Nov. 16, 2017

Issue Spotlight

2018 another transition year for Quality Payment Program

As Medicare moves to the second year of its Quality Payment Program (QPP), 2018 will largely serve as another transition period. Most physicians and other health professionals who bill Medicare won't have to participate in 2018 and hardly any are projected to receive a penalty that will affect their payment in 2020.

In the 2018 QPP final rule, the Centers for Medicare & Medicaid Services (CMS) tripled the low-volume threshold for participation to the point where the agency estimates that only 37 percent of clinicians who bill Medicare will be required to participate in the QPP's Medicare Merit-based Incentive Payment System (MIPS).

The increase to the low-volume threshold means that physicians would be required to take part in MIPS if they treat 200 or more Medicare beneficiaries in a year or bill Medicare $90,000 or more in allowed charges. Because of this and other measures CMS is taking, the agency estimates that 90 percent of clinicians in practices of one to 15 and 97 percent of clinicians in all practice sizes will receive either a neutral or positive adjustment in 2020.

The initiation of virtual groups, the low-volume threshold, reduced requirements and bonus points for small practices are among the regulatory wins that would help small practices. Bonus points for treating complex patients and making 2018 another transition year were other regulatory wins, but CMS warned that requirements will get tougher in 2019 due to requirements in law.

Read more at AMA Wire®.

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National Update

House passes CHIP reauthorization

The House of Representatives passed legislation reauthorizing funding for the Children's Health Insurance Program (CHIP) for five years. Passed in early November by a 242-174 vote, the Championing Healthy Kids Act (H.R. 3922), also includes reauthorizations of other significant programs, including the Community Health Centers, the National Health Service Corps and the Teaching Health Center Graduate Medical Education  program.

The AMA sent a letter supporting House passage of the legislation. The letter also opposed the use of the Public Health and Prevention Fund as an offset while urging Congress to continue efforts to identify alternative offsets for the package. The Senate has not scheduled a vote on CHIP reauthorization as it is continuing to discuss how to offset the cost of the reauthorizations in a manner that garners bipartisan support.

Energy and Commerce Committee holds hearing on APMs

The House Energy and Commerce Subcommittee on Health held a hearing Nov. 8 that focused on developing options for value-based care with regard to the Medicare Access and CHIP Reauthorization Act (MACRA) and alternative payment models. The first witness panel consisted of representatives from the Physician-Focused Payment Model Technical Advisory (PTAC).

The PTAC was established under MACRA to make comments and recommendations to the Health and Human Services secretary on proposals for physician-focused payment models. Testimony from PTAC representatives, Jeffrey Bailet, MD, and Elizabeth Mitchell, MD, focused on the group's work with physicians and suggested the need for clarification from Congress on its ability to provide technical assistance in development of alternative payment models (APMs).

A second panel consisted of physician organizations representing different specialties and practice sizes that participate in APMs. The AMA provided a statement highlighting examples of physician-focused APMs, encouraged congressional action to clarify PTAC's ability to provide technical assistance and made policy recommendations to address challenges for APM participants and developers. Additional hearings on MACRA implementation are expected.

House moves to expand veterans' access to telemedicine

AMA-supported legislation that recently passed the House would expand access to health care services for veterans being treated within the Department of Veterans Affairs (VA) system through telemedicine.

The Veterans E-Health and Telemedicine Support (VETS) Act of 2017 (H.R. 2123) would authorize physicians and other health care professionals, who are employed directly by the VA and possess the appropriate licenses, to provide telehealth services to VA beneficiaries without regard to the location of the patient or the health professional.

This bill, introduced by Rep. Glenn Thompson (R-PA), would address the significant and unique need to expand access to health care services for veterans being treated within the VA system while also ensuring that important patient protections remain in place, including the direct oversight, accountability, training and quality control specific to VA-employed physicians and other health care professionals.

Importantly, the bill does not authorize a contracted physician or other health care professional who is not directly employed by the VA to provide health care services via telemedicine to a VA patient located in a state in which the contracted physician or other health care professional is not licensed. The Senate is unlikely to directly consider the companion bill (S. 925), which was introduced by Senator Joni Ernst (R-IA). The measure is expected to be included in legislation in the House and Senate that will reform and reauthorize the VA Choice program.

