April 28, 2016

National Update

Energy and Commerce Committee considers multiple opioid bills

The U.S. House Energy and Commerce Committee Subcommittee on Health unanimously approved 12 bills April 20, most of which are related to stemming the epidemic of opioid misuse and addiction. The bills address issues such as co-prescribing and increasing access to naloxone, allowing pharmacists to partially fill prescriptions, and increasing the number of patients who may receive medication-assisted treatment (buprenorphine) from an individual physician.

The full committee this week is marking up the bills, which are expected to be packaged with a modified House version of the Comprehensive Addiction and Recovery Act (CARA) (H.R. 953) and considered on the House floor the week of May 9.

The U.S. Senate passed its version of CARA (S. 524) in March. The AMA supports efforts to confront the opioid and prescription drug epidemic through meaningful legislation and will continue to work with Congress to refine several of the proposals.

AMA expresses concerns with Medicare Part B reform proposal

On April 13, the AMA sent a letter to the House and Senate, expressing concerns with the Centers for Medicare & Medicaid Services’ (CMS) recent proposal to restructure the manner in which Medicare pays physicians for Part B drugs. Specifically, the letter outlined how the first phase of the proposal would reduce the amount of payment to physicians for many drugs, but would not address the issue of rising drug costs.

Patients served by practices that are small, rural or located in economically disadvantaged areas could be disproportionately affected by the proposal. There is a strong possibility that administration of these drugs would shift from physicians’ offices to hospital outpatient departments, which would increase costs for both patients and Medicare.

The AMA is committed to working with CMS, Congress and other stakeholders to consider alternatives that have the potential to reduce the high cost of Part B drugs without producing the unintended consequences of this proposal.

Medical groups submit comments on proposed changes to enrollment process

The AMA and 27 national medical societies signed a comment letter (log in) submitted in response to the Medicare Proposed Rule on Program Integrity Enhancements to the Provider Enrollment Process. The proposed rule seeks to require all re-enrolling physicians to document any current or previous affiliation with a provider or supplier that has any of the following disclosable events:

In the comment letter, the groups expressed concern with Medicare’s proposal to combine a five-year look-back period on the affiliations with an indefinite look-back period on the disclosable event. As an alternative, the groups recommended establishing a finite look-back period for disclosable events, which should in no case precede the date that the physician established a covered affiliation with the relevant entity.

The letter also opposed a proposal to report disclosable events when appeals are pending and urged the agency to implement a “good faith” reasonableness standard that would not require physicians to proactively ferret out reportable affiliations.

New primary care model announced

The Centers for Medicare & Medicaid Services (CMS) recently announced a new alternative payment model (APM) for primary care services called Comprehensive Primary Care Plus  (CPC+). The APM builds on experience to date with the original CPC model, launched in late 2012 in seven regions.

The new five-year CPC+ model is set to start in 2017 in up to 20 regions. Its design reflects several recommendations that the AMA has made to CMS:

This APM is a multi-payer model, and the next step in selecting the participating regions is for private and state payers to express their interest in participating. Once the CPC+ regions have been selected, CMS will solicit applications from physician practices in those localities. Additional information about the APM is available on the CMS website.

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Issue Spotlight

Historic Medicare payment policy changes an opportunity for success

Medicare Access and CHIP Reauthorization Act (MACRA) proposed rules issued Wednesday by the Centers of Medicare & Medicaid Services (CMS) represent the most sweeping change in physician payment policy in the last 25 years.

The proposed regulations
"Our initial review suggests that CMS has been listening to physicians' concerns,” AMA President Steven J. Stack said in a statement Wednesday. “In particular, it appears that CMS has made significant improvements by recasting the electronic health record (EHR) meaningful use program and by reducing quality reporting burdens.”

Among the questions the 962-page proposed rule addresses are:

Providing physician feedback
“We are at the beginning of the formal rulemaking process,” Dr. Stack said in an AMA Viewpoints Wednesday. “CMS leadership has asked for feedback on what the agency did well in the proposed rule, what needs to be revised and what else needs to be included.”

