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July 13, 2017

Issue Spotlight

Senate considers health-bill revisions; AMA advocacy continues to focus on patient impact

As Congress returned from its Independence Day recess this week, the Senate focused once again on its effort to rewrite portions of the Affordable Care Act (ACA). A revised draft of the Senate's proposed Better Care Reconciliation Act of 2017 (BCRA) was released today, and new spending and coverage estimates from the Congressional Budget Office (CBO) will be released soon. The AMA is closely examining the proposal to see if it aligns with the Association's objectives for health-system reform.

The AMA expressed its opposition to previous versions of BCRA, most recently in a letter sent to the Senate on June 26, based largely on the discussion draft's projected impact on the number of Americans who will become uninsured and the reduced federal support for Medicaid. Direct written and personal communications with members of Congress represent one component of a broad-based advocacy campaign that the AMA has been pursuing throughout 2017, highlights of which include:

Physicians and patients who want to engage in the advocacy campaign to preserve access to affordable and meaningful health insurance coverage are encouraged to visit the AMA's campaign website, at Patientsbeforepolitics.org. The site explores the AMA's health reform objectives in depth and provides resource documents, patient profiles and grassroots action links to facilitate communications with their Senators.

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National Update

AMA urges modifications in opioid prescriber education blueprint

In comments submitted on draft revisions to the Food and Drug Administration (FDA) "blueprint" that provides the foundation for its required educational content on opioid prescribing, the AMA cautioned that public policies to reduce the supply of prescription opioids can have unintended consequences and will not address the rising use of heroin and fentanyl. Instead, public health interventions and investments need to comprehensively support access to multimodal, evidence-based treatment for substance use disorders as well as for pain.

The comments also reinforced the AMA's strong support for implementation of the National Pain Strategy, and encouraged the agency to support educational efforts that use data on variations in pain care and prescribing to develop physician-specific plans rather than a one-size-fits-all approach. Find out more about AMA efforts to end the opioid epidemic.

New update provides better Quality Payment Program reporting

The Centers for Medicare & Medicaid Services (CMS) has published new technical guides that can help with Quality Payment Program (QPP) reporting. Updates to the Quality Reporting Document Architecture Category III (QRDA III) implementation guide will now allow electronic health record (EHR) vendors to better support physicians' QPP participation. Specifically, this holds when reporting performance in the Advancing Care Information (ACI) and Improvement Activities (IA) Categories, as well as the Quality Category when reporting through the EHR or registry. If supported by the EHR or registry vendor, using the new QRDA III format will allow CMS to provide immediate, clear and actionable feedback at the time of submission and better eliminate data-submission errors for more successful QPP reporting. If there is a problem with the submission, the vendor will be notified of the issue and be able to address it in near real-time.

The AMA has encouraged CMS to improve procedures for QPP reporting and decrease the time it takes for physicians to receive performance feedback. QRDA III submissions to CMS for the 2017 performance period will be submitted through the new QPP submissions application programing interface (API) or via file upload on the QPP website. To take advantage of these new features, reach out to your EHR vendor and request that they adopt the new updated guide. For more information on QPP reporting, visit CMS' website and the AMA's online resources.

Many physicians, still fuzzy on details, feel unprepared for QPP

Regardless of their size, specialty or level of preparedness, medical practices are concerned that the implementation of Medicare's QPP will be burdensome and time consuming, according to a new survey conducted by the AMA and the KPMG consulting firm.

"It's a big challenge all the way across" practice types, said Carol Vargo, director of physician practice sustainability at the AMA, who said this finding was the survey's "big takeaway."

The AMA and KPMG surveyed 1,000 practicing U.S. physicians involved in their practice's decision making regarding the implementation of the QPP, whose two pathway options include the Merit-based Incentive Payment System (MIPS) or the adoption of an Advanced Alternative Payment Model (APM). The survey was conducted between April 25 and May 1, prior to the recent release of proposed QPP updates to the program by CMS.

