April 6, 2017

National Update

Health system reform legislation stalls in the House

On March 24, the U.S. House of Representatives began consideration of H.R. 1628, the American Health Care Act (AHCA), which would have made significant revisions to the Affordable Care Act (ACA), including elimination of the penalty for individuals who do not purchase health insurance. When it became apparent that the measure lacked the votes needed for passage, House leadership withdrew the bill prior to a vote. According to the Congressional Budget Office, the AHCA, with amendments approved by the House Rules Committee, would have resulted in 14 million Americans losing health care coverage in 2018. By 2026, it was estimated that 52 million Americans would have lacked health insurance, 24 million more than under current law. 

The AMA sent a March 22 letter to House Speaker Paul Ryan and Democratic Leader Nancy Pelosi stating that the AMA was unable to support "legislation that would leave health insurance coverage further out of reach for millions of Americans." 

It is possible that Congress could return to consideration of health system reform later this year, but the timing and process to do so are unknown. Additionally, Congress may need to consider measures to stabilize the health insurance exchanges at some point this year. The AMA continues to stand ready to work with Congress on proposals that will increase the number of Americans with high-quality, affordable health insurance.

CMS delays reporting deadline for physician office-based laboratories

Following a request from the AMA and six other medical organizations, the Centers for Medicare and Medicaid Services (CMS) on March 30 announced its intention to exercise "enforcement discretion" with respect to the deadline for physician office-based laboratories to meet new reporting requirements. Qualifying laboratories will now have until May 30 to complete reporting of private payer payment data for clinical testing services as required by the Protecting Access to Medicare Act (PAMA). Under PAMA, laboratories meeting certain revenue thresholds are required to report private payer payment rates and associated volumes for tests they perform that are paid on the Clinical Laboratory Fee Schedule (CLFS). CMS will use data collected to set new payment rates for these tests, a move that is expected to result in decreased reimbursement for these services. 

Due to expectations of a detrimental impact on physicians' ability to continue providing point-of-care testing services, the AMA led a recent sign-on letter to CMS requesting a one-year delay in the implementation of the new CLFS and requesting that CMS work with the physician community to find an appropriate path forward that would preserve point-of-care testing in physician office-based laboratories. The AMA continues to work closely with CMS, physician specialty organizations, and the laboratory community to preserve these critical services for patients.

More information on the announcement by CMS and the PAMA reporting requirements are available on the CMS website.

President announces new commission to combat opioid crisis

The AMA applauded President Trump's executive order establishing a commission to combat drug addiction and overdose, expressing interest in working with the new commission to create policies intended to end the opioid epidemic sweeping the country. AMA Board Chair Patrice A. Harris, MD, noted that the AMA and its Task Force to Reduce Opioid Abuse are poised to offer guidance in areas of effective public health approaches, best practices, clinical tools, medication-assisted treatment (MAT) and barriers to effective treatment. The AMA also emphasizes the need to treat substance-use disorder as a medical illness and eliminate the stigma associated with seeking treatment for pain and substance abuse. In addition, the AMA is offering a new education module that offers clinicians a review of the basic approaches and actions to reduce opioid-related harm in patients with acute or chronic pain.

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State Update

Task force promotes safe storage and disposal of meds

The AMA Task Force to Reduce Opioid Abuse this week released a new recommendation urging physicians to make increased efforts to raise awareness about safe storage and disposal of expired, unwanted or unused medications. The recommendations emphasize three steps for physicians to take:

The task force also pointed to several resources that physicians and patients can use to search for drug disposal locations.

To download a copy of the new task force recommendation and to learn more, visit this webpage on safe storage and disposal of opioids.

More than 10,000 physicians trained to provide MAT in past year

More than 10,000 physicians have become trained in the past 12 months to provide in-office buprenorphine to treat patients with substance-use disorders, according to the most recent Substance Abuse and Mental Health Services Administration data. Encouraging more physicians to become trained to treat substance-use disorders is a top recommendation of the AMA Task Force to Reduce Opioid Abuse.

"This is an excellent reflection on the efforts of physicians to educate themselves about treatment and also to potentially increase access to treatment," Dr. Harris said.  "We need to continue the momentum and reduce barriers to patients accessing treatment, including urging all public and private payers to remove administrative barriers such as prior authorization for medication-assisted treatment."

In addition, more than 3,000 physicians have become certified in the past 12 months to provide MAT for up to 275 patients. This is significant because, for years, physicians could only provide MAT for up to 100 patients, but advocacy from the AMA and many other physician organizations led to a provision in the 2016 Comprehensive Addiction and Recovery Act to increase the patient cap to 275. 

Medicaid expansion vetoed in Kansas; reauthorized in Arkansas

On March 30, Kansas Gov. Sam Brownback vetoed House Bill 2044, which would have expanded Medicaid eligibility under the ACA. The bill passed both houses of the legislature with bipartisan support. In his veto message, the governor said the bill would overburden the state budget. Under the ACA, the federal government currently pays 95 percent of the cost of Medicaid expansion, which will drop to 90 percent by 2020. Medicaid expansion would bring coverage to about 180,000 low-income adults in Kansas.

