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February 4, 2016

National Update

New funding proposal for addiction treatment

This week President Obama announced a proposal to provide more than $1 billion in new funding to expand patient access to treatment for opioid use disorder. The funding announcement is a follow-up to the White House’s high-priority initiative to prevent opioid and heroin overdose deaths and expand access to treatment announced last October.

Ninety percent of the new funding will go to support cooperative agreements with states to expand access to medication-assisted treatment by increasing treatment capacity and making services more affordable. Expanding treatment access is one of the five major goals of the AMA Task Force to Reduce Opioid Abuse and the AMA applauded the funding announcement.

Congressional action is required before funding becomes available.

Avoid meaningful use penalties: Apply for exemption by March 15

Physicians have until March 15 to apply for a hardship exemption from the electronic health record (EHR) meaningful use financial penalties for the 2015 program year. Those who don’t apply could face up to a 3 percent cut in their Medicare payments in 2017 since the meaningful use program operates on a two-year look-back period. New this year, individuals can apply on behalf of a group of physicians.

Everyone should apply: The Centers for Medicare & Medicaid Services (CMS) has stated that it will broadly grant hardship exemptions as a result of the delayed publication of the Stage 2 meaningful use modifications rule, which left physicians with insufficient time to report under the modified program requirements issued in late 2015.

This inclusive approach to hardship exemptions is a result of the Patient Access and Medicare Protection Act, passed just before Congress adjourned for the holidays, which directed CMS to make AMA-supported changes to the previously limited exemption process.

All physicians should apply for the exemption since there isn’t a downside to doing so. Even physicians who believe they met the requirements of the meaningful use program in 2015 can apply. Submitting an application for a hardship exemption will not prevent those who qualify from receiving an incentive payment.

How to apply: Physicians should be sure to submit their applications before midnight Eastern Time on March 15, 2016. To get started, download an application from CMS and consult step-by-step instructions (log in) the AMA compiled to help simplify the submission process.

While CMS has given a deadline for applications, it has not yet indicated when physicians will receive confirmation of their exemption status.

Senate committee releases draft health IT legislation

The Senate Committee on Health, Education, Labor and Pensions (HELP) recently released draft bipartisan legislation to improve health IT. The proposal includes several important provisions that will advance electronic health records (EHR) by prioritizing key areas, such as interoperability, provider directories and patient matching.

The proposal also includes the TRUST IT Act (S. 2141)—legislation previously introduced by Sen. Bill Cassidy, MD, R-La., and Sen. Sheldon Whitehouse, D-R.I.,—that promotes greater transparency of EHR capabilities through a public rating system to assist purchasers in making more informed decisions and prohibits information blocking.

The AMA will continue to work with Congress and regulators to improve EHRs for both physicians and patients.

Telemedicine bill introduced in Congress

A bill to advance the practice of telemedicine recently was introduced in both the U.S. House of Representatives and the Senate. The AMA has offered support for the CONNECT for HEALTH Act (S. 2484/HR. 4442), which was introduced Wednesday by Sens. Brian Schatz, D-Hawaii, Roger Wicker, R-Miss., Thad Cochran, R-Miss., Ben Cardin, D-Md., John Thune, R-S.D., and Mark Warner, D-Va. Reps. Diane Black, R-Tenn., and Peter Welch, D-Vt., introduced the measure in the House.

The bill would remove outdated statutory restrictions on Medicare coverage of telemedicine that limit beneficiary access to these services, including for physician participants in alternative payment models and the new Merit-based Incentive Payment System (MIPS). The legislation also would accelerate the adoption of health care delivery models that promote coordinated and patient-centered care.

The AMA has been committed to working with Congress to unlock the promise of telehealth technology to improve patient care and looks forward to working with the bill’s sponsors to advance this legislation.

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Issue Spotlight

Top 4 issues physicians will take to state legislatures in 2016

Throughout the year to come, physicians will see some key issues play out across all 50 states as medical associations and policymakers put forth new legislation and protect existing policy on critical components to the practice of medicine. Four issues weigh heavily at the top of the list.