The survey is seen as a baseline to measure MACRA implementation progress and a tool to help guide education efforts and policy decisions. The AMA is working to provide a "glide path" for physicians to transition to value-based care, she said. This includes launching an educational campaign, "One patient, one measure, no penalty," which provides physicians with resources to guide physicians on meeting the minimum requirements for this year.

"Our resources include a step-by-step video on minimum reporting requirements to avoid a penalty in 2019 and a payment model evaluator that offers a brief assessment of where a practice stands," AMA President David O. Barbe, MD, said in a statement. "In just 10 steps, physicians can successfully meet the standard under MACRA."

To learn more about CMS' "pick your pace options," listen to this recent ReachMD interview with Kate Goodrich, MD, CMS' chief medical officer and director of its Center for Clinical Standards and Quality.

Read more at AMA Wire®.

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Judicial Update

Sugary-drinks tax passes legal muster in Pennsylvania

A panel of judges in Pittsburgh has ruled that Philadelphia's 1.5-cent per fluid ounce tax on sugar-sweetened beverages is valid and not duplicative of the general retail sales tax. And, since the tax is paid by distributors and not consumers, it does not violate federal law prohibiting taxes on retail transactions conducted with food stamps, the court ruled.

Just the day before the ruling was issued, the AMA House of Delegates adopted policy to "encourage state and local medical societies to support the adoption of state and local excise taxes on sugar-sweetened beverages with the investment of the resulting revenue in public health programs to combat obesity."

The AMA Litigation Center filed an amicus brief in the case in support of the Philadelphia ordinance. The Litigation Center was joined by several other organizations, including the American Heart Association, the American Cancer Society Cancer Action Network, the Pennsylvania Medical Society and the Philadelphia County Medical Society.

The tax was enacted in June 2016. Last September, a coalition of retailers and retail groups filed an injunction to block it. And on Dec. 19, 2016, a local court denied the injunction and cited long-standing precedent addressing the duplicative tax issue.

The case was then heard by a seven-judge panel in commonwealth court, a branch of the Pennsylvania appellate court system which mostly hears cases involving state and local governments and regulatory agencies.

That was where the AMA and the other organizations joined the case. And the long-ago established precedents were cited in their amicus brief.

"These taxes are a well-established tool of local and federal governments alike; they are just new to soda," the brief stated, citing the efforts of Alexander Hamilton, the nation's first treasury secretary. Hamilton used fiscal and health justifications for imposing a tax on whiskey in 1791.

In the 5–2 majority opinion upholding the tax, Judge Michael Wojcik cited other precedents involving overlapping state and local laws concerning the regulation of alcohol, anthracite coal strip mining and the hunting of game.

"It shows that these taxes are likely to be upheld and it is within the powers of local governments to impose these types of taxes," said attorney Rachel Bloomekatz, co-author of the amicus brief and a principal at the Gupta Wessler law firm in Washington. "There is certainly historical precedent for using taxes to promote public good and public health."

Read more at AMA Wire.

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Other News

2016 Open Payments data shows that 5.6% of physicians looked at their data

The Medicare Open Payments program collects information about the payments drug and device companies make to physicians and teaching hospitals for things like travel, research, gifts, speaking fees and meals. Medicare publicly released calendar-year 2016 Open Payments data on June 30.

This followed a 45-day period for physicians to review their data and dispute errors that were presumably adjudicated during a data-correction period. In response to AMA recommendations that the CMS release information on the number of physicians who registered to review their data before its public release, CMS revealed that 34,871 physicians registered to review their data in 2016, which is 5.6 percent of the 630,824 physicians who received payments in 2016. Physicians can view their Open Payments data or see how they compare to their peers.

It's not too late for physicians to review their data! The official review-and-dispute period ended May 15, but physicians can still register to review their data and dispute errors—unresolved disputes or corrections will be reflected in the next scheduled update of the database. Please direct your members to the AMA website for step-by-step instructions on how to register and review their Open Payments data.

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