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May 18, 2017

Issue Spotlight

Anthem ends pursuit of Cigna deal that threatened patient care

A Delaware Chancery Court last week gave health insurer Cigna the OK to walk away from a proposed $54 billion merger with fellow insurance Goliath Anthem. Anthem had the option to appeal the decision but last Friday the company terminated its merger agreement with Cigna.

The termination of the merger "is a clear victory to preserve competition in the health insurance industry," said AMA President Andrew W. Gurman, MD. "To the detriment of patients, there is already far too little competition among insurers. Networks are already too narrow, and premiums are already too high. Competition, not consolidation, is the right prescription for health insurance markets.

"Following 21 months of advocacy before the U.S. Department of Justice, congressional committees, state attorneys general, insurance commissioners, and federal courts, the break-up of the Anthem-Cigna mega-merger deal shows again that when doctors join together, the best outcome for patients and doctors can be achieved," Dr. Gurman added.

The action concluded a successful campaign by the AMA and 17 state medical societies—on behalf of patients and physicians—to stop the Anthem-Cigna merger. In September 2015, soon after the merger was proposed, the AMA released Competition in Health Insurance, an annual analysis of insurance markets that showed nearly half of all states could see diminished competition in local health insurance markets if the Anthem-Cigna and Aetna-Humana mega-mergers were allowed to proceed.

That same month, AMA leaders testified before Congress regarding the mergers. They argued for more choices for patients for health care services and coverage, and for close scrutiny of the proposed mergers, respectively. Two months later, the AMA outlined detailed concerns with further market consolidation and urged the Department of Justice to block the proposed mergers.

Over the past year and a half, the AMA and its coalition of state medical societies worked tirelessly to protect patients and block the mergers. For more information on the steps taken by the AMA to maintain competition in the insurance marketplace, view a comprehensive timeline or read the AMA Wire Special Series, "Protecting Health Insurance Competition."

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National Update

AMA reaffirms principles on health-system reform legislation to Senate leaders

On May 15, the AMA sent a letter to the Senate leadership reaffirming the principles that should guide consideration of any changes to the Affordable Care Act (ACA). The letter acknowledges that there are problems that need to be fixed. However, the AMA does not support changes to the health care system that would result in affordable health care coverage being beyond the reach of those who are currently covered, that would weaken the health care safety net, or that would compromise the ability of physicians to provide care for their patients.

Specifically, the letter calls for legislative proposals that would maintain key insurance market reforms—such as coverage for pre-existing conditions, guaranteed issue and parental coverage for young adults—as well as strengthen the individual insurance market. It also advocates adequate support for Medicaid, the Children's Health Insurance Program and other safety-net programs. Further, the AMA calls for reducing regulatory burdens that detract from patient care and increase costs, and for providing greater cost transparency throughout the health care system.

Following House passage of the American Health Care Act (AHCA), Senate Republicans have begun to work on developing alternative proposals that address issues several of their members have raised with the AHCA. It is unclear at this time when a new or revised legislative proposal will be released and considered in the Senate.

Global ransomware attack jeopardizes security of computers and medical devices

The United States Computer Emergency Readiness Team (US-CERT) has received multiple reports of " "WannaCry" (also known as "WannaCrypt") ransomware infections in several countries around the world and in the United States. Some of these infections are having an impact on patient access to care.

On May 15, the AMA emailed the Federation of Medicine with information about ransomware, as well as the steps that physicians should take to guard against WannaCry infection. Anyone who has been affected by the WannaCry infection or did not receive the AMA's email on the topic is encouraged to email Terri Marchiori.

In addition to the information provided in the email, the AMA has resources to help physicians conduct a checkup of their systems, and to secure their networks and office computers. Additionally, the AMA has been engaged with the administration since the cyberattack and will continue to monitor the situation to update its members as more information becomes available.

Physicians recommend comprehensive approach to pain management

Participants in a two-day public workshop convened by the Food and Drug Administration (FDA), including AMA Board Chair Patrice A. Harris, MD, MA, urged the government to help facilitate more comprehensive treatment of pain and substance-use disorders, and not expect a short course on safe prescribing to serve as a meaningful solution to the growing epidemic of overdose deaths.

