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Dec. 20, 2016

Issue Spotlight

How physician advocacy shaped health care in 2016

The evolving health care system benefits from a strong physician voice. Here are a few ways that voice impacted health policy this year.

Making MACRA more flexible
The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the flawed sustainable growth rate formula in 2015. In 2016, regulations were issued to create the new Quality Payment Program (QPP). As a result of efforts by the AMA and other organized medicine groups, physicians have a much greater opportunity for success under Medicare's physician payment system, the QPP.

In the first year of the program, physicians will not receive penalties if they simply report on one measure for one patient thanks to the addition of "Pick Your Pace." Those who choose to report more data for the year may be eligible for significant bonus payments. Physicians spoke up and the AMA pressed CMS to create a transition year that allows physicians to ease into the new program. Andy Slavitt, acting administrator of CMS, listened and, in addition to Pick Your Pace, changed much of the program in the final rule.

Reporting burdens were significantly reduced, with fewer measures required and a 90-day period rather than full-year reporting. CMS removed some challenging EHR measures, such as computerized provider order entry and clinical decision support, from the QPP. The twenty-nine percent of physicians who have a low volume of Medicare patients—fewer than 100 patients or less than $30,000 in Medicare revenue—will be exempt from penalties and reporting requirements. Small practices received specific accommodations in the final rule and will benefit from lower reporting burdens and technical assistance. And, due to AMA advocacy, the final QPP policies provide a more welcoming environment for physicians interested in APMs.

The AMA has developed a collection of tools and resources to help practices prepare for Medicare changes.

Blocking insurer mergers
Mergers between major health insurers Aetna Inc. and Humana Inc., and Anthem Inc. and Cigna Corp. were announced in July 2015. Since then, the AMA led a successful effort to convince the U.S. Justice Department and several state attorneys general to block the mergers–as well as insurance commissioners of both Missouri and California.

The foundation of this effort was the 15th edition of Competition in Insurance: A Comprehensive Study of U.S. Markets, published in September by the AMA. The study supported the argument that the two mega-mergers would exceed federal antitrust guidelines designed to preserve competition, which would also negatively affect patient access to affordable coverage and care. The study, combined with an AMA-generated physician survey and collaboration with medical associations and patient coalitions, ensured that the physician voice was heard by federal and state regulators.

Efforts to end an epidemic
Through the work of the nation's medical societies and the AMA's Task Force to Reduce Prescription Opioid Abuse, notable progress was made toward reversing the nation's opioid overdose epidemic. A Nationwide physician awareness campaign helped lead to a 10.6 percent decrease in opioid prescriptions, greater use of prescription drug monitoring programs (PDMP), increased physician education and expanded access to naloxone.

Patients will have greater access to medication assisted treatment for opioid use disorder, and hospital payments will no longer depend on patient satisfaction survey questions that promote opioid prescribing.

AMA Wire® spoke with several physicians this year on how to work with patients to prevent overdose, reduce stigma, use PDMPs and manage chronic pain.

Clearing the view on drug prices
In response to nationwide concerns about the rising cost of prescription drugs, the AMA launched a grassroots campaign, TruthinRx.org, calling on pharmaceutical companies, pharmacy benefit managers and health insurers to provide more transparency regarding costs, pricing and financial practices. The campaign is also collecting and sharing patients' stories of how rising drug costs have affected their lives and access to health care.

Covering diabetes prevention
With the release of the Medicare Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Service (CMS) made a landmark decision to provide coverage for diabetes prevention programs (DPP), marking the first time that the CMS Actuary concluded that prevention services generate cost savings. With coverage, the AMA's work with physicians and health systems across the nation to prevent diabetes will see an expansion in 2018.

The AMA also established a partnership with Omada Health and Intermountain Healthcare to develop an online DPP to overcome challenges of geography and feature a social experience similar to that of an in-person program.

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National Update

AMA urges DEA to reverse changes to new registration renewal process

The AMA is urging the U.S. Drug Enforcement Administration (DEA) to reverse new registration renewal processes—effective Jan. 1—that could result in physicians' registration being "retired," and patients being unable to obtain even an emergency refill for their prescription medications.

