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May 28, 2015

National Update

CMS proposes changes to the meaningful use program

The Centers for Medicare & Medicaid Services (CMS) recently took the rare step of reopening rulemaking for Stages 1 and 2 of the meaningful use electronic health record program and proposed some changes to the program following AMA advocacy.

The AMA has been actively urging the administration to reduce the prescriptive nature of meaningful use and to add flexibility to the reporting requirements. The agency's proposed changes include reduced thresholds physicians must meet on some of the more challenging measures—like requiring patients to view their records on a patient portal—while still retaining a patient's individual choice about when and how they want to access their medical information. The changes would also shorten the meaningful use reporting period to 90 days in 2015.

Although the AMA supports many of the proposed changes, it asked CMS to make further adjustments, such as reducing all meaningful use reporting periods past 2015 to less than a full year. The AMA also continues to advocate for a permanent end to the 100 percent pass or fail approach in both Stages 2 and 3 of the program.

Read more about the proposed changes at AMA Wire®, and read detailed feedback and recommendations in the AMA's comment letter (log in) to CMS.

Physicians voice concern about annual wellness visit standards

Several state medical societies have raised concerns about commercial entities that have no ongoing relationship with patients providing the Medicare annual wellness visit. In response, the AMA joined with several national medical specialty societies whose members often provide the annual wellness visit in sending a letter to the Acting Administrator of the Centers for Medicare & Medicaid Services (CMS).

In a meeting with senior CMS officials following their receipt of the letter, agency staff expressed appreciation to the physician community for bringing this issue to their attention. CMS indicated that it shares these concerns, particularly for Medicare patients who have a regular source of care that also provides their annual wellness visits. It becomes an even more significant concern when annual wellness visit providers do not send a reliable report to the patient's usual source of care after the service is provided.

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Issue Spotlight

Changes physicians should know in the SGR repeal law

When the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law in April, it didn't just repeal the Medicare sustainable growth rate (SGR) formula that had been plaguing physicians for nearly two decades. The bill contained other provisions that will impact how physicians deliver care now and in the future.

Here are several provisions that should be beneficial for physicians:

Medicare payment rates will be stable.
MACRA prevented an impending physician payment cut under the SGR and increased the Medicare conversion factor, part of the formula for calculating physician payments. As a result, Medicare physician pay this year will be 27 percent greater than under SGR.

The bill also provides for positive payment updates of 0.5 percent, starting July 1 this year and then on Jan. 1 annually through 2019. Over the next decade, MACRA is projected to increase Medicare funding for physician services by roughly $150 billion.

Quality reporting programs will be consolidated.
Medicare's current quality reporting programs will be simplified into one merit-based incentive payment system, referred to as "MIPS." This means the current web of penalties under the Physician Quality Reporting System (PQRS), meaningful use electronic health record (EHR) program and the value-based payment modifier will expire at the end of 2018 and will be replaced with the MIPS.

Beginning in 2019, physicians who score well in the MIPS could receive substantial bonuses.

Performance under the MIPS will be based upon four categories—quality, resource use, meaningful use and clinical practice improvement activities. The MIPS also would build and improve upon current quality measures and concepts in existing programs.

Physicians will be encouraged to report quality measures through certified EHR technology or qualified clinical data registries. Participation in a qualified clinical data registry would also count as a clinical practice improvement activity.

Alternative payment models will be rewarded.
Physicians who participate in qualified alternative payment models will receive a 5 percent bonus starting in 2019. These physicians also will be exempt from participating in MIPS. Technical support will be provided to help smaller practices participate in alternative payment models.

The AMA is engaging with medical specialty societies and other organizations to help develop and get payers to support implementation of physician-designed alternative payment models. Results from a recent AMA study conducted by the RAND Corporation found that doctors want to improve patient care delivery through new payment models but need help successfully managing the transition. That includes being able to resolve the diverse priorities and quality metrics of different payers and securing more timely and accurate clinical data to ensure long-term success.

Through its Professional Satisfaction and Practice Sustainability initiative, the AMA is taking on this challenge. Visit the Web page on Medicare alternative payment models for more information.

