July 30, 2015
National UpdatePDMP support bill moves through House committee
A bill that would help improve prescription drug monitoring programs (PDMP) passed the U.S. House of Representatives Energy and Commerce Committee this week.
The National All Schedules Prescription Electronic Reporting (NASPER) Act, initially authorized in 2005, created a U.S. Department of Health and Human Services grant program for states to implement or enhance PDMPs. H.R. 1725 would reauthorize funding for NASPER, and was previously approved by voice vote in the House Energy and Commerce Health Subcommittee.
PDMPs help physicians in their clinical decision making to appropriately prescribe opioids. The AMA sent a letter of support (log in) for the bill and also called on Congress to fully fund the program through the appropriations process at its authorized level.
The AMA last week submitted comments (log in) on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule on Medicaid managed care, which represents the first major revision to the federal requirements for Medicaid managed care in more than a decade.
“The AMA applauds CMS for taking important steps through these regulations to modernize and strengthen the Medicaid managed care program by aligning its rules and requirements with other major sources of coverage,” AMA Executive Vice President and CEO James L. Madara, MD, wrote to CMS’ acting administrator. “The AMA generally supports alignment of rules across public and private plans as a way to reduce administrative burdens on medical practices, improve care provided to patients and promote accountability by the plans.”
In addition, the AMA:
- Supports the application and reporting of an 85 percent minimum medical loss ratio, greater transparency regarding capitation rate setting and public disclosure of plan operations
- Recommends greater scrutiny of physician payment rates as a critical element to ensure enrollees’ access to care
- Supports new network adequacy and provider directory requirements, but urges CMS to develop stronger standards
- Opposes drug utilization review activities that create barriers to treatment and undermine clinical judgment
- Supports continuation of enrollee benefits during appeals and additional requirements to ensure continuity of care
- Cautions against overly burdensome quality measures and application of the Medicare Advantage Star Ratings system to Medicaid health plans
Issue SpotlightEHR town hall strengthens call for meaningful use improvements
The message from physicians is loud and clear: Electronic health record (EHR) systems have so much potential, but frustrating government regulations have made them almost unusable.
Atlanta-area physicians shared these thoughts firsthand last week in the AMA’s first-ever town hall meeting on EHRs and the meaningful use program, held jointly with the Medical Association of Georgia. Rep. Tom Price, MD, from Georgia’s sixth district, and AMA President Steven J. Stack, MD, listened to physicians’ everyday challenges with EHRs and burdensome government regulations that detract from patient care. About 500 other people registered to watch the event via live-streaming.
During the event, physicians shared their struggles to meet the requirements for the Centers for Medicare & Medicaid Services’ (CMS) meaningful use program.
For example, Melissa Rhodes, MD, a Georgia physician in pulmonary critical care and sleep medicine, is fed up. She was an early adopter of the technology, implementing her first EHR in 2006, more than three years before the meaningful use program was created in legislation. She wanted the system to live up to its promise—but that didn’t happen.
“I don’t think we’re going to do meaningful use Stage 2,” she said at the town hall. “And we’ll take the penalty.”
Dr. Rhodes tallied up how much her three-physician practice has spent on her EHR and related IT costs—over the past year, that number hit $84,000.
But more important than the costs, Dr. Rhodes’ EHR has limitations that affect her patients. The system won’t allow her to titrate orders for patients in the intensive care unit. And she has to personally enter orders, no matter what time of day or night, without being permitted to benefit from the help of nursing colleagues at the hospital.
“There are so many orders you can’t put in,” she said. “It only leads to harm for patient care, and more medical errors—not less.”
Dr. Rhodes’ story sounds like so many others shared at the town hall. Physicians are trying to use EHRs to improve patient care, investing a lot of time and money into making them work, but they are being thwarted.
