Aug. 18, 2016

National Update

New requirements for physician office-based lab reporting

The Centers for Medicare & Medicaid Services (CMS) has released a list of codes describing laboratory testing services for which laboratories, including physician office-based laboratories, will be required to report pricing data starting Jan. 1. This new reporting requirement is part of CMS' implementation of the Protecting Access to Medicare Act (PAMA) of 2014.

Under PAMA, physician office-based laboratories meeting certain Medicare revenue thresholds will be required to report private payer payment rates for all laboratory tests included on the Clinical Laboratory Fee Schedule to CMS.

Laboratories meeting the threshold requirements are required to report private payer payment rates for the period from Jan. 1, 2016 to June 30, 2016, starting on Jan. 1, 2017.

View the codes on the CMS website.

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Issue Spotlight

CDC discusses updated guidelines in Zika virus webinar

The AMA and the Centers for Disease Control and Prevention (CDC) recently held a webinar to provide an update for physicians and other clinicians on the status of the Zika virus outbreak and the latest clinical guidance to help them diagnose and manage patients and prevent further transmission.

"As the Zika virus outbreak continues to evolve and more Americans become impacted by the virus," said AMA President Andrew W. Gurman, MD," we must ensure that our nation's physicians, and all clinicians, are prepared to handle possible cases of the virus and are equipped with the most up-to-date information to answer patients' questions."

The webinar, "Preparing for Zika transmission in the United States," is available online at the AMA's Zika Resource Center. Experts provided details of the latest epidemiological and clinical aspects of the current Zika outbreak, implications for pregnant women and the CDC's most up-to-date clinical guidance to support health care professionals in combatting and preventing complications.

Updated pregnancy guidelines
There is emerging data indicating Zika virus RNA can be detected for prolonged periods of time in some pregnant women. The CDC hopes to increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis by expanding real-time reverse transcription polymerase chain reaction (rRT-PCR) testing.

Testing recommendations vary according to the type and timing of possible exposure. "Possible exposure" is defined as travel to or living in an area with Zika virus, or sex without barrier protection, such as a condom, with a partner who has traveled to or lives in these areas. The CDC stressed that all pregnant women should be asked at each prenatal visit if they have had one of these exposures.

For symptomatic pregnant women, the CDC recommends:

The CDC also delivered recommendations for testing of asymptomatic pregnant women. A flowchart detailing testing and recommendations is available on the CDC website.

Preventing sexual transmission
Because the Zika virus can be sexually transmitted, the CDC offered new guidance for couples at risk, including:

Couples in which a woman is pregnant:

Couples who are not pregnant and are not planning to become pregnant:

The webinar also includes up-to-date statistics on the spread of Zika in the U.S., recommendations for counseling women and men living in areas with ongoing spread of Zika virus who are interested in conceiving, and the use of standard precautions to prevent the spread of Zika in the health care setting.

Congress must provide more resources
With an increasing number of Zika cases confirmed in the U.S., including this week's news of the death of a newborn baby with Zika-linked microcephaly, the AMA continues to call on policymakers on Capitol Hill to immediately make the necessary resources available to combat the growing threat of the virus and protect public health. Congress failed to pass legislation to deploy a robust public health response to the Zika virus before it adjourned for summer recess.

The AMA will also continue to update its online Zika Virus Resource Center with the latest Zika-related information from CDC and other trusted organizations to support health care professionals' efforts to prevent and combat complications from the virus.

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State Update

AMA, Rhode Island and Alabama partner to combat opioid epidemic

The AMA announced two pilot programs last week in partnership with the Rhode Island Medical Society and the Medical Association of the State of Alabama—along with state officials—to develop and distribute a statewide educational toolbox for health care providers to help reverse the state's opioid epidemic. The toolbox will be released in September.

The pilot program will build a state-specific toolbox for each state—available online and in print—that incorporates the best information from the AMA, medical associations and state health officials. It will be provided to physicians and other health care professionals with key data, valuable resources and practice-specific recommendations to enhance decision-making when caring for patients suffering from chronic or acute pain and opioid use disorders, as well as for patients needing overdose prevention education.

The AMA was awarded funding through the Prescriber Clinical Support System for Opioid Therapies, funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by the American Academy of Addiction Psychiatry.

Read more about the effort at Providence Business News and Alabama News.

For more information, contact the AMA's Daniel Blaney-Koen.

AMA Telemedicine Act ensures appropriate coverage of telemedicine services

Are you one of the 21 states that do not yet have coverage parity? The AMA Telemedicine Act (log in) can ensure that when physicians treat their patients using telemedicine, that treatment is covered as if it had taken place in-person.

The model bill, which has been adopted in nearly a dozen states to date:

Please contact Kristin Schleiter of the AMA to learn more.

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Judicial Update

Challenge to medical liability law could complicate pre-suit process

A medical liability case, even if successful, can cause financial, emotional and reputational harm to a physician—and also to the patient who brings the suit. A 2013 amendment to the Florida Medical Liability Act, which requires the plaintiff to release relevant health information to determine whether a claim for medical liability is meritorious, is under threat in the Florida Supreme Court.

At stake in Weaver v. Myers is whether the Florida Medical Malpractice Act, which requires the plaintiff to authorize the release of otherwise confidential health information as a condition of bringing a lawsuit for medical liability, is valid. Both a trial court and the Florida First District Court of Appeals confirmed the amendment's validity.

Florida's pre-suit investigation process was intended to allow both claimants and potential defendants the opportunity to determine whether a medical liability claim has merit and to encourage early resolution of claims between the parties. This process can avoid costly and time-consuming proceedings through a less complicated pre-suit process that allows both parties to examine the evidence.

What happened
Emma Weaver, widow and representative of Thomas C. Weaver, sued her late husband's physician, Stephen C. Myers, MD, for medical liability. However, she did not want to allow Dr. Myers' attorneys to interview the other physicians who had treated her deceased husband's medical condition. She asserted that the Florida constitution and a regulation promulgated under the Health Insurance Portability and Accountability Act (HIPAA) to protect patient privacy invalidated the Florida Medical Malpractice Act.

When a case goes into suit, the Rules of Civil Procedure allow parties to have a fair chance to fully explore their opponents' medical condition when that condition has been placed at issue. For example, a defendant may even require the plaintiff to sit for a compulsory medical examination by another physician of their choosing.

The Florida Medical Malpractice Act was passed in response to a common complaint from advocates and clients on both sides: Medical liability lawsuits take too long to be brought to resolution. The intent of the act was to reduce the cumbersome and expensive process of discovery. A formal deposition can disrupt the physician practice and displace patients in that physician's schedule.

"The time, expense and potential asymmetry of information can be cured by allowing the current law to stand," said the Litigation Center of the AMA and State Medical Societies in an amicus brief. "A phone call between defense counsel and the treating physician can serve to facilitate the same information that would be revealed during a formal deposition."

Allowing the claimant to withhold key information unfairly prejudices potential defendants and circumvents the goals of the pre-suit investigation process.

"If the right to this informal discovery is removed," the brief said, "the result will be to return to an uneven playing field and the inability to avoid cumbersome and costly formal discovery."

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Other News

How Medicare regulatory penalties will change

Regulatory penalties under the current Medicare payment system have been rising, overwhelming physicians with reporting burdens just to avoid payment cuts. But how will financial penalties and bonuses change in the new system? Under the Medicare Access and CHIP Reauthorization Act (MACRA), regulatory penalties starting in 2019 will be less severe, and physicians will have greater opportunity for bonuses. Learn more at AMA Wire®.

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