January 7, 2016
National UpdateCMS issues draft quality measurement development plan
The Centers for Medicare & Medicaid Services (CMS) in December released for comment its draft Quality Measure Development Plan (MDP). The Medicare Access and CHIP Reauthorization Act (MACRA) required the Secretary of the Department of Health and Human Services to develop and post “a draft plan for the development of quality measures” on the CMS.gov website by Jan. 1 for application under certain provisions related to the new Medicare Merit-based Incentive Payment System (MIPS) and to certain alternative payment models (APM).
The purpose of the MDP is to meet the requirements of the statute and serve as a strategic framework for the future of clinical quality measure development to support MIPS and APMs. The MDP also highlights known measurement and performance gaps and recommends approaches to close those gaps through development, use and refinement of quality measures. CMS has informed the AMA that the MPD and the comments CMS receives on it will influence the type of funding CMS distributes for measure development over the next five years.
CMS will accept comments through March 1. The final MDP, taking into account public comments CMS receives on the draft plan, will be posted on the CMS.gov website by May 1, followed by updates annually or as otherwise appropriate. Read the CMS blog post on the release of the Quality Measure Development Plan for additional information.
In the final days of 2015, the AMA submitted comments (log in) to the Centers for Medicare & Medicaid Services (CMS) on its 2017 Proposed Notice of Benefit and Payment Parameters Rule. CMS proposed use of quantitative standards to measure network adequacy for qualified health plans (QHP) on federally facilitated exchanges (FFE). The comments were particularly timely because the recently revised National Association of Insurance Commissioners (NAIC) model act on network adequacy failed to require the use of such quantitative standards to regulate networks.
The AMA expressed support for use of quantitative measurements to determine network adequacy and encouraged CMS to require standards that address access to specialists and subspecialists, participating providers at participating hospitals, and providers that care for low-income or vulnerable patients. The comments also urged measurement using a full-time equivalency standard.
Additionally, the comments asked that CMS require all network QHPs to be reviewed and approved prior to being sold, as well as continuously reviewed and reapproved, specifically when a material change is made to the network or the plan population. The AMA supported proposals to increase transparency of provider selections standards and to apply out-of-network cost-sharing to a patient’s out-of-pocket maximum when out-of-network care is received at a participating facility.
The AMA also provided comments on rate review, navigators, providing notices to exchange enrollees transitioning to Medicare coverage, standardized plan options, the drug formulary exceptions process, premium payment threshold policies and the grace period, and changes to the medical loss ratio. The AMA strongly supported CMS’ proposal to clarify the availability of medication-assisted treatment for substance use disorders as an essential health benefit.
Issue SpotlightTop 9 issues that will affect physicians in 2016
What issues should you follow closely in the year ahead? Crucial developments will emerge in health care regulations, legislation and the health insurance market—and many of them will profoundly impact your practice and patients. Taking a look ahead, we’ve identified nine of the top issues you’ll want to watch in 2016.
- 1. Medicare reform. The elimination of the sustainable growth rate (SGR) formula with the passage of the Medicare Access and CHIP Reauthorization Act in 2015 was a giant leap forward for Medicare reform. The law paves the way for important payment reforms. The Merit-Based Incentive Payment System (MIPS) under development is intended to streamline the various reporting programs for physicians, and alternative payment models (APM) will support physicians in adopting new models of care.
Shaping the MIPS so that it fixes the problems of the current system and is beneficial for both physicians and patients will be at the heart of Medicare reform efforts in the coming year. The AMA will continue its work, which includes a task force of physicians from various states and specialties who already drafted and delivered to the Centers for Medicare & Medicaid Services (CMS) 10 principles to guide the foundation of the MIPS, which will streamline requirements for quality, electronic health records (EHR) and resource use.
The AMA also will offer additional resources to help physicians successfully participate in the new system. One resource you can check out already is the recently released the “Guide to physician-focused APMs,” which outlines barriers in current payment systems, presents the three characteristics of successful payment models and details seven physician-focused APMs.
- 2. EHR meaningful use program. This burdensome regulatory program is scheduled to move forward next year, following the Centers for Medicare & Medicaid Services’ (CMS) release of the meaningful use Stage 3 final rule late in 2015. The medical community immediately called on policymakers to put physicians back in control of their practices and put patients before bureaucracy after the rule was released and will continue these efforts this year.
