January 7, 2016

National Update

CMS 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 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 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.

AMA emphasizes quantitative standards to measure network adequacy

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.

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Issue Spotlight

Top 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.

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State Update

Nation’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 forms coalition to tackle prescription drug abuse

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:

“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.

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Other News

Register 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:

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.

New research on prevalence of new payment models released

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®.

CMS announces submission timeframes for 2015 PQRS data

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.

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 from 7 a.m. to 7 p.m. Central time. Complete information about PQRS is available on the CMS website.

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Upcoming Events

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.

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