Dr. Harris cautioned that a mandated federal education program could be a check-the-box compliance exercise that would have little impact on patient care. Participants described academic detailing, mentorship and programs that encourage use of multiple modalities to treat pain in a patient-centered manner, not just pharmaceutical options, as necessary to help end the epidemic.

Some participants called for major change in the way the medical profession views pain so that it is not just considered as a symptom of another condition that will go away when the other condition is treated, but instead approached as a condition itself for which a treatment plan is needed. Other federal agencies also described their successful strategies, including the CMS Opioid Overutilization Monitoring System. That system helps physicians coordinate care for their patients with Medicare Part D by informing them when their patients are receiving opioid prescriptions from multiple physicians and pharmacies. The FDA is seeking comments on the topics discussed at the workshop through July 10.

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State Update

Iowa adopts comprehensive medical liability reform legislation

The Iowa legislature has enacted sweeping medical liability reforms. On May 5, Iowa Gov. Terry Branstad signed SF 465 into law, marking the culmination of decades of work by the Iowa Medical Society and its physician advocates.

The new law enacts the following medical liability reforms:

The AMA is proud to have supported the work of the Iowa Medical Society in its successful effort to pass this comprehensive tort reform legislation, which takes effect July 1.

South Dakota enacts Good Samaritan overdose protection law

South Dakota became the latest state to enact a Good Samaritan overdose protection law when Gov. Dennis Daugaard signed HB 1082 into law last month. The new law was a multiyear effort led by the South Dakota State Medical Association (SDSMA), which coordinated efforts within the state and the AMA.

The new law says: "No person may be arrested or prosecuted for any misdemeanor or felony offense of possession, inhalation, ingestion, or otherwise taking into the body any controlled drug or substance if that person contacts any law enforcement or emergency medical services and reports that a person is in need of emergency medical assistance as the result of a drug-related overdose." The law does require the person making the call to remain on the scene to assist law enforcement as necessary. For more information about the new law, contact the SDSMA's Mark East.  

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Other News

CMS urged to adjust implementation of Social Security number removal initiative

On May 11, the AMA and 89 state and specialty medical societies sent a letter to the Centers for Medicare and Medicaid Services (CMS) to express concern over the planned enactment of the Social Security Number Removal Initiative (SSNRI). The SSNRI is the process CMS developed to implement a provision in the Medicare Access and CHIP Reauthorization Act (MACRA) requiring the removal of Social Security numbers from Medicare cards due to concerns about identity theft. To implement the SSNRI, CMS will create new Medicare Beneficiary Identifiers (MBIs) for all active and deceased Medicare beneficiaries.

The AMA and other signatories have concerns about patient and physician awareness of this change and backup plans to mitigate potential problems. Among other issues, multiple provider groups have expressed concern regarding the lack of a contingency system that will allow medical practices to obtain the MBI for a patient who arrives at an appointment without a new Medicare card. This lack of a provider look-up system may strain a practice's ability to conduct administrative transactions and delay patient care in the event that a patient does not present his or her card at the time of service.

The sign-on letter calls for CMS to pursue the SSNRI through the traditional notice-and-comment rulemaking process so that industry feedback may be considered prior to implementation of the initiative. It further asks that CMS develop a mechanism for providers to quickly and securely access MBIs to avoid disruptions in access to care.

New CMS tool available to determine MIPS eligibility

Physicians can now use a new tool from CMS to determine whether they should participate in the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program this year. The tool shows participation status and resources after a national provider identifier (NPI) is issued.

Clinicians new to Medicare in 2017 do not participate in MIPS, although they may participate voluntarily without being subject to payment adjustments. Other exemptions exist for those participating in an Advanced Alternative Payment Model (APM), those meeting a low-volume threshold of $30,000 in Medicare claims submissions each year or no more than 100 Medicare patients per year, and those qualifying for one of the special rules for certain types of clinicians. The CMS MIPS participation fact sheet has more details.

AMA presses for additional federal support for GME positions

The AMA recently sent a letter in support of the Resident Physician Shortage Reduction Act of 2017, which would provide 15,000 additional Medicare-supported graduate medical education (GME) positions over five years. While new medical schools are opening and existing medical schools are increasing their enrollments to meet the need for more physicians, federal support for residency positions is still subject to an outdated cap dating back to the Balanced Budget Act of 1997. This bill would ameliorate this problem by providing critical federal funding to expand GME training positions.

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