The AMA’s grassroots campaign Break The Red Tape is calling for physician-led and patient-focused medicine and pressing for a reset of Stage 3. Recommendations for the reset seek to alleviate meaningful use burdens and revise the program to improve flexibility, expand patient engagement and clear the way for increased health IT interoperability and innovation.
- 3. Insurance mergers. The nation’s largest health insurers have proposed mergers that would reduce competition in the health insurance market. If approved, this consolidation would have a damaging impact on patients and physician practices by reducing health care access, quality and affordability.
In a letter (log in) to the U.S. assistant attorney general, the AMA urged the Department of Justice to block the proposed mergers and will continue to advocate to Congress and state policy makers to prevent this detriment to health care. Physicians also adopted new policy on the matter at the 2015 AMA Interim Meeting.
- 4. Provider networks and balance billing. Insurer networks are expected to continue narrowing, and out-of-pocket expenses for insured patients will continue to increase. In the face of these trends, the AMA will continue to work with states, the Department of Health and Human Services (HHS) and other groups to protect patients’ access to care and seek solutions to unanticipated out-of-network bills while preserving incentives for insurers to contract and physicians’ rights to fair payment.
- 5. Prescription drug abuse and addiction. A four-fold increase in opioid deaths in the last decade highlights the importance of the opioid overdose epidemic in the year ahead. The AMA Task Force to Reduce Opioid Abuse will continue to provide national leadership to stem this public health crisis. Solutions that need to be adopted this year include use of prescription drug monitoring programs, evidence-based prescribing, a reduction in the stigma associated with substance use disorder, enhanced access to treatment and expanded access to naloxone—the lifesaving medication that can reverse the effects of an opioid overdose.
- 6. Graduate medical education (GME) funding and student debt relief. Critical funding for graduate medical education (GME) is in danger of being cut. The AMA’s Save GME grassroots campaign will continue to urge Congress to maintain funding. Grassroots activities also will focus on simplifying student loan application processes and improving repayment rules as part of the Higher Education Reauthorization Act.
- 7. Prescription drug costs. The cost of prescription drugs has soared in recent years, making it challenging for patients to afford their necessary medications. Pharmaceutical spending growth has shown no signs of abating. In November, physicians voted at the 2015 AMA Interim Meeting to convene a task force and launch an advocacy campaign to drive solutions and make prescription drugs more affordable.
The task force will develop principles to address pharmaceutical costs and support physicians and patients in local and national initiatives that will bring attention to rising prescription drug prices and help put forward solutions to make these drugs more affordable.
- 8. Health data security. Threats to health data security have been increasing over the past two years. A study found that 81 percent of health IT executives reported cyberattacks in that time span. Such endangerment of health data is expected to increase this year. With such private information so vulnerable to attack, appropriate protections for sharing and data storage must be a focal point for health IT. The AMA is working with the federal government to ensure better protections for health information.
- 9. Telemedicine. Already a growing trend in care delivery, telemedicine will see more widespread use in the upcoming year. The AMA intends to advance the Interstate Medical Licensure Compact of the Federation of State Medical Boards, which facilitates state licensure for telemedicine. The AMA also will advocate for the removal of arbitrary barriers to telemedicine coverage under Medicare and promote AMA model state telemedicine legislation.
State UpdateNation’s health policy experts discuss state legislative strategy
The nation’s leading health policy experts are gathering in Tucson Thursday through Saturday to discuss state legislative trends and strategy on issues ranging from prescription drug abuse to health care technology to narrow networks and more.
The 2016 State Legislative Strategy Conference opens Thursday night with a keynote speech by Abraham Verghese, MD, the senior associate chair at Stanford University School of Medicine and a New York Times bestselling author.
The conference brings together more than 75 state and specialty societies and their physician leaders, government relations and health policy experts. The interactive sessions highlight substantive policy issues and provide a forum for organized medicine to discuss strategy, examine tactics and build relationships to share best state legislative practices.
To learn more about the conference, visit the AMA Advocacy Resource Center event Web page.
Idaho’s professional licensing boards recently issued a joint statement of understanding to help promote safe prescribing and dispensing of opioids and other controlled substances. The Idaho Boards of Medicine, Pharmacy, Nursing, Dentistry, Podiatry and Optometry—with support from the legislature and the Governor’s Office of Drug Policy—drafted and signed the statement.
