October 8, 2015

National Update

HHS issues new meaningful use regulations despite calls for reassessment

Late in the afternoon of Oct. 6, the Department of Health and Human Services (HHS) issued two major regulations pertaining to the electronic health record (EHR) meaningful use program.

The Medicare and Medicaid Programs Electronic Health Record Incentive Program–Stage 3 and Modifications to Meaningful Use in 2015 through 2017” final rule includes changes in current reporting requirements, as well as setting forth requirements for meaningful use Stage 3, which is planned for implementation in 2018.

The “2015 Edition Health Information Technology Certification Criteria, 2015 Edition Base Electronic Health Record Definition, and ONC Health IT Certification Program Modifications” rule finalizes new certification criteria for EHR systems that will qualify for achieving meaningful use in Stage 3.

The AMA is still in the process of reviewing the lengthy and complex regulations. The first rule does ease some of the previous meaningful use requirements, although its late publication raises questions about whether and how physicians who postponed reporting in 2015 can qualify for a hardship exemption.

That rule also finalizes new requirements for meaningful use Stage 3, despite calls from the AMA and the Federation to postpone issuing more requirements until the overall framework is developed for the new Merit-Based Incentive Payment System (MIPS) mandated by the Medicare Access and CHIP Reauthorization Act. HHS has, however, noted that it will continue to receive comments on Stage 3, suggesting that the program may still be revised in the future.

Members of the U.S. House of Representatives and U.S. Senate also urged regulators to delay finalizing the meaningful use Stage 3 regulations. In the House, Reps. Renee Ellmers, R-N.C., Tom Price, MD, R-Ga., and David Scott, D-Ga., led a bipartisan letter that was signed by 113 other members of the House, urging a delay in the rule.

Sen. John Thune, R-S.D., chairman of the Senate Committee on Commerce, Science and Transportation, and Sen. Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions (HELP), sent a similar letter to the administration on the same day.

The AMA will urge the administration to use the 60-day comment period and the upcoming MIPS rulemaking process to evaluate and reset the meaningful use program.

Physicians switching EHR vendors now can apply for meaningful use exemption

The Centers for Medicare & Medicaid Services (CMS) recently clarified that physicians who switch electronic health records (EHR) vendors now can qualify for a hardship exemption to avoid penalties under the meaningful use program. The AMA has advocated that this hardship exemption be made available.

Many physicians who are not satisfied with their EHR systems are thinking about purchasing and migrating to alternative products. Switching vendors is a laborious, expensive and time-consuming process. Physicians who opt to switch vendors risk failing to meet all the requirements necessary to successfully attest for the meaningful use program.

In a new frequently asked questions document, CMS says that physicians who have switched EHR vendors during the meaningful use program year can apply for an “Extreme and/or Uncontrollable Circumstances Hardship Exception.” If approved, those physicians will be exempt from meaningful use penalties for the year they switch technology. However, CMS is not clear on whether this exemption covers physicians who switch platforms or upgrade technology while staying with the same vendor—which also can be disruptive. For more information on hardship exemptions, visit CMS’ hardship information page.

CMS also has clarified that a decertified EHR may still be used to meet meaningful use requirements if the reporting period ended before decertification occurred. If the reporting period ends after a product is decertified, CMS says physicians may apply for a hardship exemption. For further information on decertified EHRs, visit CMS’ FAQ page.

How to address ICD-10 issues

With the Oct. 1 ICD-10 implementation date behind us, the AMA has revised its online ICD-10 information and resources. If physicians experience any problems with the processing of claims or other administrative transactions, they should take the following steps.

Medicare advance payment for ICD-10 problems

CMS has announced that MACs will issue advance payments in situations where claims cannot be processed within established time limits because of administrative problems, such as contractor system malfunction or ICD-10 implementation problems. An advance payment is a conditional partial payment and will require repayment.

To apply for an advance payment, the physician is required to submit the request to their appropriate MAC. Should there be Medicare systems issues that interfere with claims processing, CMS and the MACs will post information on how to access advance payments. CMS does not have the authority to make advance payments in the case where a physician is unable to submit a valid claim for services rendered.

