February 18, 2016
National UpdateSenate committee approves bipartisan opioid abuse legislation
The U.S. Senate Judiciary Committee approved the Comprehensive Addiction and Recovery Act (CARA) (S. 524) by voice vote Feb. 11. The bill was introduced by Sens. Sheldon Whitehouse, D-R.I., and Rob Portman, R-Ohio, and has 28 additional cosponsors. It represents a bipartisan, holistic approach to addressing the opioid abuse issue.
The bill would authorize funding for several grant programs that would be overseen by the Department of Health and Human Services and the Department of Justice.
The AMA supports major elements of the CARA, including initiatives on prevention, education, treatment and recovery, and has worked closely with the sponsors to secure improvements. Companion legislation (H.R. 953) was introduced in the U.S. House of Representatives by Rep. Jim Sensenbrenner, R-Wis.
The full Senate is expected to begin consideration of the CARA, along with other opioid abuse legislation, as early as Feb. 22.
The Senate Health, Education, Labor Pensions (HELP) Committee unanimously approved the Improving Health Information Technology Act (S. 2511) Feb. 9; it was the outgrowth of six HELP Committee hearings in 2015 assessing the health IT environment.
The bill, which was introduced by HELP Committee Chairman Lamar Alexander, R-Tenn., and Ranking Member Patty Murray, D-Wash., would advance electronic health records (EHR) by prioritizing key areas such as interoperability, provider directories and patient matching. In addition, the bill includes provisions from the TRUST IT Act, a bill previously introduced by Sens. Bill Cassidy, MD, R-La., and Sheldon Whitehouse, D-R.I., that promotes greater transparency of the capabilities of EHRs through a public rating system to assist purchasers in making more informed decisions.
The AMA will continue to work with the HELP Committee to improve EHRs and the meaningful use program. The HELP Committee will consider additional legislation this spring as part of its health care “innovations” series of mark-ups, including bills that would modernize the Food and Drug Administration and boost investments in the National Institutes of Health.
The House Committee on Veterans Affairs (VA) Subcommittee on Health held a recent hearing titled “Choice consolidation: Improving VA community care billing and reimbursement.” The AMA submitted a statement for the record (log in) on the VA’s proposal to improve partnerships with private physicians to ensure that veterans receive timely access to care through the Veterans Choice Program (VCP).
The AMA highlighted its support for consolidating the VCP and all existing community care programs into one program, improving the payment process through automated billing and ensuring that payments are at least as high as Medicare rates. Additionally, the AMA expressed concerns with the VA’s proposal on the issue of tiered networks.
This was the second in a series of hearings that the House VA Committee has held to consider streamlining the VCP and other programs that allow veterans to access care outside the VA.
New fact sheets on permitted uses and disclosures of protected health information (PHI) for treatment and health care operations purposes under the Health Information Portability and Accountability Act (HIPAA) were released by the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and Office of the National Coordinator for Health IT (ONC). HIPAA generally permits physicians to use and disclose protected health information for treatment and health care operations without first obtaining a patient’s written authorization.
The fact sheets were announced in the first of a series of blog posts created to correct misunderstandings about HIPAA, address physician concerns related to the exchange of PHI in the absence of patient authorization and demonstrate how HIPAA supports interoperability by allowing the transfer of electronic PHI through Certified Electronic Health Record Technology or other electronic means.
In addition to its ongoing efforts to improve the interoperability (log in) and usability of electronic health records, the AMA continues to advocate for more clarity on how HIPAA relates to physicians and their patients. The AMA has also created a toolkit on related aspects of HIPAA, which includes the requirements around privacy and security.
Physicians now have an additional two weeks to attest to meaningful use for the 2015 program year. The Centers for Medicare & Medicaid Services (CMS) extended the original Feb. 29 attestation deadline to midnight Eastern time March 11.
Physicians must attest to meaningful use every year to receive an incentive payment and avoid a penalty. Note that CMS is only extending the attestation period, not the reporting period, so physicians must have concluded their reporting by Dec. 31, 2015.
To attest, physicians should submit their data through the CMS registration and attestation system. Physicians may select an EHR reporting period of any continuous 90 days from Jan. 1, 2015, (the start of the 2015 calendar year) through Dec. 31, 2015.
To speed the attestation process, the AMA recommends that physicians attest during off-peak hours, such as evenings and weekends, and take time now to ensure that their information is up-to-date before beginning to enter 2015 data.
As a reminder, the AMA is encouraging all physicians to apply for a hardship exemption as a result of the delay of the 2015 meaningful use modification rule. The AMA has confirmed with CMS that applying for the hardship exemption will not preclude physicians from receiving the incentive if they successfully attest. In essence, the hardship exemption will act as a safety net. Step-by-step instructions (log in) on how to file for the exemption may be found on the AMA website.
Issue SpotlightAMA president calls on physicians to turn the tide of the opioid epidemic
The nation’s physicians Wednesday received a direct appeal from AMA President Steven J. Stack, MD, urging them to take swift action to end the opioid epidemic that has claimed more than 250,000 lives over the past 15 years.