Through a notice on its website, the DEA said that only one renewal notice will be sent to each registrant's "mail to" address approximately 65 days prior to the expiration date; no other reminders to renew the DEA registration will be provided.

Additional changes include:

The AMA urges medical societies and physicians to share this information widely.

PQRS and Value-based Modifier reprieve due to Oct. 1 ICD-10 update

The AMA several months ago learned that the yearly ICD-10 coding update could potentially affect successful 2016 Physician Quality Reporting System (PQRS) results and Value-based Modifier calculations. Due to a several-year freeze of ICD-10 codes, there was a larger than normal update of new codes on Oct. 1, 2016—three-quarters of the way through the 2016 PQRS reporting period.

The AMA has been working with the Centers for Medicare and Medicaid Services (CMS) to reach a fair resolution that would ensure physicians would not be adversely penalized in 2018 due to the 2016 PQRS measure specifications failing to incorporate the updated information. Due to AMA advocacy, CMS will not apply the 2018 PQRS payment adjustments to any eligible professional (EP) or group practice that failed to satisfactorily report from Oct. 1-Dec. 31, 2016, due to the ICD-10 update. The Value-based Modifier program will also consider EPs as successful if they met PQRS reporting requirements.

CMS also addressed EPs who were part of a Shared Savings Program ACO participant TIN in 2015 and are now reporting outside of their ACO for the secondary reporting period because their ACO failed to report on their behalf for the 2015 PQRS reporting period. CMS will apply the same policy and EPs or group practices will not receive a penalty if their fourth quarter 2016 PQRS measure specifications were affected by the ICD-10 update.

For the 2017 quality measure specifications that are affected by the ICD-10 update, CMS will publish an addendum containing the relevant ICD-10 codes. The addendum should be published very soon and the AMA will provide an update once the information is released by CMS.

VA finalizes rule allowing most APRNs to practice independently

The Department of Veterans Affairs (VA) Dec. 13 published a final rule that permits full practice authority for three categories Advanced Practice Registered Nurses (APRNs): Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS) and Certified Nurse-Midwife (CNM). The Final Rule defines "full practice authority" to mean that an APRN working within the scope of VA employment would be authorized to provide services without the clinical supervision or mandatory collaboration of a physician, regardless of state or local law restrictions on that authority.

Certified Registered Nurse Anesthetists (CRNA) were carved out of the final rule— that is, CRNAs will be excluded from full practice authority— but the VA has requested further comment on this issue. The rule also clarifies that radiology studies should not be performed and read by APRNs who are not credentialed in radiology.

The AMA discussed its concerns with giving APRNs full practice authority in meetings with VA officials and in its comment letter. The AMA emphasized that providing physician-led, coordinated, patient-centered, team-based care is the best approach to improving quality care for our nation's veterans. The AMA will monitor the implementation of this policy and will engage the VA if issues arise.

The deadline to submit comments on the CRNA exclusion is Jan. 13, 2017.

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State Update

Interactive workshops announced for State Legislative Strategy Conference

Join physician leaders and medical society staff at the 2017 AMA State Legislative Strategy Conference Jan. 5-7, at the Ritz-Carlton in Amelia Island, Fla.

Thursday afternoon will feature a series of interactive strategy workshops, beginning with a discussion with state legislators Richard Pan, MD, California State Senate, and John Zerwas, MD, Texas House of Representatives. Subsequent sessions will engage attendees in strategic discussions about how to grow grassroots efforts at the state level, develop a coordinated advocacy strategy and create a polling strategy that can shape a state legislative agenda. The strategy workshop will be followed by Thursday evening's keynote address and reception.

Don't miss this opportunity to share your organizations' priorities, concerns and tactics with advocacy leaders from across the country, and to discuss the challenges and opportunities likely to be part of your upcoming legislative sessions.

Register today, view the schedule and make your hotel reservation.

SAMHSA accepting applications for state opioid grants

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and Center for Substance Abuse Prevention (CSAP), are accepting applications for FY 2017 State Targeted Response to the Opioid Crisis Grants. The program aims to address the opioid crisis by increasing access to treatment, reducing unmet treatment need and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder.

These grants will be awarded to states and territories through a formula based on unmet needs for opioid use disorder treatment and drug poisoning deaths.

Learn more about the available grants on SAMHSA's website.