News from the 2017 AMA Interim Meeting

As another Interim Meeting came to a close this week, physicians adopted a number of new policies to improve the health of the nation. Highlights include opposition to Medicaid work requirements, the removal of categories from the essential health benefits (EHB) package and waivers of EHB requirements that could lead to the elimination of EHB categories and their associated protection against annual or lifetime benefit limits and out-of-pocket expenses.

The AMA House of Delegates also adopted a new policy that seeks to facilitate consistent coverage of genetic medicine and more transparency in how coverage is being determined. The new policy calls for more transparency and clarity in the processes that determine coverage and payment. Read more AMA Wire. Read more news coverage of the 2017 AMA Interim Meeting.

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State Update

Maine votes to expand Medicaid, other states may follow

Voters in Maine approved a referendum requiring the state to expand Medicaid eligibility to up to 89,000 low-income residents. As a result of the Nov. 7 vote in favor of expanding expand Medicaid under the Affordable Care Act, individuals with incomes up to 138 percent of the federal poverty level will have access to coverage.

The referendum came after efforts to expand Medicaid legislatively had failed; Gov. Paul LePage's vetoed Medicaid expansion five times. With the vote, Maine became the first state to expand Medicaid through a ballot initiative. Maine's success is expected to spur additional states to pursue expansion by referendum. Voters in Utah and Idaho have taken initial steps to put Medicaid expansion on the ballot in 2018.

Educational webinars on opioids a resource for Indiana physicians

A new webinar series aims to provide physicians with updated education and training resources on using opioids with their patients. Recently launched by the Indiana State Medical Association (ISMA), the free webinars highlight: how to better use INSPECT, the state prescription drug monitoring program; how to have difficult conversations with patients; and review the current evidence for the use of opioids to treat chronic pain, including strategies for safer use in opioid-tolerant patients.

Access to the webinars can be found on the ISMA website and the Indiana-specific page on the AMA opioid microsite.

Naloxone research shows importance of post-administration intervention

More than 84 percent of Massachusetts patients who received naloxone from emergency medical services were alive one year following the administration. The study abstract, published in the Annals of Emergency Medicine, reviewed data from more than 12,000 naloxone administrations between July, 1, 2013, and Dec. 31, 2015. The study's authors concluded that, among other things: "Patients who survive opioid overdose should be considered extremely high risk and should receive interventions such as offering buprenorphine, counseling and referral to treatment prior to [emergency department] discharge."

Read more about naloxone on the AMA opioid microsite.

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Judicial Update

Honor for ally in bid to defend medical staff independence

As physicians await resolution of a lawsuit that will determine the fate of medical staff independence, the California Medical Association presented AMA President David O. Barbe, MD, MHA, with a formal resolution of gratitude for the AMA's work in protecting medical staff rights.

The AMA and the Litigation Center of the American Medical Association and State Medical Societies have provided significant legal and financial support in a California medical staff's lawsuit, Tulare Regional Medical Center Medical Staff v. Tulare Local Healthcare District et al. The suit was filed after the hospital's board of directors voted to terminate the medical staff organization, remove elected medical staff officers, install a slate of appointed officers and approve new medical staff bylaws and rules without staff input.

"The support of the AMA and the Litigation Center was indispensable to protecting medical staff rights not only in Tulare Regional Medical Center Medical Staff v. Tulare Local Healthcare District et al but throughout California," reads the declaration presented in late October at the CMA House of Delegates' meeting. The CMA recognized the AMA and Litigation Center for "extraordinary commitment to the cause in California of protecting medical staff rights to independence and self-governance.

Read more at AMA Wire.

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Other News

2018 Medicare Physician Fee Schedule provides regulatory relief for physicians

The Centers for Medicare & Medicaid Services (CMS) released its final rule on the 2018 Medicare Physician Fee Schedule (MPFS). The final rule includes the following changes for 2018:

Read the AMA's summary for additional details.

New video shows how physicians are shaping the future of APMs

As medicine continues shifting toward value-based care, it is crucial that those at the forefront of care have practical payment models that are flexible, innovative and help to improve outcomes. On Oct. 4, nearly 200 physicians and others participated in the second AMA alternative payment models (APM) workshop. Learn how physicians are taking the reins in creating these new models—and what comes next, by viewing highlights of the workshop in a new video. Visit the AMA's new topic hub, "Navigating the Payment Process," for additional information on the Medicare Quality Payment Program and APMs.

