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October 22, 2015

National Update

President announces new initiatives to solve opioid crisis

As the nation struggles with an opioid abuse crisis, President Obama Wednesday announced new partnerships to halt this public health epidemic. In the President’s announcement, he emphasized the need to expand access to treatment for substance abuse as well as increasing public and provider awareness and education.

“We are extremely pleased that President Obama is undertaking initiatives to halt the nation's opioid crisis,” said Patrice A. Harris, MD, chair-elect, AMA Board of Trustees, in a statement. “The AMA recognizes the severity of this public health epidemic and is fully committed to being an active partner in implementing solutions to combat it.”

The AMA and more than 40 other professional organizations have committed to:

These elements are crucial to ending this public health epidemic, and also form the basis of work being done by the AMA Task Force to Reduce Opioid Abuse. Further underscoring the commitment and leadership of the nation’s physicians, this task force is identifying best practices for physicians to combat this crisis and strategies for quickly implementing these practices. Dr. Harris and Task Force members will present an educational program on the opioid epidemic at the upcoming AMA House of Delegates Interim Meeting.

The Administration also committed to addressing AMA concerns about how pain management is evaluated in patient satisfaction surveys and the impact of these surveys on the environment facing physicians as they evaluate options for treating their patients’ pain.

Additional partnerships announced by the President today will increase access to nonpharmacologic treatments for pain, such as physical therapy, and improve the ability of first responders, family members and others to administer naloxone to patients experiencing an overdose.

Visit the AMA Task Force to Reduce Opioid Abuse website to learn more about the task force and the AMA’s commitment to ending this public health epidemic.

How community-based physicians can improve care for service members

The White House Joining Forces initiative is hosting 2015 Wellness Week Nov. 9-13 in honor of Veterans Day, which will include a series of educational webinars on important topics that affect health services for service members, veterans and their families. Each hourlong webinar is worth one continuing medical education credit.

The AMA and several other organizations are cosponsoring Joining Forces Wellness Week 2015. In addition to the Joining Forces webinars, physicians can view an archived AMA webinar to learn how to sign up to deliver care to veterans through the Veterans Choice Program. This new program was established by Congress following the revelation of significant wait times and falsified documents at Veterans Health Administration facilities.

CMS extends comment period for MACRA request for information

Directly pursuant to aggressive AMA advocacy, the Centers for Medicare & Medicaid Services (CMS) has extended the comment period for the request for information (RFI) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The comment period, which was originally just 30 days, will now close Nov. 17.

CMS’ announcement of the extension also includes a list of the RFI issues that the agency has assigned as initial priority areas. The extension and prioritization of sections and questions is a result of the AMA strongly urging CMS to allow stakeholders the opportunity to offer thoughtful and meaningful comments.

HHS payment models committee includes physician-backed candidates

To expand the opportunities for physicians to become qualified participants in alternative payment models (APM), the Medicare Access and CHIP Reauthorization Act (MACRA) legislation provided for the establishment of a Physician-Focused Payment Models Technical Advisory Committee (PTAC). This committee will review APM proposals and make recommendations to the U.S. Department of Health and Human Services (HHS). Of the 11 members, no more than five can be health care professionals.

The PTAC members were appointed this month, and four of the 11 members are candidates supported by the AMA. These members include two physicians—Jeffrey Bailet, MD, a Wisconsin otolaryngologist, and Grace Terrell, MD, a North Carolina internist—as well as two payment reform policy leaders—Harold Miller from the Center for Healthcare Quality and Payment Reform and Elizabeth Mitchell from the Network for Regional Healthcare Improvement.

Legislation would loosen restrictions on physician-owned hospitals

Growth restrictions established in the Affordable Care Act (ACA) for existing physician-owned hospitals could be loosened under a bill that would allow these hospitals to expand for three years. The AMA sent a letter (log in) earlier this month to Rep. Sam Johnson, R-Texas, in support of H.R. 2513, the Promoting Access, Competition and Equity (PACE) Act.

Starting Oct. 1, 2019, physician-owned hospitals must have three years of three stars or higher on the hospital star rating program in order to be allowed to expand their facilities. The bill would allow for three physician-owned facilities that were under construction but were not completed before the ACA’s grandfather deadline to participate in Medicare. It is possible that the House Ways and Means Committee could consider this legislation this fall.

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Issue Spotlight

What physicians need to know about the new EHR regulations

More than 1,300 pages of new regulations released earlier this month outline requirements for the electronic health record (EHR) meaningful use program, with several changes applying this year. We’ve gathered some of the most important changes that will affect your practice.