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Other News

Updated AMA resources offer practice support for electronic workers' compensation billing

Physicians and practice staff who are familiar with workers' compensation programs know that this line of business can be even more manual and burdensome than regular commercial health insurer billing. The AMA's newly revised workers' compensation and property and casualty (P&C) insurance toolkit and associated webinar offer practices assistance in understanding and automating P&C processes.

The toolkit and webinar provide basic background on P&C insurance, terminology and billing procedures, discuss electronic transactions in the P&C world, and outline a five-step plan for practices to follow when automating P&C billing to ensure a smooth transition. These resources also list sample questions for practices to use in discussions with potential P&C business partners—both vendors and P&C payers—before implementing an automated P&C billing system.

Visit the AMA website to access these updated resources, as well as other tools to help practices improve the efficiency of revenue cycle processes.

CMS holding webinars on proposed patient relationship codes

As announced in the last Advocacy Update, Medicare officials modified an earlier list of patient relationship categories they are constructing to improve their ability to accurately attribute costs of care to particular physicians and then compare costs among physicians. A series of webinars have been scheduled by the Centers for Medicare and Medicaid Services (CMS) to familiarize physician organizations and practice managers with the codes. Comments on the revised categories, which were suggested by the AMA and developed with assistance of a joint CPT/RUC workgroup, are due Jan. 6.

Comments should be sent to patientrelationshipcodes@cms.hhs.gov. The presentation will be the same for both, but the webinar on Dec. 20 will be focused on medical specialties, while the webinar on Dec. 21 will be focused on practice management organizations.

CMS halts plans for Part B drug demo

Through media reports, the Centers for Medicare and Medicaid Services (CMS) revealed on Dec. 15 that it was not proceeding with a plan announced last March to test a new Medicare Part B payment model for physician-administered drugs. That two-phased proposal would have initially reduced Medicare's reimbursement for the cost of acquiring these drugs significantly while creating a new flat fee payment of $16.80 per drug per day; at a later time more value-based payment models would be tested. The proposal was met with significant bipartisan opposition on Capitol Hill as well as from a variety of health care stakeholder groups, including the AMA.

The AMA welcomed the announcement, praising it as an example of CMS's recent receptivity to maintaining an open and constructive dialogue with physician and other health care organizations during the regulatory process.

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Upcoming Events

Dec. 31:
Physicians who see Medicare patients have until this date to make changes to their participation status for 2017. Updated information describing Medicare participation options and answers to frequently asked questions are available for download. 

Although many physicians are appropriately focused on preparing for the new Quality Payment Program (QPP) in 2017, the QPP will not affect physicians' Medicare payment rates and participation decisions until 2019. Rather, for 2017, payment adjustments will be determined by physicians' 2015 participation in the existing Medicare payment programs: the Physician Quality Reporting System, EHR Meaningful Use and the value-based modifier. Those facing penalties in 2017 due to these programs may want to review the AMA's "Know Your Options" guide options before the deadline.

Jan. 5 – 7, 2017:
The AMA State Legislative Strategy Conference, described earlier, is where physician leaders and medical society staff meet to discuss state-related legislative issues. The meeting will take place at the Ritz-Carlton in Amelia Island, Fla., and feature keynote speaker Mike Leavitt, former HHS secretary and former administrator of the Environmental Protection Agency. Leavitt was governor of Utah from 1993 – 2003. Learn more and register.

Feb. 19 – 21, 2017:
Whether you want to run for public office or campaign for a candidate who supports issues that are important to medicine, AMPAC (the AMA's bipartisan political action committee) offers the hands-on training you need. The Candidate Workshop is designed to help you make the leap from the exam room to the campaign trail and give you the skills and strategic approach you will need to make a run for public office. Please note participants are responsible for their registration fee, hotel accommodations at the Hyatt Regency Washington on Capitol Hill and travel to and from Washington, DC. Faculty, materials and all meals during the meeting are covered by the AMA. Learn more or apply today.

Feb. 27 – March 1, 2017:
The 2016 National Advocacy Conference will take place in Washington, D.C. Participants in this year's conference will gain important insights from industry experts, political insiders and members of Congress. Conference participants will leave more well informed and empowered to advocate for patients, the medical profession and the future of health care. Learn more and register today.

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