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April 14, 2016

National Update

Proposed rule aims to increase access to buprenorphine treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) recently published a proposed rule that would increase the limit on the number of patients a physician can treat with buprenorphine for opioid use disorder from the current 100 to 200. The proposal includes a list of questions for which SAMHSA invites comments, with a deadline of May 31.

These questions address issues such as:

Raising the existing cap is consistent with AMA efforts to improve access to treatment for opioid use disorder, and the AMA will be working with other interested medical associations to respond to the SAMHSA proposal.

Homeland Security issues alert on ransomware

Following recent cyberattacks on health care facilities and hospitals in the United States and around the world, the U.S. Department of Homeland Security (DHS), in collaboration with Canadian Cyber Incident Response Centre, released an alert to provide information on ransomware. The alert addresses the main characteristics of ransomware, its prevalence, variants that may be proliferating, and things users can do to prevent and mitigate damages from ransomware.

According to DHS, ransomware is a type of malicious software that infects a computer and restricts users’ access until a ransom is paid to unlock it. Infected systems often display messaging such as:

The alert contains suggestions of actions to take to help protect against the adverse effects of ransomware. The AMA also is developing resources for physicians on good health IT system hygiene, which will be available soon.

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Issue Spotlight

Experts take a stand against insurance mergers

Leading economists and experts representing the physician community last month delivered testimony against the proposed merger of Anthem and Cigna at a hearing of the California Department of Insurance. Find out what they had to say about how the merger would affect patients and physicians.

More competition needed, not less
“California should act to block the harmful merger and foster a more competitive market place that will operate in patients’ best interests,” said Henry Allen, the AMA’s top antitrust attorney, in testimony before the California Department of Insurance.

“The state’s fragile health care system should not be left vulnerable to a giant health insurance company with anticompetitive market power,” Allen said. “The consequences of the proposed merger would have negative long-term consequences for health care access, quality and affordability in California.”

“Anthem and Cigna are two of the largest five health insurers in the United States,” said Brent Fulton, associate director of the Global Center for Health Economics and Policy Research. “We are not aware of any peer-reviewed studies that have found that higher insurance market concentration has led to lower health insurance premiums.”

The AMA presented state regulators with an analysis (log in) that found the proposed Anthem-Cigna merger would run afoul of federal antitrust guidelines in highly populated metropolitan areas across California.

If this health insurer consolidation is allowed, it would compromise the ability of physicians to advocate for their patients, Allen said. In practice, market power allows insurers to exert control over clinical decisions, which undermines the patient-physician relationship and eliminates crucial safeguards of patient care.

On the other hand, competition among health insurers can lower premiums, enhance customer service and spur inventive ways to improve quality and lower costs. Patients benefit when they can choose from an array of insurers who compete for their business by offering desirable coverage at competitive prices.

The health of the state’s patients is at stake, Allen said. “Conditions in most markets are now heavily tilted toward insurers, giving them an unprecedented advantage in determining the scope, coverage and quality of health care."

Physicians show their opposition
85 percent of California’s physicians are opposed to the merger of health insurance giants Anthem and Cigna, according to a recent survey conducted by the California Medical Association in collaboration with the AMA to gauge physicians’ opinions on the mergers.

Results of the survey detailed three specific concerns physicians have over the consequences of this consolidation:

In California, where Anthem dominates most markets, high barriers exist for new competitors entering these markets. Potential competitors are typically unable to challenge Anthem’s market dominance as a result of the insurer’s entrenched position. Allowing Anthem to enhance its market power through the Cigna acquisition would represent an insurmountable barrier for new insurers to expand to California markets and offer competitive choices for patients.

“Anthem has been unable to produce evidence to support its claim that the merger will guarantee greater efficiency and lower health care costs,” Allen said. “To the contrary, economic studies have shown that rather than passing any benefits from efficiencies to consumers, health insurer mergers actually result in higher premiums.”

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State Update

Medicaid expansion programs reauthorized in Arkansas and New Hampshire

Arkansas Gov. Asa Hutchinson signed legislation April 8 to renew the state’s Medicaid expansion program and preserve health coverage for more than 267,000 low-income residents. The legislation replaces the “public option,” which provided premium assistance to beneficiaries since 2013, with a new program called Arkansas Works.

Under Arkansas Works, unemployed beneficiaries will be referred to job-training programs, and some beneficiaries will have to pay premiums. Arkansas lawmakers still must approve funding for the program, and the federal government must approve the program changes.

On April 5, New Hampshire Gov. Maggie Hassan signed legislation reauthorizing New Hampshire’s Medicaid expansion program for two years. The program provides health care to more than 48,000 low-income residents. A controversial provision in the bill requires able-bodied adults to work or volunteer 30 hours a week in order to receive benefits. The Centers for Medicare & Medicaid Services (CMS) must approve the work requirement. CMS has rejected similar proposals from other states. However, the signed legislation permits the program to continue in the event that CMS denies the work requirement.