A top priority for the AMA, just as it is for Dr. Rhodes, is ensuring that patients’ clinical needs and those of the clinicians providing their care are given greater importance than meeting federal regulations. An AMA study with the RAND Corporation revealed EHRs are a major driver of physicians’ dissatisfaction with their practice environments. As a result, the AMA worked with doctors and other experts to create eight priorities for making EHRs usable. These priorities continue to serve as a guide for the AMA’s activities with vendors, policymakers and health care systems.
What’s being done to fix these problems
The U.S. Congress is weighing in, with both chambers targeting the third and final stage of the meaningful use program, which is set to start in 2018.
Rep. Renee Ellmers, R-N.C., yesterday introduced her Further Flexibility in HIT Reporting and Advancing Interoperability Act (Flex IT 2 Act), which would remove the meaningful use program’s pass-fail approach, provide more flexibility and ensure EHR systems address interoperability challenges. The bill also would pause Stage 3 rulemaking to align it with technology advancements and the new merit-based incentive payment system, which will align physician performance metrics.
Meanwhile, Sen. Lamar Alexander, R-Tenn., chair of the U.S. Senate Health, Education, Labor and Pension Committee (HELP), last week asked U.S. Secretary of Health and Human Services Sylvia Burwell to consider a delay in the release of the rule on Stage 3.
What physicians can do
At the town hall, Dr. Stack asked physicians to contact their members of Congress and ask them to halt Stage 3 of meaningful use until the program is fixed. The AMA has been calling for CMS to defer implementation of Stage 3 to assess how changes to earlier stages of the program will affect physician participation and success.
Physicians can visit breaktheredtape.org to share their stories about EHRs and meaningful use, and contact theirs members of Congress.
State UpdateAlaska, Utah move to expand Medicaid
Two more states may expand Medicaid eligibility under the Affordable Care Act and increase access to care.
Alaska Gov. Bill Walker said he will use his constitutional authority to expand Medicaid eligibility in his state. Gov. Walker’s actions come after the state legislature failed to take action on Medicaid expansion earlier this year. The move will give more than 40,000 low-income Alaskans access to health care and will make Alaska the 30th state to expand Medicaid eligibility under the Affordable Care Act.
In Utah, Gov. Gary Herbert and the legislative leadership have reached agreement on a broad, conceptual framework for expanding Medicaid. Formal details of the plan have not been released, but the agreement calls for the state to seek a waiver from the federal government to implement the program and an assessment on certain medical providers. The legislature, which defeated past efforts to expand Medicaid, will convene for a special session to debate the program.
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’s Medicaid expansion campaign Web page for more information.
State legislators should support legislation regulating telemedicine licensure and reimbursement, the AMA told attendees at the National Conference of Insurance Legislators (NCOIL) summer meeting.
During a special health committee meeting on telemedicine, the AMA advocated for endorsement of AMA model state legislation that:
- Ensures that, with certain exceptions (such as curbside consultations or volunteer emergency medical care), physicians and other health practitioners practicing telemedicine are licensed in the state where the patient receives services or are providing these services as otherwise authorized by that state’s medical board
- Ensures that insurers provide coverage for the cost of services provided through telemedicine
- Prohibits insurers from excluding from coverage of a service solely because the service is provided via telemedicine
- Allows parity in reimbursement for telemedicine services as compared to the same provision provided in-person
- Allows insurers to collect a deductible, copayment or coinsurance up to the amount collected for in-person diagnosis, consultation or treatment
- Prohibits annual or lifetime limits on coverage for telemedicine services
Other panelists included representatives from the American Telemedicine Association and America’s Health Insurance Plans. NCOIL will formally consider AMA model telemedicine legislation during the 2015 AMA Interim Meeting in November. For more information, please contact Kristin Schleiter of the AMA.Progress being made on state Rx issues, but more work needed
States have made significant progress enacting new laws and improving existing ones to increase access to naloxone and provide broad Good Samaritan protections, the AMA said in testimony at the National Conference of Insurance Legislators (NCOIL) summer meeting.
