planning board provides a comprehensive review of the current device safety surveillance systems and the use of the newly developed Unique Device Identifier (UDI) as an additional resource.

The AMA recently submitted a comment letter (log in) on the report “Strengthening Patient Care: Building an Effective National Medical Device Surveillance System.” The goal of the planning board is to create a national postmarket surveillance system that supports medical device safety and optimal patient care.

The AMA’s comments focused on the proposed expansion of the current device safety surveillance system to include sending specific device information, i.e., UDI, to health plans in health care claims. The AMA is concerned that sending the UDI to health plans will not achieve the goal of improving device safety surveillance due to several limitations in this approach, including the challenges involved in tracking patients who have changed health plans and the inability of claims data to capture the clinical information needed for rich device performance analysis. Furthermore, the clinical and revenue system changes for adding the UDI to the claim will likely be costly and burdensome for health care providers.

The AMA supports the capture and reporting of UDI in electronic health records and clinical registries where it can be used in evaluation of the patient’s clinical condition and with a population of patients with the same device. Access the letter (log in) to review the AMA’s complete comments on the report.

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State Update

Iowa law encourages open talks after adverse care incidents

Iowa Governor Terry Branstad last week signed into law an innovative measure, jointly drafted by the Iowa Medical Society and representatives of trial attorneys, that facilitates an open discussion between a physician and patient in the event of an unanticipated healthcare outcome.

The new law establishes a structure through which physicians and their patients can engage in open discussion, sharing medical records and steps taken to improve future quality of care and, if warranted, extending to the patient an offer of compensation. At the same time, the law offers important liability protections for communications made through this new process.

Iowa’s law follows similar legislation enacted in Massachusetts and Oregon in recent years. Contact Kristin Schleiter of the AMA for more information.

Telemedicine bills make headway in states

With bills signed into law in Arkansas, Colorado, Idaho and North Dakota in recent weeks, legislation promoting the use of telemedicine continue to find success in state legislatures.

Arkansas, Colorado and North Dakota’s bills set the stage for physicians to be reimbursed by private insurers for telemedicine services, with Colorado’s bill also removing the state’s geographic site restrictions. Arkansas’ and Idaho’s bills clarify how to establish a patient-physician relationship via telemedicine, and provide guidance to physicians on appropriate prescribing via telemedicine, obtaining informed consent and maintaining medical records following a telemedicine encounter.

Legislation addressing various aspects of telemedicine practice, reimbursement and licensure continues to progress in more than a dozen states, with bills in states including Iowa, Kentucky, Missouri, Minnesota, Oregon, Tennessee and Washington having passed the first house of jurisdiction.

Meanwhile, Patrice Harris, MD, secretary of the AMA Board of Trustees, participated in a panel at a recent Federation of State Medical Boards meeting focused on a new interstate compact designed to facilitate a speedier medical licensure process for physicians seeking licensure in multiple states. Dr. Harris highlighted AMA policy in support of the compact, as well as AMA advocacy in partnership with interested state medical associations, focused on expeditious adoption of the compact.

Read more about the compact at AMA Wire, and visit the AMA Web page on state telemedicine advocacy for more information.

Montana legislature expands health coverage with new bill

In April, Montana became the first state to pass a Medicaid expansion bill during the 2015 legislative session and the 30th state, including Washington, D.C., to opt into Medicaid expansion under the Affordable Care Act. The bill will expand health insurance coverage to 70,000 low-income residents.

Like Arkansas, Indiana, Iowa, Michigan, New Hampshire and Pennsylvania, Montana will require a federal demonstration waiver which will allow the state to design its Medicaid expansion program differently than in other states. Under the act, enrollees are required to pay premiums and copayments for services and have the option to participate in a workforce development program. The federal Centers for Medicare & Medicaid Services will have to approve the waiver program before it can be implemented.

“The AMA has long recognized the benefit of allowing states to experiment with models for covering the uninsured, and we commend your willingness to find a ‘Montana solution’ to fit the unique needs of your state’s residents,” AMA Executive Vice President and CEO James L. Madara, MD, wrote to Montana Governor Steve Bullock. “As physicians, we know that health insurance coverage is essential to making sure people get the care they need to lead healthy, productive lives.”

The AMA continues to work with state and specialty medical societies at the state level to expand Medicaid eligibility for individuals currently in the coverage gap. Visit the AMA Medicaid expansion campaign Web page for more information.

Mississippi protects physician freedom to practice

New legislation in Mississippi will protect physician licensure from being conditioned upon participation in health care programs or on compliance with the “meaningful use” of electronic health records.