New AMA, CMS resources aid transition to the new Medicare Card

The AMA has created a webpage to help physicians prepare for the new Medicare card. The cards will significantly impact physician practice workflows, so practices should take steps now to prepare. A downloadable flyer is available for physicians to give to their health information technology (IT) vendors to ensure they have information necessary to transition IT systems to the new Medicare card.

Additionally, the CMS announced a Provider Ombudsman for the New Medicare Card to serve as a resource for the physician community. The Ombudsman, Dr. Eugene Freund, will ensure that CMS hears and understands any implementation problems experienced by clinicians and will collaborate with CMS to develop solutions to any implementation problems that arise. To reach the Ombudsman, contact:

Lastly, CMS is providing free color posters, tear-off sheets, and fliers to physicians to help alert patients about the transition to the new Medicare card. The poster and tear-off sheets will be available in Spanish later this year. Register and order the products here.

Stay on track for 2017 MIPS reporting: Pick your pace

At this point in the year, physicians should verify that they that they are on the right path for their goals for the Medicare Merit-based Incentive Payment System (MIPS). If not, they should take advantage of the "one patient, one measure" reporting option to avoid a 4 percent payment penalty in 2019.

In deciding which pick-your-pace participation track to choose, physicians should consider whether their focus will be earning a bonus or avoiding a penalty. They also need to determine which measures are the most feasible to report, and evaluate their capacity for submitting 90 or more days of data.

For physicians who have not collected quality or Advancing Care Information measures or completed improvement activities, or are confused by the MIPS process, the minimum reporting option may be the best course of action to take. The AMA "One Patient, One Measure, No Penalty" tutorial offers a step-by-step guide to complete the minimum-reporting process and help physicians avoid a 4 percent Medicare payment penalty for 2019.

Read more
at AMA Wire.

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Upcoming Events

Through Nov. 22:
Join your peers and AMA staff during National Diabetes Awareness Month for a timely discussion about diabetes care and prevention. Several evidence-based interventions that help prevent diabetes, including the National Diabetes Prevention Program. The AMA, in partnership with the CDC and others, has developed tools and processes to assist today's busy practices with patient identification and referral to a lifestyle change program. Join the discussion at the AMA Reinventing Medical Practice Community to learn about these resources and share experiences about what you are doing to help manage and prevent diabetes.

Nov. 29:
Without an understanding of what is really driving poor quality or performance, it is difficult to improve. Root-cause analysis is a critical tool in the quality improvement tool box that allows professionals to understand what's at the heart of the problem, and then develop improvement ideas that can make a difference. How can you improve if you do not understand the challenge and the contributing factors?

In this one-hour webinar, "Quality Improvement Webinar—Root-cause analysis: Digging deep to improve," held from 1–2 p.m. EST, PCPI Director of Quality Improvement Stephen L. Davidow, MBA-HCM, CPHQ, APR, will cover three common forms of root-cause analysis, discuss the advantages of applying these methods to different circumstances and environments, and how root-cause analysis is used as the basis for creating and implementing ideas that lead to robust improvement. Register.

Dec. 13:
In this one-hour webinar, "Physician well-being: A discussion on burnout and achieving joy in practice," attendees will learn about the current landscape of burnout and its impact on our health care system, along with solutions, tools, and interventions for change. Allison M. Winkler, MPH, AMA senior practice advisor, will present. The webinar begins at noon CST. Register.

Jan. 4–6, 2018:
Registration is open for the AMA State Legislative Strategy Conference, which takes place at the Sanibel Harbour Marriott Resort and Spa near Fort Myers Beach in Florida. This year the AMA is offering a 20 percent discount if you register now for both the 2018 State Legislative Strategy Conference and the National Advocacy Conference. Register for both conferences and receive your discount.

Feb. 12–14, 2018:
Registration is open for the AMA National Advocacy Conference will be held in Washington, D.C. at the Grand Hyatt Washington. This year the AMA is offering a 20 percent discount if you register now for both the 2018 State Legislative Strategy Conference and the National Advocacy Conference. Register for both conferences and receive your discount.

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