May 14, 2015
National UpdateReview and dispute financial data before May 20
Physicians have until May 20 to review and dispute reports regarding their financial interactions with manufacturers of drugs and medical devices reported under the Physician Payments Sunshine Act (also known as the Open Payments program). Physicians should follow three steps to register and review their data.
Disputes initiated by May 20 will be flagged in the public release of the data on June 30. Physicians can still review and dispute data after May 20, but the data will not be flagged.
Physicians: Send an email detailing your experience registering with the system and reviewing your data. Responses will be used in the AMA's ongoing advocacy efforts.
Physicians have one last chance to find out whether their claims will be processed by Medicare following the Oct. 1 implementation of the ICD-10 code set. Volunteer by May 22 for a special end-to-end testing week being conducted by the Centers for Medicare & Medicaid Services (CMS) July 20-24.
CMS extended the volunteer deadline and will select about 850 submitters to participate in the July 20-24 testing week. Physicians who participated in the January or April end-to-end testing weeks may test again in July without re-applying.
Physicians will have a chance to test sample claims using ICD-10 codes with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The testing is available to those physicians who submit claims directly to Medicare (as opposed to using a clearinghouse). Physicians' clearinghouses may also apply to conduct the testing.
What volunteers need to do
Physicians who are interested in volunteering should visit their MAC's website to download an application form, which must be completed and submitted by May 22.
CMS has said that any issues identified during testing will be addressed prior to ICD-10 implementation. Educational materials will be developed based on the testing results. Read more at AMA Wire®.
Final acknowledgement testing week
Physicians also can conduct acknowledgement testing with Medicare. Acknowledgement testing is less robust than end-to-end testing and essentially simply acknowledges a claim has been received. Physicians can do acknowledgement testing at any time with their MAC / CEDI any time up to the Oct. 1 implementation date. Medicare, however, has placed special focus on specific weeks. The last such week will be June 1-5.
Learn more in an MLN Matters® article.
Issue SpotlightTelemedicine panelists debate future of technology
Panelists discussed how to unlock the promise of telemedicine at the 2015 American Telemedicine Association Annual Meeting earlier this month.
AMA Board of Trustees Member Jack Resneck, MD, participated in a panel discussion about the appropriate use of telemedicine. Panelists included physicians, a health care policy expert and representatives from mobile health apps.
"There is great promise in telemedicine that maintains standards of care and patient protections," Dr. Resneck said.
Establishing a relationship
The panel focused on the patient-physician relationship and the ethical duties that come with establishing a relationship with a new patient via telemedicine and introducing telemedicine into an existing relationship. Where is the line between a physician's responsibility to a patient and providing convenient care?
A valid patient-physician relationship must be established before telemedicine services are provided through a real-time, face-to-face examination, according to AMA policy. This can be done via:
- A face-to-face examination, if a face-to-face encounter would be required in the provision of the same service in the real world
- A consultation with another physician who has an ongoing patient-physician relationship with the patient
- Meeting evidence-based practice guidelines on telemedicine regarding establishing a patient-physician relationship developed by major medical specialty societies
Maintaining standards of care
The policy also calls for additional research and the development of evidence-based clinical practice guidelines that should be followed when delivering telemedicine services. Read about the AMA's policy at AMA Wire. As Dr. Resneck discussed, telemedicine should maintain appropriate standards of care.
"For example, if a family physician would need to look in a patient's ear in real time in order to diagnose an ear infection, a physician must have the opportunity to look in the patient's ear via telemedicine," Dr. Resneck said. "Just talking to a new patient over the phone or reading through the answers of an online survey simply wouldn't meet the standards of care."
As telemedicine moves forward, health care groups and professionals must strive for interoperability, Dr. Resneck said. Telemedicine services should include care coordination with patients' existing medical physicians and other providers, and medical records should be shared among them.
"Telemedicine should not create silos in medical care," he said. "There's an enormous effort in traditional health care to make it more coordinated. Why would we build a new system that's not coordinated?"
Moving into the future To ensure safety, security, usability and interoperability as telemedicine technologies are further developed, the AMA is working with public and private stakeholders and keeping physicians and patients at the heart of the transformation.
The AMA also is:
- Working hand-in-hand with state medical associations as they build, modernize and strengthen the state legislative frameworks to support rapid adoption of telemedicine
- Helping modernize state licensure through an innovative solution designed to expedite the process for physicians to become licensed to practice in multiple states
- Engaging stakeholders in discussions around coding for telemedicine services
- Urging policymakers to pay for more telemedicine services, including removing certain Medicare telehealth restrictions such as those based on geography.
Visit the AMA's Web pages on state telemedicine advocacy or federal digital health advocacy for additional information, and read more about telemedicine's challenges for the medical profession in the AMA Journal of Ethics.Back to Top
State UpdateGeorgia enacts truth in advertising legislation
This week, Georgia Governor Nathan Deal signed into law the Consumer Information and Awareness Act, making Georgia the 19th state to enact truth in advertising legislation.
Georgia's new law, which was based on AMA model truth in advertising legislation (log in), requires health care practitioner advertisements to identify the type of license the health care practitioner holds. The law also requires health care practitioners to wear a name badge during patient encounters that clearly states their license or educational degree.
Visit the Advocacy Resource Center for more information and resources related to the AMA's Truth in Advertising Campaign. If you have further questions, including how your state can introduce truth in advertising legislation, please contact Kristin Schleiter of the AMA.
More than 20 states this year have considered legislation relating to buprenorphine, a medication that is often used to help treat and manage substance use disorder. As medical societies consider policies and legislation concerning medication-assisted treatment (MAT), several medical societies and other groups offer resources that may be useful.
Ohio has a new law that governs the use of buprenorphine in certain clinics and a guidance document that offers more information. The American Society of Addiction Medicine has created a tool that allows states to review Medicaid benefits for the treatment of opioid use disorder. And the AMA recently testified in Congress about the AMA's support for recognizing that opioid use disorder is a medical condition and for increasing coverage for, and access to, MAT and related services.
If you have any questions, contact Daniel Blaney-Koen of the AMA.
Other NewsCMS releases PQRS payment adjustment data, strategic vision
A strategic vision from the Centers for Medicare & Medicaid Services (CMS) describes a long-term vision for the agency's physician quality reporting programs. The document emphasizes alignment among CMS' various quality programs and acknowledges challenges with moving to CMS' desired future.
The agency released the document around the same time as it released statistics on the 2015 Physician Quality Reporting System (PQRS) payment adjustment. Based on 2013 PQRS reporting, 469,755 physicians are subject to a reduction of 1.5 percent of their 2015 Part B Medicare Physician Fee Schedule allowed charges.
Here's a breakdown of the data:
- The majority of physicians who did not successfully participate in 2013 PQRS did not attempt to participate in PQRS.
- Just below 2 percent of physicians did attempt to participate, but they were not successful because they submitted only invalid quality data codes.
- The registry and electronic health record reporting options continue to grow in popularity.
The AMA will continue to advocate for making the PQRS program more meaningful to physicians and patients, as well as ensuring that all physicians can successfully participate in the program and avoid a penalty.
May is National High Blood Pressure Education Month. AMA Wire offers information and resources that can help physicians to engage with and educate patients on this important health issue.
Physicians have until May 20 to review and potentially dispute Physician Payments Sunshine Act financial disclosures from manufacturers of drugs and medical devices. Read more at AMA Wire.
The 2015 AMA Annual Meeting will take place at the Hyatt Regency Chicago.