Medical association leaders recently met in Tucson, Ariz., at the 2016 AMA State Legislative Strategy Conference to discuss the most imperative state legislative and regulatory priorities. Leading the 2016 agenda are these four issues:

1. Ensuring physician-led team-based care. Many state medical associations plan to strengthen care delivery through legislation that supports physician-led team-based care. The states will be considering AMA model state legislation that encourages flexible, innovative health care teams under a framework of physician leadership to achieve the “triple aim”—providing the highest quality of care at the lowest cost possible while improving patient outcomes.

The AMA’s STEPS Forward™ collection offers several modules to help physician practices move toward team-based care. These physician-authored modules include instructions for implementing team documentation, strengthening team culture, conducting effective team meetings and setting your practice up for successful change.

2. Improving patient health. State and national medical specialty societies plan to expand efforts to advance legislation that will promote healthier communities.

Last year, incursions on the patient-physician relationship continued in many statehouses with legislation that attempted to prescribe the content of information exchanged between physicians and their patients. In the year ahead, 11 state medical associations will promote legislation aimed at protecting the patient-physician relationship. Another big focus will be tobacco use and availability, with legislative efforts in 17 states.

3. Reducing prescription drug abuse and overdose. The opioid overdose epidemic has cast a spotlight on pharmaceutical and prescribing issues, drawing the interest of state policymakers and placing considerable focus on prescription drug misuse, diversion, overdose and death.

22 state medical associations and two national medical specialty societies plan to consider legislation on the use of prescription drug monitoring programs (PDMP), while 15 states will look to expand access to naloxone and other overdose and abuse prevention efforts.

“America’s physicians must do a better job of using all available tools to help stop this epidemic,” Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees, recently wrote. “Among the powerful tools in our arsenal that we must regularly use are PDMPs, enhanced education and naloxone.”

4. Managed care and payer issues. Progress was made in 2015 to pass reforms and educate lawmakers on issues such as network adequacy, prior authorization, fair contracting and transparency of insurer practices. Expanded efforts and models bills from the AMA’s private payer campaign are intended to achieve further improvements on these issues in the year to come.

18 state medical association and seven national medical specialty societies are expected to focus on network adequacy legislation. Additionally, 19 state medical associations plan to pursue legislative changes to prior authorization, which poses roadblocks to patient care, delays much needed services and can stall the delivery of patients’ treatment.

Other issues physicians will be taking to their state lawmakers this year include medical liability reform, Medicaid reform, and the legislative and regulatory environments for telemedicine and telehealth.

The AMA Advocacy Resource Center will continue to provide relevant legislative support to state and national medical specialty societies to advance these priorities through model bills and state-specific activity.

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State Update

Naloxone access and Good Samaritan laws progressing in states

Several states, including Arizona, Iowa, Missouri, Nebraska and South Dakota, have proposed legislation looking to increase access to naloxone and provide Good Samaritan protections to those who aid someone experiencing an overdose. Bills in these states, while varying in scope and breadth, continue to demonstrate the national momentum to help save lives from being taken by overdose.

More than 40 states now have enhanced naloxone access laws, and more than 30 have Good Samaritan protections.

“The most important reason for the AMA’s support is that this [type of] legislation saves lives,” AMA Executive Vice President and CEO James L. Madara, MD, recently wrote to the Nebraska State Legislature.

“Naloxone is one part of the process to help save lives,” said John R. Massey, MD, who represents the Nebraska Medical Association and Nebraska American Academy of Pain Medicine. “As physicians we must remember the importance of our diligence in preventing patients from needing this rescue treatment as well."

Visit the AMA website for more information about naloxone and Good Samaritan legislation.

Ohio physicians endorse acute care prescribing guidelines

The Ohio State Medical Association (OSMA) recently endorsed the new Guideline for the Management of Acute Pain Outside of Emergency Departments, created by the Ohio Governor’s Cabinet Opiate Action Team (GCOAT).