A mixed bag
The regulations fall under two new rules—one that modifies Stage 2 of the meaningful use program and finalizes requirements for Stage 3, and one that establishes technological parameters for the new edition of certified EHR technology.

On the upside, the first rule eases and streamlines some of the requirements for Stage 2. But the rule simultaneously ignores clear calls from Congress and physicians to hold off on Stage 3 until the program is reassessed for practicality and alignment with new payment and delivery reforms.

Immediate improvements to Stage 2 include several that the AMA had urged the Centers for Medicare & Medicaid Services (CMS) to make:

And while these are positive modifications, CMS didn’t release the final regulations until Oct. 6—several days into the final 90-day period of the year. Equally as concerning, the regulations now require a public health and clinical data registry reporting objective that previously was optional.

So far, only 12 percent of physicians have met Stage 2 requirements. Read a summary (log in) of modifications made in the new regulations.

Securing a hardship exemption
Fortunately, physicians will have some recourse for avoiding penalties. Responding to requests from the AMA, CMS has said that physicians who are unable to meet meaningful use requirements this year as a result of the delayed publication of the regulations can apply for a hardship exemption.

The AMA is encouraging physicians to apply for a hardship exemption under the “extreme and uncontrollable circumstances” category, even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements this year, but applying can serve as a safety net in staving off a penalty. The exemption application will be available early next year.

“In the past, CMS has considered these applications seriously and, in fact, has approved over 85 percent of hardship exemptions,” the agency said in a recent FAQ.

Stage 3 looms for 2018
Under the rule, all physicians will be required to meet Stage 3 requirements beginning in 2018. The finalized rule as currently written would be very burdensome for physicians, to put it mildly. Among the many mandates will be upgrading to EHR products that meet the new certification requirements. Read a summary (log in) of the main requirements for Stage 3 outlined in the new regulations.

While CMS is allowing a 60-day comment period for feedback on the final rule, a groundswell of physician responses will be needed to change the proposal, given the complexities of the lengthy regulations already issued.

The AMA is intensifying its efforts to engage lawmakers and other stakeholders to reset the direction of the meaningful use program.

What you can do now
Physicians can visit BreakTheRedTape.org to easily submit their comments on the new rule to CMS and ask the agency to take action so that critical problems with the program are addressed before moving forward.

Also, physicians can join their peers in sharing their stories about how meaningful use regulations are affecting the patient-physician relationship.

It’s time to break free from the EHR red tape.

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State Update

Legislation would ban practice of shackling pregnant prisoners

Last week, the AMA wrote New York Governor Andrew M. Cuomo a letter in support of Assembly Bill 6430.A and Senate Bill 983.A, legislation to strengthen the existing state law prohibiting the shackling of pregnant prisoners.

The AMA has long-standing policy that opposes the shackling of pregnant prisoners during labor, delivery and postpartum recovery because it is unnecessary and dangerous to a woman’s health and wellbeing. In fact, the vast majority of female prisoners or detainees incarcerated are non-violent offenders, and restraining these prisoners and detainees increases their potential for physical harm from an accidental trip or fall.

Freedom from physical restraints is especially critical during labor, delivery and postpartum recovery after delivery. Most importantly, restraints on a pregnant woman can interfere with the medical staff’s ability to appropriately assist in childbirth or to conduct sudden emergency procedures. Currently 21 states ban the practice.

For more information about AMA advocacy and resources, please email Carrie Armour of the AMA.

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Judicial Update

Supreme Court to weigh insurer payment transparency

Health insurers are fighting a state law that would create transparency for physicians and patients when it comes to health insurance payments. A case before the Supreme Court of the United States will determine whether a technicality will stand in the way of reform efforts and keep the insurance payment process cloaked in mystery.

The issue at hand in Gobeille v. Liberty Mutual Insurance Co. is whether or not the federal Employee Retirement Income Security Act of 1974 (ERISA) preempts a Vermont law requiring health insurers to submit claims payment data to an all-payer claims database maintained by the state.

The intent of increased transparency is to create a more competitive market that would benefit both health care consumers and physicians by driving down prices while improving quality.

The Litigation Center of the AMA and State Medical Societies filed an amicus brief (log in) in support of the state legislation.

Claims databases such as the one in Vermont … “provide important information to consumers, providers and policymakers about health care options, outcomes and costs that enable these stakeholders to make more informed decisions about obtaining and paying for medical treatment,” the brief said, further urging that Vermont’s statute is not preempted by ERISA.

Read more at AMA Wire®.

Court case threatens physician-patient confidentiality

What if patients no longer felt safe sharing personal—yet crucial—information with their physicians? A case to be heard by the Washington Supreme Court threatens the integrity of the patient-physician relationship, potentially raising new obstacles to communication and trust.