“We have a defining moment before us—the kind of moment that we will look back on in years to come as one in which we as a profession rose to the challenge to save our patients, our families and our communities during a time of crisis,” Dr. Stack wrote.
He likened this epidemic to the HIV/AIDS epidemic, in which policymakers, public health leaders and physicians came together to implement solutions that changed the course of history for people with an HIV/AIDS diagnosis and their loved ones. He called on physicians to “mount a similar response” to the opioid epidemic.
“The loss of lives we are seeing around us and in the news every day is unacceptable—and we don’t have to accept it,” he wrote. “Each and every one of us must band together to take specific actions that will turn the tide.”
He pointed to the five essential actions and resources for physicians that have been identified by the AMA Task Force to Reduce Prescription Opioid Abuse:
- Register for and use their state’s prescription drug monitoring program (PDMP)
- Enhance their education and training about safe prescribing
- Co-prescribe naloxone to patients at risk of overdose
- Get training to provide medication-assisted treatment (MAT) for and help reduce stigma around substance use disorders
- Speak out against stigma around patients in pain and the physicians who treat them
Physicians identify ways to improve overdose prevention efforts
Also this week, the AMA released a national survey of physicians that looks at steps physicians have taken already and barriers to providing non-opioid therapy to treat patients’ pain.
Findings of the survey, conducted by TNS of Kantar Group, include:
- PDMPs: 87 percent of physicians agree that PDMPs help physicians become more informed about a patient’s prescription history. To further enhance these databases, physicians said PDMPs need improvement to integrate with electronic health records, provide real-time data and other key features that would make them even more useful. The AMA Task Force to Reduce Prescription Opioid Abuse is urging states to ensure these and other important features are part of their PDMPs.
- Continuing medical education (CME): 68 percent of respondents have taken CME on safe opioid prescribing, and 55 percent have taken CME on managing pain with opioid alternatives. But the survey found that physicians seek more practice-specific and specialty-specific education. 1 in 4 physicians said CME on these issues was not readily available for their specialty or that directly address their practice needs. The task force offers a full collection of the most up-to-date state and specialty-specific education resources so physicians can easily find the materials they need.
- MAT education: Only 15 percent of the surveyed physicians had taken education on MAT. Several medical organizations offer waiver-qualifying MAT training to help physicians recognize patients with substance use disorder and become certified to increase access to treatment.
- Naloxone: More than 80 percent of physicians said that naloxone should be available to a patient via a standing order or collaborative practice agreement with a pharmacist.
The AMA has model legislation that includes support for standing orders and also has supported more than 20 state laws that increase access to naloxone in the community. If you’re interested in promoting the legislation in your state, email the AMA Advocacy Resource Center
Physicians can access additional information about naloxone from the task force and download recommendations for co-prescribing.
“This survey provides an important window into physicians’ perceptions about caring for patients with pain and those with substance use disorders,” Dr. Stack said in a press release. “This survey confirms that physicians support many of the key policies being considered to end this crisis. The AMA and the nation’s physicians are committed to partnering with others to implement proven solutions.”
Judicial UpdateCourt to decide on censorship in the exam room
A rare rehearing has been granted for a case that could have significant ramifications for the patient-physician relationship. The outcome physicians are hoping for: That the court will overturn a state law that limits which health and safety topics physicians can talk about with their patients in the exam room.
The 11th Circuit Court has granted a rare rehearing to decide whether a state can bar physicians from communicating freely with their patients and their families about firearm safety. Providing this kind of safety counseling can help prevent gun-related injuries and deaths, particularly among children.
The rehearing will be held en banc, meaning all 11 active judges will sit on the panel for decision.
The AMA and several other medical associations last month filed an amicus brief in support of the rehearing. “This case,” the brief (log in) said, “affects the right of patients to be given the best possible medical care from their physicians—and not just on the topic of firearm safety.”
Read more at AMA Wire®.
Other NewsPhysicians raise concerns about PQRS
The AMA, together with the Medical Group Management Association (MGMA) and 43 specialty societies, recently sent a sign-on letter to the administration outlining 2016 Physician Quality Reporting System (PQRS) payment adjustments and informal review process issues.
The letter (log in) expresses the concern that physicians and group practices were incorrectly penalized under PQRS in 2016 as a result of the Centers for Medicare & Medicaid Services’ (CMS) inadequate feedback and informal review request methods. The letter also makes recommendations to improve these processes moving forward.
Without complete and actionable data as well as a streamlined process for correcting data inaccuracies and unwarranted penalties, physicians and group practices may not only be subjected to unfair Medicare reductions in the immediate payment year but also in future years as they are unable to correct unidentified reporting issues.
The AMA/Specialty Society RVS Update Committee (RUC) recently submitted recommendations to the Centers for Medicare & Medicaid Services (CMS) that resulted from the Jan. 13-17 RUC meeting for work relative values and direct practice expense inputs. These recommendations, along with those previously submitted from the October meeting, represent the RUC’s recommendations for the 2017 Medicare Physician Payment Schedule.
The submitted recommendations address approximately 200 new or revised CPT® codes and existing services identified by the RUC or CMS as potentially misvalued. CMS will publish consideration of these submissions in the 2016 proposed rule expected this summer.
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.