The statement contains these four principles:
- 1. A thorough evaluation of the patient’s condition, needs and history as well as their risks for addiction or diversion, and establishment of a therapeutic relationship with ongoing reconciliation and alignment of goals
- 2. Regular access to the Idaho Prescription Monitoring Program
- 3. Collaboration with others on the health care team
- 4. Educating patients on the appropriate use, storage and disposal of narcotic medication as well as their potential for abuse, diversion and misuse
“Idaho physicians appreciate the efforts of our state’s licensure boards to recognize the important balance between pain management and preventing prescription drug abuse,” said Idaho Medical Association (IMA) President Ronald Cornwell, MD. “IMA believes this joint policy is a good step forward in addressing a serious problem in our state.”
For more information about Idaho’s efforts, email IMA Executive Director Susie Pouliot.
Other NewsRegister now for the 2016 AMA National Advocacy Conference
Join the AMA in Washington, D.C., Feb. 22-24 for the 2016 National Advocacy Conference. This year’s conference features a terrific lineup of guest speakers and a variety of activities and opportunities that will leave you better informed and empowered to advocate for patients, the medical profession and the future of health care.
Keynote speakers for this year’s conference include:
- Ken Adelman, former U.N. ambassador, former Arms Control Director for President Ronald Reagan, and current author, policy analyst and leadership coach
- Chuck Todd, political director of NBC News and host of NBC’s Meet the Press and MSNBC’s MTP Daily
- Joe Scarborough, co-host of MSNBC’s Morning Joe, New York Times best-selling author and former U.S. congressman
The Nathan Davis Awards dinner will be held Feb. 23. The afternoons of Feb. 23 and 24 are free of programming to encourage Capitol Hill visits.
To gain important insights from industry experts, political insiders and members of Congress regarding current efforts being made in health system reform refinement and implementation, register today to attend this year’s 2016 National Advocacy Conference. The deadline to book your hotel room at a special rate is Jan. 22.
A new AMA Policy Research Perspective (log in) presents a national view of physician participation in new payment and delivery models by specialty, practice type and practice ownership. Based on the 2014 Physician Practice Benchmark Survey, it concludes that although the majority (59.0 percent) of physicians worked in practices that received revenue from at least one alternative payment model, fee-for-service payment was still the dominant payment method used by insurers to pay physician practices. An average of 71.9 percent of practice revenue came from fee for service.
Read more at AMA Wire®.
The Centers for Medicare & Medicaid Services (CMS) recently released the timeframes for submitting 2015 Physician Quality Reporting System (PQRS) data. If physicians are not reporting through claims, GPRO Web Interface or EHR Direct, the AMA recommends physicians reach out to their registry or electronic health record (EHR) vendor to coordinate submission.
Eligible professionals who do not satisfactorily report quality measure data to meet the 2015 PQRS requirements will be subject to a negative PQRS payment adjustment on all Medicare Part B Physician Fee Schedule (PFS) services rendered in 2017.
- EHR Direct or Data Submission Vendor (QRDA I or III): Jan. 1–Feb. 29
- Qualified clinical data registries (QCDRs) (QRDA III): Jan. 1–Feb. 29
- Group practice reporting option (GPRO) Web Interface: Jan. 18–Mar. 11
- Qualified registries (Registry XML): Jan. 1–Mar. 31
- QCDRs (QCDR XML): Jan. 1–Mar. 31
- Claims: Due Feb. 28 (Last day that 2015 claims will be processed to be counted for PQRS reporting to determine the 2017 payment adjustment)
Submission ends at 8 p.m. Eastern time on the end date listed. An Enterprise Identity Management (EIDM) account with the “submitter role” is required for these PQRS data submission methods. See the EIDM System Toolkit for additional information.
For questions, contact the QualityNet Help Desk (866) 288-8912, or via email at Qnetsupport@hcqis.org from 7 a.m. to 7 p.m. Central time. Complete information about PQRS is available on the CMS website.
Feb. 19–21: 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, see the online registration form or email Jim Wilson of the AMA.
Feb. 22–24: National Advocacy Conference
Join the AMA in Washington, D.C., at the 2016 National Advocacy Conference, which empowers physicians to advocate for patients, the medical profession and the future of health care. Register today.
April 13–17: 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, see the online registration form or email Jim Wilson of the AMA.