September 24, 2015
National UpdateHow to handle ICD-10 issues starting Oct. 1
As the Oct. 1 implementation deadline for ICD-10 quickly approaches, physicians need to be prepared for handling any claims processing issues that result from using the new code set.
In July, the Centers for Medicare & Medicaid Services (CMS) announced that the AMA secured flexibilities for physicians to make the transition to ICD-10 less disruptive. One of those provisions was for CMS to establish a communication center to monitor issues and an ICD-10 ombudsman devoted to triaging physician issues.
CMS has said the communication center, headquartered in Baltimore, will begin operation at the end of September. William Rogers, MD, an emergency physician who heads CMS’ Physician Regulatory Issues Team, is the ombudsman.
Physicians who experience claims processing issues should report their complaint to CMS. Visit the AMA ICD-10 Web page to submit a complaint after Oct. 1 and access resources to aid physicians in implementing the new code set.
As frustrations and concerns with electronic health record (EHR) functionality and usability continue to rise, the Office of the National Coordinator (ONC) has launched an online form through which users can log complaints about certified EHR products.
While the ONC and Centers for Medicare & Medicaid Services (CMS) already have online resources addressing many meaningful use and EHR concerns, this new form gives physicians a place to share their certified health IT-related issues with the federal government if they cannot find a resolution within existing ONC resources.
The ONC asks that physicians describe their issues relating to these areas when they complete the form:
- ONC health IT certification
- Information blocking
- Health IT safety
- Privacy and security
- Clinical quality measures
While the ONC may not always be able to step in and fix the problem, they may be able to help in other ways, such as beginning a dialogue between physicians and their EHR vendors/developers. Submitting concerns to the ONC also helps the agency better understand the extent of problems as they work with other federal agencies to develop solutions.
The AMA has been very vocal regarding EHR usability and continues to seek further refinements to the meaningful use program. Visit breaktheredtape.org for more information about EHRs, what the AMA is doing and how to get involved.
Members of the U.S. House of Representatives heard from experts about the Affordable Care Act’s impact on competition during a Sept. 10 hearing of the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law. AMA Immediate Past Board Chair Barbara McAneny, MD, was among those who testified.
In her well-received remarks, Dr. McAneny addressed opportunities to foster competition in the marketplace through new alternative payment models and spoke about the need to reduce antitrust and regulatory barriers for physician practices. Dr. McAneny also addressed issues surrounding consolidation of health insurers and hospitals.
The hearing came just after the release of the 2015 annual update of the AMA’s Competition in Health Insurance study, as well as AMA analyses of proposed mergers between Anthem and Cigna (log in) as well as Aetna and Humana (log in). Given the presence of representatives of both hospital and insurer interests on the panel, much of the hearing focused on the potential impact of consolidation on health care markets.
During her testimony, Dr. McAneny urged rigorous review of these mergers by federal authorities based on evidence that market dominance has not been shown to foster competition or improve access to care or quality. Read the full AMA statement (log in) for additional information.
The House Committee on Ways and Means approved H.R. 1270, the “Restoring Access to Medication Act of 2015,” by voice vote Sept. 17. The bill—introduced by Reps. Lynn Jenkins, R-Kan., and Ron Kind, D-Wis.—would repeal a provision in the Affordable Care Act that requires patients to obtain a prescription for over-the-counter medications in order to purchase them with a flexible spending account or a health savings account.
Sens. Pat Roberts, R-Kan., and Heidi Heitkamp, D-N.D., introduced companion legislation S. 709 in the U.S. Senate. It is not yet known when the full House will consider this bill. The AMA strongly supports this legislation and will continue to advocate for its passage this year.
A new report suggests that the Department of Veterans Affairs (VA) may need to rely more heavily on non-VA providers than previously estimated. These findings reinforce efforts to promote new community-based care options that are now available to eligible VA beneficiaries.
In a recent webinar hosted by the AMA, VA officials described these options and how non-VA physicians could sign-up to deliver care through the Veterans Choice Program. The webinar also dispels common misconceptions about the Veterans Choice Program, and the presenters conclude with an assessment of ongoing policy challenges, many of which were reinforced by the report’s findings.
View a free archived recording of the webinar to learn about the conditions of participation, and train yourself to troubleshoot claims processing issues and payment delays.
Issue SpotlightPut brakes on meaningful use, physicians tell CMS
With the final rule for Stage 3 of electronic health record (EHR) meaningful use expected any day, physicians united last Thursday in calling for policymakers to reevaluate the program and pause it until its prohibitive problems are fixed.
More than 40 national specialty societies joined the AMA in letters to Department of Health and Human Services Secretary Sylvia Burwell (log in) and Office of Management and Budget Director Shaun Donovan (log in), warning that locking in Stage 3 rules for the meaningful use program would inhibit high-quality patient care and undermine implementation of Medicare payment reforms.
“If the administration finalizes the proposed meaningful use Stage 3 regulation now, vendors will create software that will lock in problematic technology, which physicians and patients will be living with for years to come,” the letters state.