The proactive legislation addresses the inappropriate interference of regulation on physicians’ autonomy and allows physicians to determine the caseload and innovative health information technology that allows them to focus on caring for their patients. Mississippi is the second state, after Alabama, to enact such legislation.

The AMA has developed state model legislation that prohibits states from requiring mandatory participation in health care programs, including compliance with meaningful use and participation in public insurance plans, as a condition of licensure. Please contact Emily Carroll or Annalia Michelman of the AMA for additional information.

Mississippi governor signs overdose prevention bill into law

A recent Mississippi bill authorizes physicians acting in good faith and in compliance with the standard of care applicable to that practitioner to prescribe an opioid antagonist, such as naloxone, to a person at risk of experiencing an opioid-related overdose or to other persons in a position to assist such persons at risk of experiencing an opioid-related overdose.

Mississippi Governor Phil Bryant signed H.B. 692, the Emergency Response and Overdose Prevention Act on March 13. The bill further provides liability protections for health care professionals and individuals who seek to help those at risk of experiencing an opioid related overdose.

With support from the AMA (log in), the Mississippi State Medical Association (MSMA) promoted the legislation to the chairs of the Public Health and Welfare committees in the Mississippi State House of Representatives and Senate.

“The passage of H.B. 692 will save lives while providing liability protections for health care professionals and individuals who seek to help those at risk of experiencing an opioid related overdose,” said MSMA President Claude D. Brunson, MD.

The bill received strong bipartisan support and unanimously passed both of the state’s legislative chambers. The law will go into effect on July 1.

Learn more about naloxone in an issue brief (log in).

Rhode Island physicians stand out as vital part of economy

A local Rhode Island news source says “one industry stands out” as being beneficial to the state’s economy: health care.

Physicians in the state produce $4.8 billion in total annual sales, account for $2.8 billion in total wages and benefits, and generate $196 million in state and local taxes for Rhode Island. In addition, each physician in the state supports on average 10.4 jobs.

The data comes from the AMA’s Economic Impact Study, which shows that, in addition to supporting the health of their community, physicians also play a vital role in the economy by supporting jobs, purchasing goods and generating tax revenue. The report’s findings show physician impact nationally and in each state based on four key economic indicators: jobs, output, wages and benefits, and state and local tax revenues. Analysis is available for all privately practicing physicians, as well as across ten select specialties, including anesthesiology, cardiology, family medicine, general surgery, internal medicine, obstetrics and gynecology, orthopedic surgery, otolaryngology, pediatric and urology.

The AMA has supporting advocacy tools available to state and specialty medical societies including data rich one-page handouts customized for each state, talking points, a model press release, and custom full-page and half-page ads. AMA staff are also available to assist in incorporating Economic Impact Study findings into issue briefs, speeches, media responses or any other resources.

FSMB to revise guidelines for using opioids for chronic pain

The Federation of State Medical Boards (FSMB) last week adopted a resolution at its 2015 Annual Meeting that will ultimately lead to the group updating its model policy on the use of opioid analgesics in the treatment of chronic pain.

The resolution calls for the FSMB to “establish a workgroup, comprised of state medical and osteopathic boards, and other key stakeholders,” including the AMA,  American Osteopathic Association, specialty societies and state medical associations that will review the current science and revise the policy.

Patrice Harris, MD, secretary of the AMA Board of Trustees, joined several physicians testifying in support of the FSMB re-opening the model guidelines to help ensure that there is an appropriate balance between detecting potential abuse and misuse with protecting patients’ access to care, which may include opioids.

“Treating a patient who experiences pain requires evaluating, diagnosing, and developing a treatment plan that is unique to each patient,” said Dr. Harris. “One-size fits all solutions raise many concerns not only for physicians, but also for patients.”

Please contact Daniel Blaney-Koen of the AMA for more information about the FSMB model guidelines.

Colorado defeats insurer-backed bill that would threaten care

Legislation that would have been damaging to the entire health care market in Colorado, incenting payers to both lower their in-network rates and creating narrower provider networks that threaten patient access, was defeated in the state earlier this month.

The Colorado Medical Society, numerous medical specialty societies and the AMA successfully opposed Colorado S.B. 259. The legislation as originally introduced would have capped total out-of-network physician payments provided in a network facility at the average contract rate for the relevant geographic area as established by the health plan and prevented related billing by the out-of-network providers.  The legislation was well intended to address unanticipated patient costs, but the legislation ignored the roots of these out-of-network patient costs including network inadequacies and uncompetitive out-of-network payments.

Similar legislative efforts are being initiated across the country. Meanwhile, an April Kaiser Health Tracking Poll found that the public would like to see strong patient protections when out-of-network costs are incurred at network hospitals.