This set of guidelines, which is are the third issued by the GCOAT, provides:

“These guidelines represent a recommended standard of care for outpatient management of acute pain,” the OSMA said in a statement. “And while these guidelines are not intended to replace the clinical judgment of a physician, the OSMA welcomes the guidelines as an additional and necessary tool for helping physicians and other prescribers determine the best and most appropriate form of treatment for a patient.”

Previous guidelines issued by GCOAT were: Ohio Emergency and Acute Care Facility Opioids and Other Controlled Substances Prescribing Guidelines and Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain 80 mg of a Morphine Equivalent Dose (MED) “Trigger Point.”

For more information about the guidelines, contact Jennifer Hayhurst of the OSMA.

States continue to pursue Interstate Medical Licensure Compact

Legislation to facilitate joining the Interstate Medical Licensure Compact is off to a busy start in 2016. The compact is a newly proposed licensing option under which qualified physicians seeking to practice in multiple states would be eligible for expedited licensure in certain states. So far in 2016, seven states (Alaska, Arizona, Colorado, Kansas, Maryland, New Hampshire and Washington) have seen compact legislation introduced.

In several other states, legislation carried over from 2015 continues to progress. State medical societies in many of these states expect to support such legislation. The AMA has endorsed the compact and stands ready to work with any state interested in joining. Contact Kristin Schleiter of the AMA for more information.

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Other News

CMS issues DMEPOS prior authorization final rule

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule that establishes a prior authorization process for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

The final rule does not create any new clinical documentation requirements but will require physicians to submit information supporting Medicare payments for certain items prior to those items being furnished to a beneficiary. These items will be selected by CMS from a “master list” of items identified by the agency as being frequently subject to unnecessary utilization. A list of the items targeted for prior authorization will be published by the agency with 60 days’ notice before prior authorization is required.

Under the final rule, CMS notes that it will “make reasonable effort” to provide a prior authorization determination to providers within 10 business days of submission. Physicians will be allowed unlimited resubmissions, and an expedited review process will be available where delay could jeopardize the life or health of the beneficiary.

The AMA continues to oppose the use of prior authorization programs by payers and has worked diligently to limit the use of these controls. In a July 2014 comment letter to CMS (log in) addressing the DMEPOS prior authorization proposed rule, the AMA opposed this program because of the administrative burdens it would place on physician practices and the negative impact on patient access to care. The AMA urged CMS to shorten prior authorization response times, restrict the program to a small number DMEPOS items, and limit application of the program to statistical outliers instead of broadly requiring prior authorization of all physicians.

AMA provides feedback to Chronic Care Working Group

On Jan. 26, the AMA issued comments (log in) on the Bipartisan Chronic Care Working Group Policy Options Document, released by the Senate Committee on Finance in December. The options document contains key policy ideas that the work group is considering based upon initial input received from stakeholders earlier in the year.

The comments applauded the inclusion of initiatives to expand access to prediabetes education programs, which is consistent with the work of the AMA’s Improving Health Outcomes initiative.  Several recommendations regarding the use of telehealth and accountable care organizations in the treatment of chronic conditions also were included.

It is expected that the working group, which is co-chaired by Sens. Johnny Isakson, R-Ga., and Mark R. Warner, D-Va., will review this second round of comments and develop a more finite list of policy options that show the most potential for improving care coordination and the treatment of chronic conditions in Medicare. The working group and the Finance Committee plan to develop bipartisan legislation to be acted upon later this year.

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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.

March 20–22: AMA-MGMA Collaborate in Practice Meeting
Join the AMA and MGMA in Colorado Springs to gather leadership techniques to help propel you and your organization to future success. Former U.S. Sen. Bill Bradley, D-NJ, and Richard Deem, AMA senior vice president of advocacy, will speak on leadership and the changing health care landscape. Register online, and receive a discount when you register two or more of your team members.

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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