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September 10, 2015

National Update

EHRs lose meaningful use certification

The Office of the National Coordinator for Health Information Technology (ONC) recently announced that two electronic health record (EHR) systems that previously were certified for use in the meaningful use program had their certifications terminated. These products both are versions of SkyCare 4.2 developed by Platinum Health Information System, Inc., and physicians can no longer use them to meet meaningful use requirements.

Although fewer than 50 physicians have attested to meaningful use with these products, the decertification of any EHR places the burden of non-compliance squarely on the shoulders of physicians. Physicians caught in this situation must purchase a new product and transfer patient data at a considerable expense. They also must devote staff time to training and implementing a new system if they wish to participate in the meaningful use program and avoid a penalty.

Although the Centers for Medicare & Medicaid Services (CMS) provides a hardship exemption, physicians must go through the process for each reporting period in which they are without a certified EHR.

The AMA continues to advocate (log in) that in the event an EHR is decertified, CMS should provide a process to exempt physicians from meaningful use—or any other reporting program that stipulates the use of certified EHRs. CMS also should require decertified vendors to offset the switching costs physicians face in migrating to another certified product.

Read the ONC’s announcement, and access CMS’ hardship exemption information page. Visit breaktheredtape.org for more information about what the AMA is doing to help fix the meaningful use program and EHR issues.

CMS bundled payment model needs to be voluntary, physician led

In comments (log in) on the proposed Medicare bundled payment model for joint replacement surgery, the AMA urged the Centers for Medicare & Medicaid Services (CMS) to make the program voluntary across the country and allow for physician leadership and greater flexibility.

CMS has proposed a mandatory bundled payment model for 75 localities that would cover all surgical, hospital, post-acute and rehabilitation services until 90 days after a joint replacement operation. CMS would calculate a discounted rate for the episode and then reconcile total episode costs with hospitals where the surgery occurred. CMS then would provide extra money to hospitals if total costs for episodes are below the discounted rate and penalize those with higher costs.

The AMA’s comments recommend that CMS instead allow physicians to form joint replacement teams with hospitals and rehabilitation providers, then work with patients to develop a treatment plan for the entire episode of elective surgery and recovery. The team would designate a jointly governed management organization that could either pay providers based on their service claims or accept and distribute a prospectively determined payment for the episode.

If CMS accepts the AMA’s recommendations, patients all over the country could benefit from the reduced complications, shorter recovery times, increased coordination, stronger patient engagement and improved health outcomes that will be possible from redesigning care for joint replacements.

Specialties call for data access and flexibility in alternative payment models

A number of national medical specialty societies and state associations recently met with the Centers for Medicare & Medicaid Services (CMS) to discuss implementation of the alternative payment model (APM) provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) at the AMA office in Washington, D.C.

Staff representing the societies expressed strong interest in developing APMs and asked CMS for help and support to develop them for discrete conditions that their members manage. AMA and medical society staff emphasized the following:

The group told CMS it also wants to hear from people who have already developed CMS-approved APMs so that they can learn from their experience.

CMS plans to issue a request for information this fall, seeking input from the public on criteria for APMs. Access additional information about MACRA and APMs.

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Issue Spotlight

States where health insurers are squeezing out competition

Proposed mergers among four of the nation’s five largest health insurers could have a big effect on patients and physicians in many communities around the country. What will competition look like in your state? Find out which areas will be most impacted by changes in the health insurance market.

According to special AMA analyses released Tuesday, the proposed mergers of Anthem and Cigna (log in) and of Aetna and Humana (log in) would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states. The mergers also would raise significant competitive concerns in additional areas. All told, nearly one-half of all states could see diminished competition in local health insurance markets.

A breakdown of changes brought by the proposed mergers
The Anthem-Cigna merger would exceed federal antitrust guidelines in 85 metropolitan areas within 13 states:

The merger also would raise significant competitive concerns in additional markets. All told, the Anthem-Cigna merger would diminish competition in up to 111 metropolitan areas within all 14 states in which Anthem currently operates. The 14th state affected is Wisconsin.

A closer look at the Aetna-Humana merger shows that it would exceed federal antitrust guidelines in 15 metropolitan areas within seven states:

The merger also would raise significant competitive concerns in additional markets. In total, the Aetna-Humana merger would diminish competition in up to 58 metropolitan areas within 14 states. The seven additional states are Arizona, Indiana, Louisiana, Mississippi, Tennessee, Wisconsin and West Virginia.

What the current market looks like
The findings about the effects of these two proposed mergers are based on an in-depth analysis of data used to create the newly released 2015 edition of the AMA’s study Competition in Health Insurance: A Comprehensive Study of U.S. Markets, which offers the largest and most complete picture of competition in health insurance markets for 388 metropolitan areas, as well as all 50 states and the District of Columbia. The study is based on 2013 data captured from commercial enrollment in fully and self-insured plans. It also includes participation in consumer-driven health plans.

The prospect of reducing five national health insurance carriers to just three should be viewed in the context of the unprecedented lack of competition that already exists in most health insurance markets. According to the AMA’s latest study, the 10 states with the least competitive commercial health insurance markets were:

Additional important findings include:

“A lack of competition in health insurer markets is not in the best interests of patients or physicians,” AMA President Steven J. Stack, MD, said in a news release. “If a health insurer merger is likely to erode competition, employers and patients may be charged higher than competitive premiums, and physicians may be pressured to accept unfair terms that undermine their role as patient advocates and their ability to provide high-quality care.”