The letters point out that the proposed Stage 3 regulation exacerbates the problematic policies of Stage 2, which requires physicians to meet “one-size-fits-all” criteria, rather than allowing them to focus on the clinical activities that would support patient care in their practices.
Implications of finalizing the rule
The Stage 3 proposed rule was developed before the Medicare Access and Chip Reauthorization Act (MACRA) was enacted earlier this year, the letters note. That means the rule also was written without consideration of the changes that law brings about. The meaningful use program will be a component of the new fee-for-service payment framework the MACRA introduces. High-functioning and interoperable EHRs also are expected to be essential resources for physicians who choose to participate in alternative payment models.
“There is growing bipartisan recognition in Congress that the direction of the meaningful use program needs to be reassessed in light of usability and interoperability challenges with EHR systems,” AMA President Steven J. Stack, MD, said in a news release. “Poorly performing systems that do not facilitate the seamless exchange of data would severely undermine the ability of the health system to support the implementation of the payment reforms outlined in MACRA.”
Through the AMA’s Break the Red Tape campaign, physicians have been sharing the repercussions meaningful use is having in their practices. As one physician observed, “I must make [a choice] between direct care for sick, needy, dying and suffering patients, and the need to satisfy the many EHR requirements to complete the visit …. The health of patients is taking a back seat to the need to chart ostensibly to satisfy administrative, regulatory and financial needs.”
Not surprisingly, while 80 percent of physicians have adopted EHRs in their practices, less than 10 percent of physicians have successfully participated in meaningful use Stage 2 so far.
Calls in Congress
Several members of Congress are calling for a delay of meaningful use Stage 3. That includes a bill introduced in July by Rep. Renee Ellmers, R-N.C.
Just this week, Senate Health Committee Chairman Lamar Alexander, R-Tenn., called for a delay in making Stage 3 rules final until 2017.
“Patients need an interoperable system that enables doctors and hospitals to share their EHRs,” Sen. Alexander said at a Senate hearing. “But the government, doctors and hospitals need time to do it right.”
What you can do
Federal policymakers need to hear from you. Join the groundswell of physician input by sharing your experiences and stories of how EHRs and current meaningful use regulations have impacted your practice and the care you provide your patients. Visit breaktheredtape.org, where you also can see testimonies from your fellow physicians.
While there, you can quickly send an email to your members of Congress, asking them to halt Stage 3 of meaningful use until the program is fixed.
Also plan to participate in a special town hall meeting from 6:30 to 8:30 p.m. Eastern time Sept. 29 at the Massachusetts Medical Society’s headquarters in Waltham, Mass. The meeting will give participants an opportunity to shine a spotlight on the problems with meaningful use regulations and what they have meant for your patients and practice. If you’re not in the Boston area, you can participate via live streaming, beginning at 7 p.m. Eastern time. Sign up today.
State UpdateAMA opposes portions of network adequacy draft model legislation
The AMA this week filed technical edits on the current draft of the National Association of Insurance Commissioners (NAIC) Managed Care Plan Network Adequacy Model Act #74. In addition, the AMA publicly opposed incorporation of language that would regulate provider payments and language that could substitute telemedicine providers for in-person physicians.
The AMA’s comments to the network adequacy subgroup request that rather than modeling regulation of provider payments, the NAIC should make significant changes to network adequacy standards to address the root of so-called “surprise billing.” The AMA will separately call on the NAIC parent committees of the subgroup to remove the problematic language and address the network adequacy issues that lead to “surprise billing.” The AMA will be reaching out to multiple Federation partners to assist with this effort.
Though the NAIC’s intent was to support the use of telemedicine to complement in-person providers and assist patients in rural locations where in-network providers are unavailable, the current language allows telemedicine providers to replace in-person physicians for the purposes of meeting network adequacy standards.
While the AMA noted its significant concern with the above issues, it also addressed several positive elements to the draft model act that, if adopted by states, would help ensure patient access to care. Included in these provisions are ones that:
- Would require stronger regulation and transparency of provider directories
- Create a shift toward regulator evaluation of networks and a shift away from using accreditation as a “deeming” tool
- Put forward options for using quantitative standards to measure adequacy
- Define and suggest attention be paid to tiered networks to prevent discriminatory network designs
- Increase focus on access to appropriate specialty care, including pediatric specialty care
- Require transparency in carriers’ selection and tiering criteria used to build networks
The number of deaths from opioid overdose is on the rise and expected to be in the thousands this year. In an effort to curb this steep increase, the AMA and the New Hampshire Medical Society (NHMS) recently collaborated on two op-eds in the state.
“Combating the nation’s opioid epidemic will require comprehensive efforts with specific approaches that must be implemented in emergency departments, physician practices, outpatient surgical settings and community health centers in every town and city in America,” wrote AMA Chair-elect Patrice A. Harris, MD, and NHMS President Lukas Kolm, MD. The two op-eds appeared this month on Fosters.com and in The Keene Sentinel.
