March 3, 2016

National Update

AMA calls for reauthorization and funding for prescription drug monitoring programs

The AMA last week joined almost 100 state medical associations, national medical specialties, as well as pharmaceutical manufacturers, payers, dispensers and others, in a letter (log in) calling on Congress to reauthorize the National All Schedules Prescription Electronic Reporting Act (NASPER) to provide support for state prescription drug monitoring programs (PDMP).

While the U.S. House of Representatives already passed this important legislation (H.R. 1725), the U.S. Senate has yet to act. NASPER provides vital funding to support and improve PDMPs, which are an important tool to assist prescribers in making appropriate decisions about whether to prescribe opioids and other controlled substances. Support for NASPER reauthorization also was a featured issue at the 2016 AMA National Advocacy Conference last week, during which attendees asked their members of Congress to support a number of policies (log in) to help to stem the current epidemic of opioid misuse, addiction, overdose and death.

Meaningful use deadline extended; CMS issues FAQ

Physicians now have until July 1—an additional three months—to apply for a hardship exemption from the electronic health record (EHR) meaningful use financial penalties for the 2015 program year. Those who do not apply could face a 3 percent cut in their Medicare payments in 2017, since the meaningful use program operates on a two-year look-back period.

In response to requests from the AMA, the Centers for Medicare & Medicaid Services (CMS) issued FAQ #14357 to clarify that applying for a hardship exemption from the 2017 meaningful use payment penalty will not preclude physicians from receiving the incentive if they successfully attest to meaningful use in 2015. In essence, the hardship exemption will act as a safety net.

As a reminder, the AMA is encouraging all physicians to apply for a hardship exemption due to the delayed release of the 2015 meaningful use modification rule. Step-by-step instructions (log in) on how to file for the exemption may be found on the AMA website.

Provide input to FDA on new tanning rule

Consistent with longstanding AMA policy, a proposed rule from the U.S. Food and Drug Administration (FDA) would tighten requirements on indoor tanning devices and restrict minors from using them. The FDA is accepting public comments on this proposed policy until March 21.

The American Academy of Dermatology Association has launched a website where physicians, patients, patient advocates and the public can easily submit pre-populated comments to the FDA with one click. 

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Issue Spotlight

Conversing with Congress: Physicians take top issues to the Hill

Hundreds of physician voices echoed through the halls of offices on Capitol Hill last week as they took their message to Congress on what needs to be done to address the top health policy issues and burdensome regulations that steal time and resources from patients.

The 2016 National Advocacy Conference gave physicians the opportunity to meet face to face with members of Congress and gain important insights from industry experts, political insiders and members of Congress.

Among the topics physicians discussed this year were the upcoming regulations for implementing the Medicare Access and CHIP Reauthorization Act, solutions for addressing the opioid epidemic and legislation that would ensure that patients and their physicians are able to use new technologies that remove barriers to timely, high-quality care.

Why physicians are talking to their lawmakers
“Simplify, standardize and make clinically relevant laws and regulations to make more time for patients, less red tape and less physician burnout,” said Katie Lozano, MD, a musculoskeletal radiologist and president-elect of the Colorado Medical Society. “That’s the mantra in our state, and the AMA has been really supportive.”

Dr. Lozano and her group met with several representatives and senators from Colorado throughout the three days they spent in the nation’s capital. Most groups of physicians from different states who attended the conference had between five and eight appointments with their members of Congress.

“Though we’re bringing our own issues to the Hill,” Dr. Lozano said, “we want to thank them for the work they’ve done so far—for repealing [Medicare’s sustainable growth rate formula]. But we also want to ask them what they need from us. We offer to serve as a resource because this is a partnership for the people in our state.”

Scott E. Shapiro, MD, a cardiovascular disease and internal medicine specialist and president of the Pennsylvania Medical Society, attended the conference with a number of colleagues from the Keystone State. “We are going to several representatives to talk about… how small independent practices are going to be able to participate in alternative payment models under” the new Medicare payment framework, Dr. Shapiro said as the group prepared for their meetings on the Hill.

“We need viable options to deal with population health management and help with payment reform,” he said. Dr. Shapiro and his colleagues also talked with their members of Congress about their state prescription drug monitoring program (PDMP), which has seen funding problems as a result of budgetary issues in their state.

Discussing solutions to the opioid epidemic
Sheila Rege, MD, a radiation oncologist from the state of Washington, sat down with six members of Congress during the National Advocacy Conference to discuss the opioid epidemic. Addressing the epidemic in the right way is important, both to prevent overdoses and to ensure “that oncologists like me can still help our cancer patients,” she said. “Having the AMA involved and the effort being physician-led is key.”

“[I]t’s critical that we do this right away,” Dr. Rege said. “I think physicians don’t realize that [legislators] do want to hear from us.”

Bob Dannenhoffer, MD, a pediatrician in Oregon, flew into D.C. to raise similar concerns. “We’re going to talk a lot about opioids,” he said. “This is really important in Oregon; we’re seeing this become especially devastating for our rural county.”

“I think it’s really important that the congressional delegation knows about this,” Dr. Dannenhoffer said. “This is affecting all ages and all races. We need better use of PDMPs and naloxone. I think this will be an issue where there will be a lot of bipartisan support.”

Positive results
Dr. Lozano and her group had an excellent series of visits, which culminated in a meeting with Sen. Michael Bennett, D-Colo., who is a member of the Committee on Health, Education, Labor and Pensions (HELP).

