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June 18, 2015

National Update

House to take up IPAB repeal bill

The U.S. House of Representatives is expected to vote on legislation this week that would repeal the Independent Payment Advisory Board (IPAB), an independent panel empowered to make significant health care payment and policy decisions that could adversely affect access to health care for millions of Medicare patients.

H.R. 1190, the Protecting Seniors' Access to Medicare Act, is sponsored by Reps. Phil Roe, MD, R-Tenn., and Linda Sanchez, D-Calif.

Similar to the now-repealed sustainable growth rate formula, the IPAB is an arbitrary system that relies solely on payment cuts to reduce Medicare spending.

Unfortunately, the legislation included a last-minute provision to offset its estimated $7 billion cost through reduced funding for the Prevention and Public Health Fund, which provides expanded and sustained national investments in prevention and public health—an offset that the AMA cannot support.

The AMA will continue to work with House and U.S. Senate supporters of IPAB repeal to move the legislation forward and secure final passage without the inclusion of the Prevention and Public Health Fund cuts.

Bill would alleviate Medicare audit and appeals backlog

A bill that would address the current two-year backlog of Medicare appeals advanced through the U.S. Senate Committee on Finance earlier this month.

The committee passed the Audit and Appeal Fairness, Integrity and Reforms in Medicare Act on June 3 by voice vote. This legislation, sponsored by its chairman Sen. Orrin Hatch, R-Utah, and ranking member Sen. Ron Wyden, D-Ore., includes several policy provisions the AMA supports. The legislation would significantly increase the resources for the Office of Medicare Hearings and Appeals (OMHA) and the Departmental Appeals Board of the U.S. Department of Health and Human Services (HHS) to decrease processing times and increase the volume of adjudications. Other improvements to the OMHA were included to reduce the variation in appeals decisions across the continuum.

The AMA believes a fundamental cause of the current appeals backlog relates to the significant flaws with the recovery audit contractor (RAC) and other audit programs. This legislation would help address this issue by requiring the secretary of HHS to promote transparency and consistency in Medicare payment and coverage policy and ensure that Medicare review entities apply them consistently. It is not yet known when the full Senate will consider the measure.

Senate committee considers meaningful use improvements

The second in a series of five Senate committee hearings to improve electronic health records (EHR) focused on proposals to improve the meaningful use program.

The Senate Committee on Health, Education, Labor and Pensions held the hearing Tuesday, part of a series intended to help inform the bipartisan EHR working group formed earlier this year by its chairman Sen. Lamar Alexander, R-Tenn., and ranking member Sen. Patty Murray, D-Wash.

Witnesses representing health care systems discussed the need for flexibility in the EHR reporting requirements, including allowing allied health professionals to enter information in the EHR when appropriate and the need for standardized terminology and data elements across EHR systems. The panel generally did not support halting Stage 3 of the program, scheduled to begin in 2018. The next hearing in the series will examine the exchange of patient data and who owns the data.

Register for PQRS group practice reporting option by June 30

Practices with two or more physicians can participate in the 2015 Physician Quality Reporting System (PQRS) group practice reporting option. Register for this option by 11:59 p.m. Eastern time June 30.

Physicians in a practice with two or more physicians do not have to participate as a group practice and may participate as individuals in the program, which may be a better option for certain practices. Upon group practice registration, a practice must indicate which of the following PQRS options it intends to use:

If a practice wants to participate in PQRS through a qualified clinical data registry, it should not register as a group practice, since that option is not available to them—it is only available to physicians participating as individuals. In addition, it is highly recommended that practices wishing to participate as a group practice and submit data via the EHR first consult with the practice's EHR vendor before registering, since some vendors do not support the group practice EHR option. All practices considering group practice reporting in 2015 should weigh all their options, since they cannot change their designation with the Centers for Medicare & Medicaid Services once the registration period closes. Those who are participating in PQRS as an individual do not need to register.

Access the registration system using a valid Individuals Authorized Access to the CMS Computer Services (IACS) account. Step-by-step instructions for obtaining an IACS account with the correct role and for registering are on the PQRS group practice reporting option Web page.

Apply for meaningful use hardship exemptions by June 30

Physicians can apply for a meaningful use hardship exemption by 11:59 p.m. Eastern time June 30 to avoid a 2016 penalty. Some of the hardship exemptions require physicians to file accompanying documentation that may be hard to compile in a single day, so it is important not to wait until the last day to file.

Certain types of physicians designated by their Medicare Provider Enrollment, Chain and Ownership System (PECOS) code are not required to file for a hardship. Instead, Medicare will automatically grant a hardship exemption to the following specialties:

Get more information and instructions.

Sunshine Act payment data to be released June 30

Physicians' 2014 financial data under the Physician Payments Sunshine Act, also known as the Open Payments program, will be released to the public June 30. There is still time to review and dispute errors that will be reflected in the next scheduled update of the database.

Even though CMS overrode the AMA and other medical associations' calls to delay the release of 2013 payment data in light of all the problems, the AMA was able to head off much of the anticipated interpretation troubles by educating reporters about issues with the data, guiding physicians through the review and dispute process and providing talking points to explain the data to inquiring patients.

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Issue Spotlight

Doctors call for two-year grace period for ICD-10 implementation

With less than four months to go before the deadline for implementing the ICD-10 code set, physicians last week agreed to seek a two-year grace period to avoid financial disruptions to facilitate a smoother transition that would allow physicians to continue providing quality care to their patients.