“This proposed rule gives us an opportunity to provide thoughtful feedback to CMS in order to secure further improvements in the final regulations,” Dr. Stack said.

The AMA will develop a detailed analysis of the proposed rule and coordinate formal written comments with state and national medical societies in the coming weeks.

Keys to successful implementation
Barbara McAneny, MD, immediate past-chair of the AMA Board of Trustees, was among four physician leaders who testified last week at a hearing of the U.S. House Energy and Commerce Committee’s Subcommittee on Health. Dr. McAneny pointed to three aspects of implementation that CMS will need to pay careful attention to as it works on regulations coming out of MACRA:

Helping physicians succeed
To help physicians succeed under the new Medicare system, the AMA will be offering step-by-step guidance and practical resources for practices that will pursue participation in APMs or MIPS. Resources currently available include an expert-authored guide to physician-focused payment models, key points of MIPS and five things you can do now to prepare.

The AMA’s STEPS Forward™ collection of practice improvement strategies also offers a variety of education modules to help physicians take steps toward advancing team-based care, implementing electronic health records, improving care and practicing value-based care.

A physician expert will be the featured speaker for a webinar at 2 p.m. Eastern time May 11, during which she will share how her practice has adopted a value-based care model that has let them focus on keeping patients at the center of care. Register to participate.

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State Update

Oregon physicians take multifaceted approach to opioid epidemic

The Oregon Medical Association (OMA) recently devoted its entire annual meeting to a single topic: Ending the state’s opioid epidemic. This year, the OMA supported legislation that streamlines the state prescription drug monitoring program (PDMP) with physicians' electronic health record systems and increases access to naloxone—the overdose-reversal drug—through pharmacists and social service agencies.

The bill also protects patient privacy of information within the PDMP. Read more about the OMA’s legislative efforts.

AMA Trustee David O. Barbe, MD, delivered the keynote presentation at the OMA meeting, emphasizing the need for physicians to be leaders in ending the epidemic. Dr. Barbe highlighted the five recommendations of the AMA Task Force to Reduce Opioid Abuse as specific ways in which physicians can take action. The OMA is one of the state society member organizations of the task force.

In advance of the meeting, the AMA and the OMA also co-authored an op-ed in the Portland Oregonian.

AMA urges veto override to increase access to naloxone in Maine
The AMA this week urged the Maine legislature to override a veto of a bill that would increase access to naloxone. In a letter (log in) sent to the legislative leaders in the Maine House and Senate, AMA CEO and Executive Vice President James L. Madara, MD, highlighted that “naloxone is a proven medical intervention that saves lives and does not increase the risk of opioid misuse.”

The legislation (LD 1547), “An Act to Facilitate Access to Naloxone Hydrochloride,” would, among other things:

Physician payment is key to adoption of telemedicine
Physicians consistently report that payment—or lack thereof—is the primary obstacle to adoption of telemedicine within physician practices. So it is no surprise that states are working to fix that.

To date, 29 states and the District of Columbia (log in) have adopted laws that require private insurers to cover services delivered via telemedicine. Nearly one-third of these laws were adopted in 2015 alone, and many were based on the AMA model state legislation, the AMA Telemedicine Act.

The AMA Telemedicine Act outlines an approach by which states can support insurance coverage of and payment for telemedicine, which:

States interested in introducing the AMA Telemedicine Act can contact Kristin Schleiter of the AMA to learn more.

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Judicial Update

Supreme Court case could have major health implications

Depending on how it reads the Clean Air Act, the Supreme Court of the United States could limit the authority of the Environmental Protection Agency (EPA) to restrict carbon emissions that cause climate change and have been proven to inflict major health problems on the people of the world. Find out how this case could affect your patients.

A case for clean air
At stake in West Virginia, et al. v. EPA, is whether that federal agency has the authority to enforce recent regulations known as the Clean Power Plan. The final rule of the plan was released in October. On the same day, 12 state governments, led by West Virginia, sued the EPA in the U.S. Court of Appeals for the District of Columbia Circuit, claiming that the regulations exceeded the EPA’s authority under the Clean Air Act.