Drs. Harris and Kolm emphasized that it is physicians’ collective responsibility to work together to provide a clear road map that will help bring an end to this public health epidemic. Specifically, they recommended five ways that physicians can make a significant difference and save lives:
- 1. Register for and use state-based prescription drug monitoring programs.
- 2. Discuss with patients available treatment options.
- 3. Take advantage of educational opportunities.
- 4. Reduce the stigma of pain and of having a substance use disorder.
- 5. Increase access to naloxone and support Good Samaritan protections.
“There is still much work to be done, and we recognize that it will take time to turn the tide,” they wrote. “But physicians in New Hampshire and across the nation are committed to showing the leadership our patients need and deserve to once and for all bring an end to this deadly epidemic.”
Learn more about AMA advocacy through the AMA Task Force to Reduce Opioid Abuse and New Hampshire state efforts.
Other NewsUpdated toolkit outlines 6 steps for selecting a practice management system
Physicians who make well-informed practice management system purchases for their practices can significantly increase staff productivity, improve practice work flow and reduce administrative burden within the claims revenue cycle. To assist practices in making this important decision, the AMA and the Medical Group Management Association (MGMA) have collaborated on an updated Selecting a Practice Management System Toolkit.
The revised toolkit offers tips on how practices can identify their top priorities and needs for a new system, as well as tools that can be used during the selection process. Toolkit resources include:
- 6 steps to practice management system selection, which offers a stepwise, proactive approach in selecting the right technology partner for the practice
- Practice management system criteria checklist, an editable Word document that serves as a starting point for practices in identifying system features and functionality that will increase overall practice efficiency and compliance
- Sample request for proposal (RFP), a template practices can use in preparing RFPs to send to vendors
- Smart steps for selecting a practice management system, an archived webinar by AMA and MGMA staff that walks through the decision-making process
Visit the toolkit Web page to access these resources and learn more about how technology can help practices meet today’s challenges.How physician collaboration can create stronger practices
A newly updated resource from the AMA, Strengthen your practice: How to collaborate with peers and other practices (formerly “Competing in the marketplace”) can help physicians navigate the changing practice landscape. It covers practice options ranging from mergers to a wide variety of other, more basic collaborative arrangements.
Taking the initial steps toward collaboration with peers and other practices can provide physicians with important benefits, including being able to:
- Take advantage of new payment models that reward physicians financially based on performance with respect to quality, resource utilization and other metrics (e.g., reducing hospital readmissions or emergency department visits)
- Develop economies of scale and raise capital that can help fund the development of practice infrastructure (e.g., health IT)
- Lawfully negotiate jointly with payers
Contact the AMA for pre-written messages you can customize and use in your own communications to let your members know about this resource.Physicians are still paid based on productivity, report shows
A new Policy Research Perspective (log in) from the AMA describes the use and intensity of various payment methods among non-solo physicians. Based on the 2014 Physician Practice Benchmark Survey, the report concludes that despite the continued focus on alternative payment models, pay based on productivity is still a large and important factor—and its use appears to have changed little since 2012.
In 2014, 33 percent (or 33 cents of every dollar) earned by non-solo physicians was received through pay based on productivity. For owner physicians, this was even higher: 42 cents. 50 percent (or 50 cents of every dollar) of compensation was received through salary. 51 percent of non-solo physicians said that their compensation was based on more than one method.
Nearly 60 representatives from 24 states recently came together in Washington, D.C., for the annual AMPAC Federation Meeting. Held in conjunction with the AMA Council on Legislation (COL) fall meeting, nine members of the COL joined AMPAC participants for the legislative briefing and Capitol Hill visits.
These representatives participated in 55 lobbying visits to Capitol Hill as the AMA advocates for Congress to postpone Medicare’s Stage 3 electronic health record meaningful use regulations, repeal the Independent Payment Advisory Board and support diabetes prevention programs. Indications are that the AMA’s messages were favorably received, but with a full issue agenda this fall and the distraction of the presidential election campaign, physicians need to continue to weigh-in on these issues.
After the Capitol Hill visits, the program continued with presentations on fundraising. The meeting concluded with national political handicapper Stu Rothenberg’s look at the 2016 elections.
News You Can Use
Following is suggested content to use in your association’s communication vehicles throughout the month of October. 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 ways Medicare payment policies could soon change (log in)
- How to get the power of numbers—even if your practice is small (log in)
- New data: Diabetes, prediabetes affect 1 in 2 adults—but there’s hope (log in)
- How new med students are diving into health care delivery science (log in)
Participate in a special town hall meeting from 6:30 to 8:30 p.m. Eastern time at the Massachusetts Medical Society’s headquarters in Waltham, Mass. The meeting will give participants an opportunity to shine a spotlight on the problems with meaningful use regulations and what they have meant for your patients and practice. If you’re not in the Boston area, you can participate via live streaming, beginning at 7 p.m. Eastern time. Sign up today.
Physicians need to make sure their practices are ready for the ICD-10 implementation deadline. Download resources in a free module on the AMA STEPS Forward website. Additional information is available at AMA Wire®, including the last-minute guide to prepping for ICD-10.
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.