CMS issues additional ICD-10 question and answers

On Sept. 22, CMS updated “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities,” providing further clarification on issues such as prior authorization requirements, Medicare Advantage claims and coding guidelines.

House Judiciary Committee examines health insurance mergers

On Sept. 29, the House Judiciary Committee’s Subcommittee on Regulatory Reform, Commercial and Antitrust Law held a hearing entitled, “Healthy Competition? An Examination of the Proposed Health Insurance Mergers and the Consequent Impact on Competition.” The hearing investigated issues surrounding the proposed Aetna-Humana and Anthem-Cigna mergers, which would reduce the five large national health insurers to three.

Andrew Gurman, MD, president-elect of the AMA, testified that competition rather than consolidation is the answer to controlling costs and expanding the availability of new, innovative health insurance products. He stated that the AMA’s 2015 Market Competition Survey, which is based on federal merger guidelines, suggests that the proposed mergers warrant careful scrutiny. The AMA believes that further erosion of competition in health insurance markets is not in the best interest of patients, and will continue to urge federal and state regulators to closely scrutinize the proposed health insurer mergers and use enforcement tools to protect consumers and preserve competition.

House members urge reconsideration of Medicare episode payment model

Under the Comprehensive Care for Joint Replacement Model (CCJR) proposed rule, the Centers for Medicare & Medicaid Services (CMS) would calculate total spending during an “episode” of care for hip and knee replacement patients, defined as the hospitalization and 90 days following discharge. Hospitals would receive financial bonuses or penalties based on whether the average episode spending for patients who received surgery at the hospital was lower or higher than a target level defined by CMS. Participation in the CCJR payment model would be mandatory for five years in 75 metropolitan areas selected by CMS.

Rep. Tom Price, MD, R-Ga., sent a letter to CMS on Sept. 21, urging the agency to reconsider and delay implementation of the CCJR proposed rule. Issued July 9, the proposal is intended to reduce Medicare’s spending on the services hip and knee surgery patients receive after they leave the hospital.

The bipartisan letter, which was signed by 60 members of Congress, raised several issues, noting that this would be the first mandatory Medicare episode payment model promulgated by CMS. The letter specifically urges that the proposal be delayed for at least one year. The AMA submitted detailed comments (log in) to CMS on the rule.

AMA receives Transforming Clinical Practice Initiative Award

The AMA is one of 39 health care collaborative networks selected to participate in the Transforming Clinical Practice Initiative (TCPI), announced recently by Department of Health and Human Services Secretary Sylvia Burwell. This means that the AMA will receive more than $650,000 per year to provide technical assistance to help equip our nation’s physicians with the tools, information and network support needed to improve quality of care, increase patients’ access to information and spend health care dollars more wisely.

“We are very pleased to have been selected for this important work, as it provides a strong platform to expand the impact of our strategic focus areas,” said AMA CEO James L. Madara, MD. “We plan to play an important role by broadly communicating the goals and progress of the TCPI initiative to the physician community and using AMA education platforms to help clinicians adapt to the changing landscape of payment and delivery of care. This will help participating physicians meet the initiative’s phases of transformation and associated milestones, clinical and operational results.”

Read the AMA news release for additional information.

Preview quality measures reported on Physician Compare

The Centers for Medicare & Medicaid Services (CMS) is publicly reporting a subset of the 2014 Physician Quality Reporting System (PQRS) measures on Physician Compare. CMS began facilitating a 30-day preview period Oct. 5 for select quality measures through the PQRS portal—Provider Quality Information Portal (PQIP). This preview period provides an opportunity for group practices and individual eligible professionals to review their measures before they are publicly reported on Physician Compare.

To learn more about which measures will be publicly reported and how to preview your measures, visit the Physician Compare Initiative page. Group practices and eligible professionals will need an enterprise identity management account (EIDM) to preview their Physician Compare report.

Physicians who have any questions about Physician Compare, public reporting or the 2014 quality measure preview period should contact CMS’ contractor Westat at

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State Update

New naloxone co-prescribing resources available

The AMA Task Force to Reduce Opioid Abuse launched the latest update to its new website, highlighting tools and resources to aid physicians in co-prescribing naloxone to patients at risk of overdose.