The states involved moved to prevent the regulations from being enforced until the appeals are resolved. The Court of Appeals denied the stay motions, and the states appealed this denial to the U.S. Supreme Court. By a 5:4 vote, the U.S. Supreme Court stayed these regulations until complete resolution of the case.

How this case affects public health
The Clean Air Act empowers the EPA to establish standards for the regulation of pollution from existing stationary sources of emissions. In response to this directive of the Clean Air Act, the EPA adopted the Clean Power Plan, which establishes carbon pollution standards for power plants that will help slow the harmful impacts of carbon pollution on public health. The plan was designed to achieve a 32 percent reduction of the 2005 levels of carbon emissions by 2030.

“These regulations are well within [the] EPA’s statutory authority,” the Litigation Center of the AMA and State Medical Societies said in an amicus brief (log in) submitted to the U.S. Supreme Court. “Failure to uphold the Clean Power Plan would undermine [the] EPA’s ability to carry out its legal obligation to regulate carbon emissions that endanger human health and would negatively impact the health of current and future generations.”

Carbon emissions are a significant driver of the anthropogenic greenhouse gas emissions that cause climate change and consequently harm human health. Direct impacts from the changing climate include health-related illness, declining air quality and increased respiratory and cardiovascular illness. Changes in climate also facilitate the migration of mosquito-borne diseases, such as dengue fever, malaria and most recently the Zika virus.

“In surveys conducted by three separate U.S. medical professional societies,” the brief said, “a significant majority of surveyed physicians concurred that climate change is occurring … is having a direct impact on the health of their patients, and that physicians anticipate even greater climate-driven adverse human health impacts in the future.”

Read more at AMA Wire®.

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Other News

Open Payments reminder: 45-day review and dispute period ends May 15

The official 45-day review and dispute period for the Open Payments program runs from April 1 to May 15. Even though physicians can review their data and dispute errors throughout the year, disputes filed during this timeframe will be flagged in the Open Payments data that is released to the public on June 30.

Physicians planning to review their 2015 Open Payments data should test their CMS Enterprise Portal (EIDM) login credentials beforehand. Locked accounts and other login issues can be troubleshooted by visiting frequently asked questions for EIDM users.

The AMA website offers step-by-step instructions on how to register to review and dispute your data. For answers to additional questions, please email Medicare’s Open Payment Help Desk at, or call (855) 326-8366.

New resources available from the Patients’ Action Network

In order to provide patient advocates with the best tools and resources, the AMA Patients’ Action Network recently made some new changes to its website.

These updates include:

Visit to use these new resources.

Senator speaks to campaign school attendees

A tight race in a swing district was once again the backdrop for the annual AMPAC Campaign School April 13-17 in Arlington, Va. Twenty-seven participants from 15 states worked on the congressional “campaigns” of either a Democrat or Republican. The participants included 21 physicians, three medical students and three spouses.

The program opened with a talk from AMPAC alumnus Sen. John Barrasso, MD, of Wyoming. Dr. Barrasso talked about his path to public service, starting with his weekly appearances on television 30 years ago, that helped him become known as “Wyoming’s Doctor.” He reminded the participants that more physicians are needed in public office but that campaigns require careful planning and a willingness to take advantage of opportunities when they arise.

The campaign school is AMPAC’s annual program for AMA member physicians, residents, students, spouses and state medical society staff who want to improve their political campaign skills. The core curriculum is centered on building skills in campaign strategy and message. New sessions this year included a talk on digital media buying, where participants saw the relative low cost and expansive reach of social media advertising, and a new social media exercise. For the social media exercise, the teams were each given a scenario, such as appearing at a county fair or leading up to a debate, and then came up with plans to engage voters on Facebook.

Information on the 2017 AMPAC Campaign School and Candidate Workshop will be coming soon.

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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.

May 11: Webinar on value-based care model
A physician expert will be the featured speaker for a webinar at 2 p.m. Eastern time May 11, during which she will share how her practice has adopted a value-based care model that has let them focus on keeping patients at the center of care. Register to participate.

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