“We’ve been doing this all day,” Dr. Lozano said Tuesday. “We gave them our real-life experiences; that’s why we brought everyone to the meeting. It’s important for them to see how it affects us day to day.”

“I think it went really well,” said Patrick Pevoto, MD, an OB-GYN who was part of the Colorado group. “We had four points we wanted to bring up… I think everyone was receptive. I’m very encouraged by the response we had from both the House and the Senate.”

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State Update

Register to attend the National Rx Drug Abuse and Heroin Summit

At the upcoming National Rx Drug Abuse and Heroin Summit, Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees and chair of the AMA Task Force to Reduce Prescription Opioid Abuse, will lead a vision session to discuss the work of the task force and how the nation’s medical societies have responded to America’s opioid epidemic.

This summit is the largest national collaboration of stakeholders to impact the opioid crisis, including physicians, pharmacists, nurses, nurse practitioners and other clinicians, organizational leaders from U.S. government agencies, state and local governments, businesses, academia, clinicians, treatment providers, counselors, educators, advocates, and others.

Attendees will learn about the latest research from the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, the National Institutes of Health, university medical centers and more. Learn more about the summit, to be held March 28-31 in Atlanta, and register to attend. AMA members can receive a $100 registration discount by calling Cheryl Keaton of Operation UNITE at (606) 657-3218.

States continue to advance overdose prevention legislation

More than 40 states are considering legislation to enact or improve legislation that would increase access to naloxone and provide Good Samaritan protections to save lives from opioid overdose. The widespread efforts underscore efforts from the AMA Task Force to Reduce Opioid Abuse to encourage co-prescribing naloxone and more recent national support from the National Governors Association to increase access to naloxone for patients at risk of overdose.

This national support is having an effect. U.S. retail pharmacies saw a 1,170 percent increase in naloxone prescriptions dispensed between the fourth quarter of 2013 and the second quarter of 2015, according to new research published in the American Journal of Public Health. While the report found that “most naloxone in the community continues to be distributed through community-based programs,” it also highlighted the massive increase in prescribing by physicians and other health care professionals.

For more information, check out a task force document (log in) on when physicians should consider co-prescribing naloxone.

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Other News

New guidance on meaningful use reporting

As a result of the AMA’s request for clarification around the new Public Health-Clinical Registry objective finalized in the 2015-2017 electronic health record (EHR) meaningful use modification rule, the Centers for Medicare & Medicaid Services recently published frequently asked questions (FAQ) clarifying the requirements.

The FAQs include new and updated answers about when physicians can register their intent to report to a registry, what physicians should do in 2016 if they did not previously intend to report on a public health reporting measure, the alternate exclusions available for public health reporting in 2016, steps physicians have to take to determine if there is a specialized registry available, and the definition of a specialized registry. Review these FAQs to learn more:

OCR updates guidance on fees for patient access to health records

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has updated its guidance on patients’ access to their health information under the Health Insurance Portability and Accountability Act (HIPAA). The guidance now includes a set of frequently asked questions addressing the fees that covered entities may charge patients for copies of their protected health information. The AMA encourages physicians to review the new FAQs and update applicable policies and procedures to reflect this recent guidance.

HIPAA’s Privacy Rule generally requires covered entities to provide patients, upon request and in a format requested by the patient, with access to the health records the covered entity maintains about them in a designated record set. Physicians can find additional information about HIPAA’s privacy and security requirements in the AMA’s HIPAA toolkit.

AMA advocates for electronic prior authorization and clinical attachments

The AMA testified Feb. 16 before the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards to provide feedback and recommendations regarding electronic prior authorization and clinical attachments. During oral testimony, the AMA underscored the significant burdens and care delays imposed on both physician practices and patients by the current manual prior authorization process and urged the NCVHS to recommend a more robust set of operating rules to spur industry implementation of electronic prior authorization for medical services.

The AMA also advocated for swift adoption of an electronic standard for clinical attachments to reduce the practice burdens associated with clinical documentation requests and to create a uniform, automated process across all health plans. Written testimony summarizing the AMA’s recommendations for improving electronic claims submission also was submitted. Visit the AMA’s administrative simplification advocacy Web page to access the oral presentation slides and written testimony.

2016 AMPAC Candidate Workshop trains physicians from across the U.S.

AMPAC began its third decade of political education for AMA members last month, holding the Candidate Workshop in Arlington, Va. 30 participants (20 physicians, four students, four spouses/family members and two state society staff) came from 19 states.

The Candidate Workshop is AMPAC’s annual training program for AMA members and other friends of medicine who are considering a run for public office. An overview lecture on a campaign plan provided the foundation for intensive instruction in modern campaign functions—fundraising, social media and Internet communications, polling, campaign messaging and strategy, public speaking, and press relations—to name just a few.

The keynote lecture was given by the honorable Dan Morhaim, MD, elected member and deputy majority leader of the Maryland House of Delegates, winner of the 2011 AMA Nathan Davis Award and AMPAC Candidate Workshop/Campaign School alumnus. Dr. Morhaim talked about his experiences as a physician both on the campaign trail and in the state capital, reminding the participants of the vital impact physician legislators can have on health care policy at the state and local levels.

The workshop, along with the annual AMPAC Campaign School, provides intensive political training to AMA members, spouses and state medical society staff members. AMPAC covers all expenses for AMA members. For more information on the workshop or the April 13-17 Campaign School, email Jim Wilson of the AMA.

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Upcoming Events

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 now through the conference for a discount.

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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