The AMA supported the Colorado Medical Society’s call for an interim study to develop appropriate and effective patient protections from unanticipated medical costs. Contact Emily Carroll of the AMA for additional information.

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Judicial Update

Health data vital to patient safety under Supreme Court review

Patient care information shared by physicians for the purpose of improving health care quality and safety could lose its protected status in a case that could be heard before the Supreme Court of the United States.

Where physicians now freely share patient safety information without fear of liability in support of higher quality health care, the Kentucky-based case Tibbs v. Bunnell could allow this data to be released for use in lawsuits.

Health care professionals now are asking the highest court in the land to overturn a Kentucky Supreme Court ruling that would lift confidentiality protections in place under the federal Patient Safety and Quality Improvement Act of 2005 (PSQIA) for data that is collected in patient safety systems.

PSQIA gives physicians and other health care providers a confidential way to share information related to patient safety events through a patient safety organization (PSO). Information submitted to a PSO is meant to be used for improving care quality and safety without threat that the information will be used against the physicians involved.

If upheld, the Kentucky court’s decision “will stifle the collection and use of ‘patient safety work product,’ and frustrate one of the fundamental purposes of the act—to provide a nationwide repository where adverse health care outcomes can be studied and corrected,” physicians said in a friend-of-the-court brief filed by the Litigation Center of the AMA and State Medical Societies.

Read more at AMA Wire®.

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Other News

CMS issues new Open Payments guidance

The Centers for Medicare & Medicaid Services (CMS) issued new frequently asked questions on when continuing medical education (CME) would be reportable under the Physician Payments Sunshine Act, also known as the Open Payments program.

The new guidance unambiguously states that reporting is not triggered unless the manufacturer requires, instructs, directs or otherwise causes the third party to provide the payment or transfer of value, in whole or in part, to a covered recipient. CMS issued the new guidance in response to advocacy efforts by the AMA and other stakeholders.

This is not a “free pass”—the exclusion only applies to independent CME. The AMA encourages medical societies to review their planning processes to ensure adherence to standards for independence. At a minimum, meeting funding should in no way influence program development and other aspects of the planning process. Every effort should be made to maintain up-to-date conflict of interest disclosures from all involved in the planning process.

For additional guidance, please review the AMA’s policy regarding Financial Relationship with Industry in Continuing Medical Education.

Reminder: Register and review financial data

Physicians have until May 20 to register in the Open Payments System and review their 2014 financial interactions with manufacturers of drugs and medical devices reported under the Open Payments program.

Disputes that are initiated by May 20 will be flagged in the public release on June 30. Physicians can get instructions for how to register and review their data at AMA Wire.

Physicians can share the details of their registration experience by sending an email to the AMA. Responses will be used in the AMA's ongoing advocacy efforts.

SGR repeal set stage for dynamic AMPAC Campaign School

Campaign SchoolPassage of a bill that eliminated the sustainable growth rate (SGR) on April 14 set an excited tone for AMPAC’s Campaign School, April 15-19 in Arlington, Va.

A total of 28 people from 18 states—19 physicians, 4 medical students, 4 spouses and one state society staffer—participated in the 2015 school (pictured right).

A new addition to this year’s “faculty” was Congressman Ami Bera, MD, also a 2011 AMPAC Candidate Workshop graduate. The Campaign School is AMPAC’s annual political training “boot camp” for AMA-member physicians and friends of medicine.

Dates for the 2016 AMPAC political education programs will be released as soon as they are available. For AMA members, spouses and state society staff members, AMPAC covers all expenses except transportation, which is a tremendous value for AMA membership. Please contact Jim Wilson of the AMA for more information.

AMA developing free database of practice management services

Does your organization provide practice management services to practicing physicians or recommend groups that do?

The AMA is developing a free searchable online database of practice management professionals, consultants and vendors that provide practice business services to physicians. If you provide practice services or have referrals that are interested in being listed in this directory, please email Sam Reynolds of the AMA.

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Upcoming Events

May 5:
AMA Board of Trustees Member Jack Resneck, MD, will participate in a plenary session, “Examining Diagnosis and Treatment by Telemedicine: What Is Safe?” at the American Telemedicine Association’s Annual Meeting.

May 8:
Send your feedback on proposed rules for meaningful use of electronic health records (EHR) and the next version of certified EHRs to Terri Marchiori of the AMA. Your input will inform the AMA’s comments on these rules. Read more in Advocacy Update.

May 8:
If your practice uses virtual credit cards (VCC), take a brief survey by May 8 to share your experiences and help the AMA, the Medical Group Management Association and the American Dental Association collect data on the impact of VCC usage and bolster their advocacy on health plan payment issues. Your participation will support the AMA’s push to ensure physician choice in health plan payment methods .

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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.

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