Forty states now have laws specifically seeking to increase access to naloxone, an opioid overdose-reversal drug, according to the National Alliance for Model State Drug Laws (NAMSDL), and 28 have enacted Good Samaritan protections for those who provide aid to someone experiencing an overdose. While the AMA noted that many of these new laws and protections have been enacted over the past two state legislative sessions, there remains more work to do in the states.
For more information about naloxone and Good Samaritan legislation, please visit the NAMSDL website and learn more ways how physicians can help with the opioid overdose epidemic.
For more information about AMA model legislation, please contact Daniel Blaney-Koen of the AMA.
Judicial UpdateMedical liability damages cap upheld
The nation’s leading medical liability reform law has been upheld yet again in a California court of appeal, with the court finding that the state’s cap on noneconomic damages is constitutional. It’s another victory to ensure physicians can afford to stay in practice and continue to provide care to the patients in their communities.
In Chan v. Curran, the plaintiff attempted to prove that the non-economic damages cap under Medical Injury Compensation Reform Act (MICRA), California’s historic tort reform law, should be struck down. The cap is set at $250,000.
The plaintiff claimed the MICRA cap was unconstitutional for a few reasons:
- MICRA was put in place to tamp down California’s medical liability insurance crisis in the 1970s, but times have changed and the crisis no longer exists. The court rejected this argument, noting that the Supreme Court of the United States rejected a similar argument.
- The noneconomic damages cap discourages attorneys from taking cases on contingency, so it limits access to the courts. The court held that parties in civil cases are not guaranteed the right to counsel.
- MICRA interferes with the right to jury trial. The court rejected this argument based on previous cases that held the same.
“All of [Chan’s] argument… are ultimately grounded on the assertion she is entitled to seek noneconomic damages sufficient to cover attorney fees,” the court said in its opinion. “No California court has ever endorsed such a proposition… it is contrary to many well-established legal principles.”
The Litigation Center of the AMA and State Medical Societies, along with the California Medical Association, California Hospital Association and California Dental Association, backed the defense of MICRA and filed an amicus brief (log in) last year.
“The noneconomic damages cap… is rationally related to the legitimate state interest of ensuring access to affordable health care,” the brief said. “The importance of MICRA has by no means waned over time.”
Visit the AMA Litigation Center’s Web page to learn more about this case and others related to professional liability and tort reform.
Other NewsRegister for the August 26 webinar on the Veterans Choice Program
Hear from leading U.S. Department of Veterans Affairs (VA) officials on new community-based care options for VA beneficiaries in an AMA-hosted webinar from 7-8 p.m. Eastern time Aug. 26. Register now.
The webinar will discuss how the VA is relying on private practitioners as a short-term solution to delivery problems and workforce shortages. Participants will hear how non-VA providers can sign up to deliver care through the Veterans Choice Program, understand the criteria for participation and learn how to troubleshoot claims processing issues and payment delays.
Read more about the Veterans Choice Program at AMA Wire®.
Voice your concerns: While most physicians have adopted electronic health records (EHR), usability issues have made them burdensome, and many physicians haven’t been able to meet meaningful use requirements. Share your story online, watch a video of real physicians discussing their own issues with the program and email your members of Congress at breaktheredtape.org.
Register for an AMA-hosted webinar from the U.S. Department of Veterans Affairs (VA) from 7-8 p.m. Eastern time Aug. 26. Leading VA officials will discuss new community-based care options for VA, including how non-VA providers can sign up to deliver care through the Veterans Choice Program.
Sign up for the 2016 AMPAC Candidate Workshop, which prepares those considering a run for public office. For more information or to apply, please see the online registration form or email Jim Wilson of the AMA.
Register for the 2016 AMPAC Campaign School, which is for AMA members who wish to become involved in the political process as advocates and volunteers for medicine-friendly candidates. For more information or to apply, please see the online registration form or email Jim Wilson of the AMA.
News You Can Use
Following is suggested content to use in your association’s communication vehicles beginning in August. 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.
- 8 free must-have ICD-10 resources (log in)
- Task force issues new clinical guideline for preventing diabetes (log in)
- 6 steps to start Lean health care in your practice (log in)