In Arkansas, lawmakers voted to reauthorize the state's alternative Medicaid expansion program known as Arkansas Works. Each year, the legislature must reauthorize the program by a three-fourths vote. This year, the bill underwent three separate votes before it garnered the supermajority needed. During a special session in May, the legislature will take up proposed changes to the Medicaid program sought by Gov. Asa Hutchinson, such as work requirements for non-disabled Medicaid enrollees.

To date, 31 states and the District of Columbia have expanded Medicaid to cover adults with incomes up to 138 percent of the poverty level. For additional information about this and other Medicaid issues, contact the AMA Advocacy Resource Center.

Tennessee passes legislation to improve physician practice financial stability

The Tennessee legislature last week passed a bill that aims to reduce the frequency and impact of changes to physician-insurer contracts on physician practices. The Tennessee Medical Association (TMA) worked for nearly four years to pass legislation addressing the constant contractual changes that affect the financial stability of physician practices. The final version of Senate Bill 437, the Healthcare Provider Stability Act, creates more predictability to payment by limiting changes to fee schedules or payment methodologies to one in a 12-month period. The bill also requires a 60-day notice of any payment policy changes. The AMA worked closely with TMA in its strong effort to pass this legislation.

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Other News

Update on national health expenditures

A new AMA Policy Research Perspective provides insight on U.S. health care spending, which grew by 5.8 percent in 2015, to a level of $3.2 trillion, or $9,900 on a per capita basis. Spending on physician services accounted for 15.7 percent of total health care spending. As in 2014, ACA-related coverage expansions contributed to 2015 spending growth. Although spending on physician services was affected by those expansions, physician spending grew more slowly (at an average annual rate of 3.9 percent) over the 10-year period from 2005 to 2015 than did other large categories of personal health care spending. Visit the AMA website for additional information.

MIPS web-interface and CAHPS for MIPS registration open until June 30

Group practices that intend to use the CMS Web Interface or administer the Consumer Assessment of Healthcare Providers Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey to meet 2017 Quality Payment Program (QPP) requirements must register with CMS by June 30. To register or learn more information, visit CMS' QPP websiteRegistration is open now. 

For 2017, only groups of 25 or more eligible clinicians that have registered can report via the CMS Web Interface. Groups or individuals that participate in MIPS through claims, qualified registry, qualified clinical data registry, or electronic health record (EHR) data submission mechanisms do not need to register. For 2017, only groups of two or more eligible clinicians that have registered can participate in the CAHPS for MIPS survey.

Of note, CMS automatically registered groups for the CMS Web Interface for the 2017 performance period that previously registered for group reporting under the Physician Quality Reporting System (PQRS) via the Group Practice Reporting Option (GPRO) Web Interface. If you need to remove your registration for Web Interface submission because your group now has fewer than 25 eligible clinicians or is reporting through a different mechanism, you must cancel your registration. If your group wants to administer the CAHPS for MIPS survey, your group will need to make an election via the registration system. 

Groups that participate in a Shared Savings Program accountable care organization (ACO) are not required to register or report; the Shared Savings Program ACO is required to report quality measures on behalf of participating eligible clinicians for purposes of MIPS.

To register, visit the QPP website. You will need a valid Enterprise Identity Management (EIDM) account with a Physician Value-Physician Quality Reporting System (PV-PQRS) role in order to register.

EIDM account information

Open Payments: 2016 industry payments ready for physician review

CMS announced April 1 that physicians could begin registering in the Open Payments System and reviewing their calendar year 2016 data. While physicians can review their data and dispute errors until Dec. 31, disputes that are initiated before May 15 will be flagged in the public release on June 30.  

Physicians who do not review their data by May 15 are still encouraged to review their data before the end of the calendar year. Errors will be corrected in the next update and, more importantly, CMS needs to know if the data it is publicizing is accurate.

To learn more, attend the Open Payments educational session April 13, 1:30–3 p.m. EDT. This CMS-sponsored call will offer step-by-step guidance from agency staff on how physicians can register to review and dispute their Open Payments data. Register.

Physicians can visit the AMA website for step-by-step instructions on how to register and review their Open Payments data. Physicians planning to review their 2016 Open Payments data should test their CMS EIDM logon credentials beforehand. Locked accounts and other logon issues can be fixed before the beginning of the review-and-dispute period by visiting Frequently Asked Questions for EIDM Users. For answers to additional questions, email Medicare's Open Payment Help Desk at or call (855) 326-8366.

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Upcoming Events

April 9–11:
The AMA and the Medical Group Management Association will hold their Collaborate in Practice Conference at the Sheraton Grand Hotel in Chicago. The conference honors physicians and administrators as partners in leading medical practices to enhance patient experience, improve population health, cut costs and improve the work life of health professionals. Learn more and register.

April 20:
Learn about the QPP created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) by attending an upcoming webinar held by AMA on April 20, 7 p.m. EDT. This webinar is open to all physicians and Federation staff. Register.

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