In addition to providing an overview of potential risk factors that may be helpful for a physician to consider when determining whether to co-prescribe naloxone to a patient—or a close family member or friend—a new Web page details states with laws that encourage access to naloxone as well as states that have “Good Samaritan” overdose protections. The task force strongly encourages widespread access to naloxone as well as broad Good Samaritan protections.

There are also additional resources for physicians from organizations in the task force, including the American Society of Addiction Medicine, the American College of Emergency Physicians, the American Society of Anesthesiologists and the American Academy of Addiction Psychiatry.

Download the task force's guide to increasing access to naloxone (log in) for more information on how to save lives from overdose.

Georgia physicians raise nearly $300,000 in support of saving lives from overdose

Last week, the Medical Center Foundation in Gainesville, Ga., raised $281,881 at its annual golf tournament to provide naloxone to law enforcement and first responders in the 13 county areas serviced by the Northeast Georgia Medical Center and provide prescription drug disposal boxes in the community. This is the second consecutive year the effort raised more than $250,000.

The funds will be donated to the Medical Association of Georgia Foundation’s (MAG Foundation) “Think About It” campaign to reduce prescription drug abuse. The “Think About It” campaign promotes four key messages:

“This event is just the latest example of MAG’s and the MAG Foundation’s commitment to saving lives from overdose,” said Jack Chapman, MD, MAG Foundation president. “We are thankful that there is such a strong commitment to this effort from law enforcement, public health officials and physicians throughout our state.”

For more information about the “Think About It” campaign, contact Lori Cassity Murphy with the MAG Foundation at or (678) 303-9282. Visit the AMA website to learn more about the AMA’s work to prevent prescription drug abuse.

North Carolina Medicaid moves to managed care

North Carolina Gov. Pat McCrory signed into law House Bill 372, titled Medicaid Transformation and Reorganization, to reform the state’s Medicaid program. The bill shifts the state’s Medicaid program to a fully capitated system in which private managed care entities insure and manage the health of Medicaid patients.

Managed care entities will receive a set payment per person rather than per procedure as it is under the current fee-for-service system. The bill is a compromise taking a hybrid approach that allows the state to contract with both a statewide health insurance plan as well as up to 10 provider-led entities, such as accountable care organizations.

The AMA has tools and resources available to assist with Medicaid reform efforts in your state. For more information, please contact Annalia Michelman of the AMA.

Rhode Island uninsured rate drops to 5 percent

The number of uninsured people in Rhode Island has dropped by more than one-half since 2012, according to a survey conducted by the state’s health insurance exchange. The rate of uninsured dropped from 11 percent in 2012 to 5 percent in 2015.

Fewer than 50,000 people in Rhode Island now lack health insurance coverage. The state’s health insurance exchange director credited the state’s decision to expand Medicaid and the availability of coverage options on the state-run exchange.

According to U.S. Census data, the rate of uninsured people has dropped more in states that have expanded Medicaid. The AMA will continue working with state and specialty medical societies to expand Medicaid at the state level.

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Other News

Strategies to ensure network adequacy

As part of its series “Improving the health insurance marketplace,” the AMA has developed a new briefing document that describes AMA advocacy efforts on network adequacy. Some health insurers offering plans in the exchanges, as part of Medicare Advantage and to employers are relying on tiered and narrow networks to achieve cost savings. In some cases, these strategies can result in networks that are inadequate to provide meaningful access to timely, convenient and quality care.

To ensure network adequacy, the AMA supports:

The marketplace series and the new briefing document on network adequacy are available online.

New resources available to bolster physician-led team-based care

A new series of advocacy positioning documents on physician-led team-based care summarizes relevant AMA advocacy and recently adopted AMA policy. Physician-led team-based care is consistent with the AMA’s long-term strategic effort to shape innovative payment and delivery models, prepare future physicians to work in interprofessional teams and improve health outcomes.

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Upcoming Events

Oct. 28:
Register for a webinar at 7 p.m. Central time, hosted by the AMA and the American Osteopathic Association: “Strengthen your practice: How to collaborate with peers and other practices.”

Feb. 19-21:
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.

April 13-17:
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.

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