In Volk v. DeMeerleer, a treating psychiatrist was charged with liability for his patient’s homicidal actions in 2010. A lower court decided that the psychiatrist could not have identified the actual victims as targets because the patient had communicated no threats against them during his treatment.

An appeals court then examined the duty of a mental health professional to protect a third party when an outpatient occasionally expresses homicidal ideas without identifying the ultimate target. The majority reversed the trial court and ruled that mental health professionals who treat voluntary outpatients may owe a duty to protect “all foreseeable victims, not only those reasonably identifiable victims who were actually threatened by the patient.”

However, a state law designed to protect doctor-patient confidentiality provides that mental health professionals owe a duty to third parties only when a patient has “communicated an actual threat of physical violence against a reasonably identifiable victim or victims.”

The Litigation Center of the AMA and State Medical Societies joined six other health care associations in Washington in an amicus brief opposing the court of appeals decision. “Therapy is not effective if patients stay away or do not open up when they do seek treatment,” the brief said.

“This case illustrates the difficulties in treating patients who have combinations of serious problems, are not under the ‘control’ of the psychiatrist and do not meet the criteria for involuntary commitment,” the brief said. “Any diminution in patient confidentiality, as the [court of appeals] decision… would do, will jeopardize the chances for continued and successful mental health treatment and will cause some practitioners to cease serving such patients.”

Read more at AMA Wire.

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Other News

Physicians should file a 2014 PQRS, Value Modifier informal review

Based on potential calculation issues with 2014 measures for the Physician Quality Reporting System (PQRS) and Value Modifier, the AMA strongly encourages physician practices to file a PQRS and Value Modifier informal review and download their Quality and Resource Use Reports (QRUR). The 2016 PQRS and Value Modifier payment adjustments are based on 2014 reporting.

For groups with 10 or more PQRS-eligible professionals who are subject to the 2016 Value Modifier, the QRUR shows how the Value Modifier will affect Medicare’s 2016 payments to physicians. Value Modifier cost and quality scores also will be provided in the QRURs for practices that are not yet subject to the Value Modifier. If physicians or group practices think an incentive payment or penalty was performed in error, they must file an informal review via the Quality Reporting Communication Support Page by Nov. 9.

The AMA continues to advocate for changes to the PQRS and Value Modifier programs, and is actively encouraging the Centers for Medicare & Medicaid Services (CMS) to extend the informal review deadline to allow practices more time to view and download their QRURs and file an informal review.

In order to access the portal to review reports and/or file an informal review, an Enterprise Identity Management System (EIDM) account is required.

CMS transitioned the portal from the Individual Access to CMS Computer Services (IACS) to this new system July 13. The IACS system is now retired, but current PQRS and Value Modifier IACS users, their data and roles have moved to EIDM. This system is accessible from the CMS Enterprise Portal at //portal.cms.gov. The EIDM system provides a way for business partners to apply for, obtain approval for and receive a single user ID for accessing multiple CMS applications.

New AMA resource helps practices step toward improved financial health

Physicians can learn ways to streamline their business processes through automation with the help of a new module on the AMA’s STEPS Forward™ website. STEPS Forward offers a series of interactive educational modules that help physicians address common practice challenges with innovative ideas.

The “Revenue cycle management in medical practice” module offers a step-by-step approach to boosting administrative efficiency, from eligibility verification to health plan payment and patient billing. The module provides a wealth of helpful information for practices, including:

Visit stepsforward.org to access this and other modules featuring proven practice solutions.

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News You Can Use

Following is suggested content to use in your association’s communication vehicles throughout the month of November. 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.

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Upcoming Events

Oct. 28: Webinar on advocacy storytelling and legislative update
If you’re ready for your members of Congress to take note of what you have to say, a special webinar at 7 p.m. Eastern time is for you. Brad Fitch, president and CEO of the Congressional Management Foundation, will give the inside scoop about the power of sharing a compelling story. AMA staff also will give a legislative update. Register today.

Oct. 28: Webinar on collaborating with peers and other practices
Think practice integration is too expensive or time consuming? Not necessarily. Hear from expert health care attorneys about how to strengthen your practice by collaborating with peers and other practices. Participate in a free webinar hosted by the AMA and the American Osteopathic Association at 8 p.m. Eastern time. Register today.

Nov. 14-17: 2015 AMA Interim Meeting
The 2015 AMA Interim Meeting is taking place in Atlanta. Visit the meeting website to learn more about educational activities, topics that will be discussed and other opportunities.

Feb. 19-21: 2016 AMPAC Candidate Workshop
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: 2016 AMPAC Campaign School
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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