Physicians will have liability protections.
The bill contains a provision similar to the Standard of Care Protection Act that will protect physicians by preventing quality program standards and measures (such as PQRS or MIPS) from being used as a standard or duty of care in medical liability cases.

Learn more about how MACRA will impact physicians on the AMA's new Web page on Medicare physician payment reform, including fact sheets on the impact of MACRA in each state. More resources include:

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State Update

Interstate Medical Licensure Compact clears key hurdle

Alabama and Minnesota last week became the seventh and eighth states to pass legislation to join the Interstate Medical Licensure Compact. These passages trigger formation of an interstate commission that will oversee the compact, which will include members from these eight states.

The compact is designed to facilitate a speedier process with fewer administrative burdens for physicians seeking licensure in multiple states. The commission will meet later this year to discuss the compact's management and administration.

Members of the commission will consist of two voting representatives appointed by each member state. Commissioners will be:


The Interstate Medical Licensure Compact model legislation creates a streamlined process for medical licensure for physicians interested in practicing medicine in multiple states. Alabama and Minnesota join Idaho, Montana, South Dakota, Utah, West Virginia and Wyoming as states that have formally enacted the compact.

Read more at AMA Wire.

Nuance, communication needed for scope of opioid epidemic

As policymakers work to craft potential solutions to the nation's opioid-related abuse, misuse, overdose and death epidemic, it is critical to look at all relevant sources of data to fully understand how policy interventions can be targeted, said Patrice A. Harris, MD, secretary to the AMA Board of Trustees, to the National Association of Boards of Pharmacy at its annual meeting last week.

Using data from the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration and other sources, Dr. Harris described differences in state prescribing rates, rates of harm, and differences in prescription drug deaths by gender, race and ethnicity. Understanding why these differences exist is key to crafting public health solutions that can reduce rates of abuse, misuse, overdose and death, Dr. Harris said.

She also emphasized that physicians, pharmacists and other health care professionals should be working together for their patients' benefits. Understanding the role that each plays in the therapeutic triad will help ensure the physician-pharmacist relationship remains strong, she said.

Learn more about the AMA's work to combat prescription drug abuse.

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Other News

Survey results show concerns with virtual credit card use

An informal online survey about physicians and other health care providers' experiences with virtual credit cards (VCC) and Automated Clearing House Electronic Funds Transfer (ACH EFT) revealed that while VCC use is growing, there are still issues to be worked out and physicians need more education on these types of payments.

The AMA, American Dental Association and Medical Group Management Association conducted the survey, which achieved significant response (1,140 participants) and reflected practices' experience and concerns with electronic payments.

VCCs are an increasingly used form of claims payment in which health plans or vendors send practices (via fax, mail, or email) a single-use number that needs to be keyed into a credit card point-of-sale system to receive contractual fees. ACH EFT is the standard for electronic health care payments, mandated by the Health Insurance and Portability Act, and similar to direct deposit.

Key survey insights included:



The survey results will be used in upcoming advocacy work, including AMA testimony before the National Committee on Vital and Health Statistics on June 17. For additional information and educational resources on VCCs and ACH EFT, visit the AMA's EFT Toolkit.

CMS to host Physician Compare informational webinar

The Centers for Medicare & Medicaid Services (CMS) will host a webinar to discuss the Physician Compare program from 1-2 p.m. Eastern time June 23.

During this session, CMS will answer questions about Physician Compare and public reporting, but the agency is requesting that participants submit their questions in advance of the webinar. All questions must be received by 5 p.m. Eastern time June 15. To register or submit question, send an email to PhysicianCompare@Westat.com. Please use the subject line "Physician Compare Virtual Office Hour" and include your name, organization, telephone number and email address. For more information, visit CMS' Physician Compare Initiative Web page.

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Upcoming Events

June 6-10:
The 2015 AMA Annual Meeting will take place at the Hyatt Regency Chicago.

June 8:
The Litigation Center of the AMA and State Medical Societies will host an open meeting from 7-9 a.m. June 8 at the Hyatt Regency Chicago. The meeting will discuss current lawsuits that seek parity of benefits for mental health and substance abuse conditions under health insurance policies, including the recent Supreme Court of the United States decision in FTC vs. North Carolina State Board of Medical Examiners.

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