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Aug. 10, 2017

Issue Spotlight

Customizable MIPS tool helps physicians build QPP strategy

How physicians participate and perform in 2017 will affect their Medicare payment rates in 2019, yet a recent survey found that most physicians don't consider themselves deeply knowledgeable about the Centers for Medicare and Medicaid Services' (CMS) new Quality Payment Program (QPP).

The AMA has acted on the findings by providing QPP resources on how to participate, avoid penalties and succeed, particularly under the Merit-Based Incentive Payment System (MIPS) track. A new customizable resource, the MIPS Action Plan, helps physicians choose and implement a practice QPP strategy, fulfill regulatory requirements, avoid federal penalties and have an opportunity for performance-based incentive payments.

The MIPS Action Plan addresses key steps for 2017 QPP participation:

  1. Determine whether MIPS applies to you.
  2. Review available performance categories.
  3. "Pick Your Pace" for MIPS participation.
  4. Review your data.
  5. Decide whether to report as an individual or a group.
  6. Identify your reporting mechanism.
  7. Perform a security risk analysis.
  8. Report for at least 90 days (CMS deadline: Oct. 2, 2017).
  9. Complete MIPS performance (CMS deadline: Dec. 31, 2017).
  10. Submit 2017 MIPS data.

Physicians who have yet to participate in the QPP program or are new to quality improvement, to explore the interactive MIPS Action Plan and other free resources and tools. A more in-depth explanation of these steps is available in a supplementary frequently asked questions file.

On step two, for example, the FAQ file offers advice and strategies on which quality measures to choose.  This includes opting for those that are most representative of your practice, such as ones that apply to the patients you see or the procedures that you perform frequently enough to ensure you have a minimum of 20 cases.

Advice is also given specifically for smaller practices as well as information on meeting minimum requirements to avoid a penalty or earning maximum points.

Read more at AMA Wire®.

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National Update

Congressional agenda for September is full

The U.S. Senate recessed Aug. 3, joining the House of Representative in a month-long summer break. While the Senate will hold pro-forma sessions throughout the month of August, no legislative business will be conducted by either chamber until the week of Sept. 4. When they return, Congress will have its plate full with many must-pass items as well as lingering questions over the future of the Affordable Care Act (ACA).

While efforts s to repeal significant portions of the ACA through the reconciliation process stalled , work remains to be done to stabilize the non-group health insurance market. Prior to recess, Sen. Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions, announced that his committee would hold hearings the week Congress returns on necessary steps. These include ensuring payment of the ACA cost-sharing reductions (CSRs) and, potentially, reinsurance for plans participating the ACA exchanges. Other conversations have also begun on bipartisan efforts to address problems with the ACA, including by a group of a dozen senators of both parties—the bipartisan House Problem Solvers Caucus—and other groups of moderates from both sides of the aisle.

When they do return, Congress members will face a long list of initiatives that must be passed before the end of September, including raising the debt ceiling, passing a budget and providing appropriations for the 2018 fiscal year that begins Oct. 1. Action must also be taken on dozens of programs that expire at the end of September, including the Children's Health Insurance Program(CHIP) and numerous Medicare and public-health provisions. Beyond health care, action will also be required to extend the authorizations for the Federal Aviation Administration and the national flood insurance program. Making matters even more challenging, the House is only scheduled to be in session for 12 days during September, and the Senate for 17 days.

CMS replaces pain-management questions from HCAHPS

In the 2018 Inpatient Prospective Payment System (IPPS) rule, Medicare finalized its proposal to remove a trio of pain-management questions from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). The AMA supported the removal of these questions as they became increasingly controversial due to concerns that they may inappropriately incentivize hospital-based providers to overprescribe paid medication, thereby fueling the opioid epidemic.

The Centers for Medicare and Medicaid Services (CMS) finalized its proposal to replace the old questions with three new HCAHPS questions (Communication about Pain composite measure) that shift the focus away from the methods of pain management toward the frequency and quality of communications between providers and patients. The AMA supports CMS' decision to finalize a delay of public reporting of the revised Communication about Pain composite measure on the HospitalCompare website until October 2020. That will allow hospitals to familiarize themselves with the new questions. The AMA will also continue urging the administration to remove pain-management questions from HCAHPS, given concerns about the appropriateness of including them in a patient-experience survey that is used for accountability.

CMS withdraws proposal for accrediting organizations to post data

Also in the 2018 IPPS proposed rule, CMS proposed to require accrediting organizations to post survey reports and plans of corrections from CMS-approved accreditation programs on their public-facing websites.

The AMA expressed concerns that accreditation survey data may be overwhelming for consumers, is unlikely to lead to better health care decisions and could increase the regulatory burden on physicians and health care facilities. In the final IPPS rule issued Aug. 2, CMS decided to withdraw this proposal after consideration of the comments it received, including those from AMA.

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State Update

New opioid-related reports focus on mortality data, women, cancer and hospitalizations

As the opioid epidemic continues to grow, new reports continue to underscore the gravity of the epidemic and highlight specific concerns related to women's health, disparities in income and data regarding opioid-related hospitalizations. As research continues to be published, however, the AMA notes that there remains a vast treatment gap and barriers to treatment for patients with opioid-use disorders as well as barriers for patients with pain to access non-opioid and non-pharmacologic care. The new studies include:

Visit the AMA opioid microsite and view select national education resources for physicians and other health professionals.