Arkansas and New Hampshire are two of six states that expanded Medicaid under federal waivers, which allow states to tailor their Medicaid programs. To date, 31 states and the District of Columbia have opted into Medicaid expansion.

For more information on the AMA’s advocacy activities related to Medicaid expansion, visit the AMA’s reforming Medicaid Web page.

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Judicial Update

Court case could extend medical liability

A state supreme court is set to decide whether the two-year statute of limitations for filing a wrongful death lawsuit should start, as it does now, from the time of death or from the moment the plaintiff learns of the circumstances that may have contributed to or caused death. The distinction is the difference between a finite period in which liability claims can be filed and an undetermined longer period.

What happened
At stake in Moon v. Rhode is whether a complaint brought against a radiologist in a wrongful death lawsuit was filed within the two-year timeline allowed under the Illinois statute of limitations.

After complications following surgery at Proctor Hospital in Peoria, Ill., Kathryn Moon died on May 29, 2009. In Feb. 2013, Moon’s estate sent CT radiographs to a diagnostic radiologist who concluded that Clarissa Rhode, MD, had negligently misread the scans which caused or contributed to Moon’s death. Moon’s estate sued Dr. Rhode and her employer in a wrongful death action on March 18, 2013.

Relying on Illinois’ Wrongful Death Act, which provides that wrongful death suits must be filed within two years of death, the defendants moved to dismiss. The estate, however, argued that the limitation period should start from the time of discovery of the negligence.

The story hasn’t stopped there. The trial court granted the dismissal, which the estate appealed. The Illinois Appellate Court affirmed the dismissal but in a split decision. On a second appeal, the case now has moved to the Supreme Court of Illinois.

Why this case matters
The statute of limitations is in place to not only allow a significant amount of time for review of the cause of death but also to protect physicians from uncertain liabilities that could hang over them for indeterminate periods of time. If the limitation is extended to the time of discovery—which could occur several years down the road—physicians would be left uncertain over whether something long-past will resurface.

“This ruling affects not only Dr. Rhode and her associates but all physicians and licensed health care providers in the state of Illinois,” the Litigation Center of the AMA and State Medical Societies said in an amicus brief (log in). “This court should give effect to the intent of the General Assembly, which created a fair and just process for tort claims.”

“The General Assembly intended to provide the citizens of this state with a limitations period fair to both plaintiffs and defendants,” the brief said. “It balances the need for plaintiffs to bring lawsuits with the defendants’ need to know when their potential liability is extinguished.”

“To expand the discovery rule as drafted by the General Assembly,” the brief said, “would contradict the laudable purpose of the legislation. The limitations period language is clear and unambiguous.”

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Other News

2016 PQRS group practice reporting option open until June 30

Practices consisting of two or more eligible professionals that would like to participate in the 2016 Physician Quality Reporting System (PQRS) under the group practice reporting option (GPRO) have until 11:59 p.m. Eastern time June 30, to register as a GPRO.

Practices with two or more eligible professionals do not have to participate in PQRS as a GPRO and may participate as individuals in the program. This may be a better option for certain practices.

Upon GPRO registration, a practice must indicate whether they plan to participate in PQRS under the following options:

If a practice would like to participate as a GPRO and submit data via electronic health record (EHR), it is highly recommended that the practice consult their EHR vendor before registration. Some EHR vendors will not support the GPRO EHR option, only the individual PQRS EHR option. Qualified clinical data registry participants also should check with their vendor to determine if they will support the GPRO option.

The AMA recommends that a practice weigh all options before signing up for GPRO in 2016, because a practice cannot change its GPRO designation with CMS once the registration period closes. If a physician is participating in PQRS as an individual, there is no need to register.

The registration system can be accessed using a valid Enterprise Identity Management (EIDM) account. Instructions for obtaining an EIDM account with the correct role are provided on the PQRS GPRO registration Web page. Instructions for registering to participate in the 2016 PQRS GPRO are provided in the 2016 PQRS GPRO registration guide.

Open Payments review and dispute period begins

The Centers for Medicare & Medicaid Services (CMS) announced the beginning of the 45-day Sunshine Act, also known as “Open Payments,” review and dispute period. After the review and dispute period concludes May 15, CMS will publish the 2015 payment data and updates to the 2013 and 2014 data June 30.

Physicians planning to review their 2015 Open Payments data should test their CMS Enterprise Portal (EIDM) logon credentials beforehand. Troubleshoot locked accounts and other logon issues by visiting frequently asked questions for EIDM Users.

Physicians can refer to the AMA website or CMS guidance for step-by-step instructions on how to register to review and dispute data. For answers to additional questions, email Medicare’s Open Payment Help Desk, or call (855) 326-8366.

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Upcoming Events

April 30: National Prescription Drug Take-Back Day
National Prescription Drug Take-Back Day aims to provide a safe, convenient and responsible way to dispose of prescription drugs and educate the general public about the potential for abuse of medications. Learn how to properly dispose of these medications.

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