The new study is intended to help researchers, lawmakers, policymakers and regulators identify markets where mergers and acquisitions among health insurers may harm patients, physicians and employers.

The study is free to AMA members, and nonmembers can purchase a copy. Visit the AMA Store, or call (800) 621-8335 and mention item number OP427113 to order a copy.

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State Update

AMA website offers physician resources aimed at curbing nation’s opioid misuse

New Web pages aimed at providing physicians with key education and training resources to help combat the nation’s opioid crisis now are available on the AMA website. The new content was developed as part of the robust work underway by the AMA Task Force to Reduce Opioid Abuse that was launched last month. The Task Force is a collaborative effort by the AMA, American Osteopathic Association, American Dental Association, and more than 20 state and specialty medical societies.

One of the task force’s main goals is to encourage physician education on effective, evidence-based prescribing.

“Voluntarily enhancing our education is a core function that all physicians should embrace,” said AMA Chair-elect, Patrice A. Harris, MD. “That’s why we are working to ensure physicians have the education, resources and training they need on effective, evidence-based prescribing. As physicians, it is our responsibility to educate ourselves on managing pain and promoting safe, responsible opioid prescribing.”

In developing this new online resource, the AMA and the member organizations of the task force identified many key resources that are free or low-cost. These include continuing medical education webinars on preventing opioid abuse, opioid prescribing guidelines, perspectives on the issue and other resources for prescribers. The new section also includes a resource that allows physicians to access state-specific and specialty-specific information from more than 50 state and specialty medical societies.

Model act on network adequacy moves forward

After more than a year of work, the National Association of Insurance Commissioners (NAIC) network adequacy subgroup has released a draft of the NAIC network adequacy model act, Revised Draft of Proposed Revisions to the Managed Care Plan Network Adequacy Model Act (#74) (9/1/2015).

The AMA and multiple state and specialty medical societies have worked on revisions to the model act with the subgroup, consumer representatives and other interested parties during this time. The AMA soon will reach out to Federation partners to discuss AMA comments on the draft and strategies for improving the model act.

The chair of the subgroup has asked for comments on the revised draft regarding technical or clarifying changes to the model, including provisions that were adopted by the subgroup during conference calls and meetings but are not reflected in this draft. The deadline for comments is Sept. 22.

The AMA is carefully reviewing the NAIC draft as it prepares comments and is interested in working with medical associations to either submit their own comments and/or contact regulators who sit on the NAIC subgroup to directly advocate for changes.

Following consideration of the comments and adoption of this model by the subgroup, the model will be considered by the two parent committees—first by the Regulatory Framework Task Force and then by the Health Insurance and Managed Care (B) Committee. Consideration by these committees, especially the B Committee, provides everyone with additional opportunity to influence the final model bill. View a list of the members of all NAIC committees. The AMA will be reaching out to many of you in the coming weeks.

The AMA will hold a national call Sept. 15 at 2 p.m. Central time to discuss the issues above. Please email AMA staff at emily.carroll@ama-assn.org or daniel.blaney-koen@ama-assn.org with any questions.

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Other News

How physician practices can integrate physical and behavioral health care

In a new briefing document (log in), the AMA emphasizes that the health of an individual includes both physical and behavioral components that are best treated holistically in a physician-led, team-based primary care setting. Providing integrated care specifically delivered by a collaborative care team has been shown to successfully manage coexisting diseases.

The document explores various integrated treatment approaches that can be implemented by physician practices according to their delivery model and the needs of their patients, with the collaborative care model being the most comprehensive.

Third annual Save GME Action Week kicked off in August

During the third annual Save GME Action Week last month, the AMA Medical Student Section encouraged students to participate via in-person visits, letters, phone calls and social media outreach. The 2015 effort also saw greater collaboration with the AMA Residents and Fellows Section, the Patient Action Network and the AMA as a whole.

Students advocated for the following during this year’s campaign:

The social media portion of the campaign generated more than 183,000 impressions and more than 2,700 acts of engagement. Additionally students contacted Congress more than 1,500 times via letters and phone calls, and dozens visited their lawmakers.

Over the past three years, the medical community has contacted Congress more than 35,000 times via calls and letters. The SaveGME.org website has had more than 52,000 visits since its launch.

Archived recording of the Veterans Choice Program webinar now available

It’s not too late to hear a recent AMA-hosted webinar on new community-based care options that are now available through the Veterans Choice Program. Register now to view the free archived recording.

By discussing how non-Veterans Affairs (VA) physicians can sign up to deliver care through the Veterans Choice Program, the webinar’s presenters explain how the VA is relying on private practitioners as a short-term solution to the health care delivery problems and workforce shortages that were uncovered last year.

Participants will understand the conditions of participation and learn how to troubleshoot claims processing issues and payment delays. The webinar also dispels common misconceptions about the Veterans Choice Program, and the presenters conclude with an assessment of ongoing policy challenges.

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Upcoming Events

Sept. 21:
Register to attend a free webinar at 3 p.m. Eastern time: “Smart steps for selecting a practice management system.” Whether your practice is looking to purchase a new practice management system or upgrade your current system, get tips on how to find the system that works best for your practice.

Sept. 25-26:
Become an advocacy expert by attending the Candidate Campaign School in Las Vegas, Nevada, hosted by AMPAC, Nevada State Medical Association and Clark County Medical Society. Members of these medical societies can attend for free. Out-of-town participants can attend for $150, and receive a 50 percent discount if they are members of their state or county society. Register to attend.

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