Wisconsin Medical Journal explores opioid epidemic

The current issue of the Wisconsin Medical Journal is highlighting the opioid epidemic for Wisconsin physicians. In "The National Opioid Epidemic: Local, State and National Responses," Joel M. Prince, MD, and William B. Seiden, MD, discuss several of the policy interventions in Wisconsin as well as education efforts by numerous groups, including the Wisconsin School of Medicine, the Centers for Disease Control and Prevention, AMA and others. Sridhar V. Vasudevan, MD, provides a close look at "Opioid Use for Treatment of Chronic Pain: An Overview and Treatment Guideline for Injured Workers."

The journal also provides original research in "The Use of a Statewide Prescription Drug Monitoring Program by Emergency Department Physicians," by Jennifer L. Hernandez-Meier, PhD, Rachel Muscott, MD, and Amy Zosel, MD. This study, which had survey questionnaires returned by 63 emergency physicians, found that nearly all of the respondents found the prescription drug-monitoring program information useful, and that more than "70 percent reported writing fewer prescriptions for some medications since implementation of the program." At the same time, respondents said that lack of time, a complex login process and the user interface were barriers to more effective use.

Access the journal and other Wisconsin-specific resources through the AMA opioid microsite.

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Judicial Update

Informed-consent ruling may have "far-reaching, negative impact"

A recent ruling by the Commonwealth of Pennsylvania Supreme Court in Shinal v. Toms could "have a far-reaching, negative impact" on physician practices, according to Justice Max Baer.

The Commonwealth of Pennsylvania Supreme Court, in a 4–3 decision, ruled that, not only do surgeons have the duty to provide their patients with information about the alternatives, risks and benefits of a particular procedure in order to obtain informed consent; the surgeon has to be the person who delivers that information personally.

"The law simply does not support such a proposition," Baer wrote in the dissenting opinion, with two other judges—including Chief Justice Thomas Saylor—joining in.

Four other justices disagreed, however, and the case has been remanded back to a lower court for a new trial.

Read more at AMA Wire.

Procedural ruling sets higher bar for expert-witness testimony

In a procedural decision that could keep so-called junk science out of the courtroom, the District of Columbia Court of Appeals adopted an evidentiary standard that places additional scrutiny on testimony from expert witnesses.

The case at the center of the ruling—Motorola v. Murray—raises the issue of whether cellphones cause brain cancer. In total, 29 cases on the subject matter were brought before the Superior Court for the District of Columbia.

The court did acknowledge isolated strands of scientific data that suggest a possible causal connection between cellphone use and brain cancer. But the court ultimately ruled that based on the research to date, there was inadequate data for any scientist to opine on a causal connection between cellphone use and cancer to any degree of scientific certainty.

In spite of this, the plaintiffs offered their own expert testimony to the contrary, arguing that the jury should determine the validity of the testimony.

Read more at AMA Wire.

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Other News

How to check qualification for special status under the Quality Payment Program

On July 24, CMS distributed an email update with an explanation for its special status calculation for the QPP. The message wrongly stated that clinicians considered to have "special status" would be exempt from the QPP. However, CMS has since clarified the matter. Special status affects the number of total measures, activities or entire categories that an individual clinician or group must report under MIPS. Individual clinicians or groups with special status are not exempt from the QPP because of their special status determination.

To determine whether a clinician's participation should be considered special status under the QPP, CMS retrieves and analyzes Medicare Part B claims data. Calculations are run to indicate a circumstance of the clinician's practice for which special rules would apply. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), rural, non-patient facing, hospital-based and small practices. Visit the QPP website for more information.

QPP hardship exception application for 2017 now available

The QPP Hardship Exception Application for the 2017 performance year is now available on the QPP website. Physicians may also contact the QPP Service Center at (866) 288-8292 and work with a representative to verbally submit an application.

This hardship exception would allow MIPS-eligible clinicians and groups to have their advancing care information (ACI) performance category score reweighted to zero percent of the final score for one of the following specified reasons:

Once an application is submitted, the applicant will receive a confirmation email that the application was submitted and is pending, approved or dismissed. Applications will be processed on a rolling basis.

In addition, some MIPS-eligible clinicians are considered as special status (e.g., hospital-based or non-patient facing). CMS will automatically reweight the ACI score for these clinicians without the need for a QPP Hardship Exception Application. Similarly, physicians participating in MIPS alternative payment models will have their ACI scores reweighted automatically to the percentage applicable to their MIPS APM. 

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Upcoming Events

Sept 12:
At noon CDT, the AMA will host, "How to Position Yourself as a Physician Leader" (1.0 AMA PRA Category 1 Credits™), a timely and empowering webinar for women physicians. Despite the increasing number of women in medicine, women physicians continue to hold a smaller proportion of leadership positions. Author, researcher and educator Vineet Arora, MD, will share strategies on how women physicians can better position themselves as leaders. Dr. Arora will discuss highly relevant topics including contract and salary negotiations, and career advancement strategies. Registration is open until Sept. 10.

Oct. 27–29:
Apply by Sept. 8 to attend the Candidate Campaign School and become an advocacy expert at the AMA office in Washington, D.C. The school is targeted to AMA members, their spouses, residents, medical students and medical society staff who want to become more involved in the campaign process. Faculty, materials and meals are covered by AMPAC. Participants are responsible for the registration fee ($350 for AMA Members, $1,000 for non-members), airfare and hotel accommodations. Learn more or apply, or email questions to politicaleducation@ama-assn.org.

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