Physicians at the 2015 AMA Annual Meeting last week passed policy calling on the Centers for Medicare & Medicaid Services not to withhold claim payments based on coding errors, mistakes or malfunctions in the system for two years directly following implementation.

Meanwhile, Rep. Gary Palmer, R-Ala., introduced the Protecting Patients and Physicians Against Coding Act, which aims to provide a two-year grace period during the transition.

Physicians have begun contacting their members of Congress through the AMA Physicians' Grassroots Network, urging them to adopt the grace period so that potential disruptions do not impact care delivery. Encourage members of your association to email their members of Congress using the AMA Physicians' Grassroots Network.

Read more about the AMA's new ICD-10 policies at AMA Wire.

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State Update

How a recent Supreme Court case affects physicians

State medical licensing board members may not be immune from the federal antitrust laws and may therefore be at risk for antitrust liability as a result of the Supreme Court of the United States' recent decision in North Carolina State Board of Dental Examiners v. Federal Trade Commission. This exposure has the potential to be significant since prevailing antitrust plaintiffs are entitled to treble damages and attorney fees. Moreover, the cost of defending antitrust cases can be prohibitive.

As a result, such concerns could easily discourage physicians from serving on medical licensure boards. This negative possibility so concerned the U.S. Supreme Court that it offered in its opinion an important solution for states to consider: "And of course, the states may provide for the defense and indemnification of agency members in the event of litigation."

This is the solution offered by new AMA model legislation, An Act to Encourage Medical Licensing Board Activities. The AMA model bill:


Email Henry Allen of the AMA for more information.

Model bills focus on naloxone, medication-assisted treatment

More than 16,000 Americans died in 2013 from causes involving prescription opioids, and more than 8,000 died from heroin-related overdoses, pointing to a need for legislation focused on overdose prevention and treatment for substance use disorder. Two model bills from the AMA can help.

The newly updated AMA model bills seek to increase access to naloxone, provide Good Samaritan protections and enhance coverage for medication-assisted treatment.

In the past two years, more than 15 states have enacted legislation to increase access to naloxone and provide Good Samaritan protections for those who assist someone who has overdosed. The AMA has supported many of those new laws and the new model legislation uses provisions from those bills.

Many states continue to struggle to ensure that patients have access to a full range of medication-assisted treatment services through their insurance. The revised model bill provides for increased physician input in a governor-created task force to develop recommendations to ensure and increase access medication-assisted treatment services.

For more information on how your state can introduce these bills, email Daniel Blaney-Koen of the AMA.

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Other News

How real physicians are making their practices thrive

Physicians have found a way to minimize stress and overcome barriers to providing the best care: A free online series of proven solutions developed by physicians that can make your practice thrive.

The AMA's newly launched STEPS Forward website offers a collection of interactive educational modules that help physicians address common practice challenges while earning continuing medical education credit. The modules include steps for implementation, case studies, and downloadable tools and resources.

Read more at AMA Wire®.

Get the updated guide to electronic remittance advice

Physicians interested in implementing or maximizing the utility of electronic remittance advice (ERA) can use an updated AMA toolkit for insight into questions to ask insurers, billing services and practice management system vendors before making the switch from paper explanations of payment.

The toolkit:



Learn more about using electronic transactions at AMA Wire®.

Sign up for AMPAC's 2016 political education programs

AMA members and their spouses who are interested in politics should check out two workshops offered by AMPAC in Arlington, Va. More than 30 past participants currently hold public office, including five members of the U.S. Congress.

Those considering a run for public office should attend AMPAC's Candidate Workshop Feb. 19-21. The workshop includes training on campaign strategy and media advertising, as well as hands-on sessions in public speaking and fundraising.

The 2016 Campaign School, April 13-17, is for AMA members who wish to become involved in the political process as advocates and volunteers for medicine-friendly candidates. The school is organized around a simulated congressional campaign, where participants are put on campaign "staff" teams and attend daily lectures on campaign strategy, media advertising and political fundraising. Each team participates in nightly exercises such as creating a campaign strategy, taping a radio commercial and writing a political fundraising letter.

For both programs, AMPAC covers all costs for AMA members except transportation to the Washington, D.C. metro area. For more information on these programs or an application, please see the online registration form or email Jim Wilson of the AMA.

CMS to host Physician Compare informational webinar

The Centers for Medicare & Medicaid Services (CMS) will host a webinar to discuss Physician Compare from 1-2 p.m. Eastern time June 23. During this session, CMS will answer stakeholders' questions about Physician Compare and public reporting.

To register for the webinar, send an email with the subject line "Physician Compare Virtual Office Hour" and include your name, organization, telephone number and email address. For more information about Physician Compare, visit the Physician Compare Initiative page.

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Upcoming Events

June 30:
Practices with two or more physicians can participate in Medicare's 2015 Physician Quality Reporting System group practice reporting option. Register for this option by June 30.

June 30:
Physicians can apply for a meaningful use hardship exemption by June 30 to avoid a penalty next year. Get more information and instructions

June 30:
Physicians' 2014 financial data under the Physician Payments Sunshine Act, also known as the Open Payments program, will be released to the public June 30. There still is time to review and dispute errors that will be reflected in the next scheduled update of the database.

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