Nov. 30, 2017

National Update

Staying 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®.

Payment cuts for physician office-based testing start Jan. 1

On Nov. 17, the Centers for Medicare and Medicaid Services (CMS) announced it finalized new payment rates for clinical laboratory testing services paid on the Clinical Laboratory Fee Schedule (CLFS) for Calendar Year 2018. These new rates are the first to be issued under the new clinical laboratory payment system mandated by the Protecting Access to Medicare Act of 2014 (PAMA) and will take effect starting Jan. 1, 2018.

Under PAMA, CMS was required to implement a new market-based payment system for all tests paid on the CLFS, with the new payment rates being based on private payer payment rates for these testing services. The final rates will result in significant reductions in reimbursement for these services, including testing services offered by physician office-based labs. The full reductions will be phased in over the next three years and will be capped at 10 percent in 2018.

The AMA has been working closely with a number of physician specialty societies and laboratory community stakeholders to avoid these reductions, as they will significantly affect physician offices providing clinical testing services that are paid on the CLFS. The AMA has submitted numerous comment letters and has had a number of discussions with CMS raising concerns about the accuracy of the new payment system and calling attention to the potentially significant impacts on patients should physician office-based testing services no longer be available. The AMA and physician specialty societies have also raised concerns with both House and Senate committees overseeing CMS-related issues. The AMA will continue to fight for changes to the payment system and to preserve access to these critical testing services.

The AMA has created a webpage with information related to the new clinical laboratory payment system, including an overview of the issue as well as advocacy materials. Information from CMS regarding the final payment rates for CY 2018 is available on the CMS website.

Medicare guidance to MIPS-eligible clinicians affected by recent hurricanes and wildfires

The Centers for Medicare and Medicaid Services (CMS) recently released regulatory guidance for clinicians participating in the Merit-based Incentive Payment System (MIPS) who have been adversely impacted by Hurricanes Irma, Harvey and Maria, as well as the Northern California Wildfires. Immediately after the first disaster the AMA urged CMS to provide relief to physicians. The "Extreme and Uncontrollable Circumstances" policy grants MIPS-eligible clinicians exceptions without having to submit an extraordinary circumstances exception request.

Under this policy, clinicians affected by Hurricanes Harvey, Irma or Maria, or the Northern California Wildfires, will not be required to submit an application to reweight the performance categories. MIPS-eligible clinicians in impacted areas will automatically receive a neutral MIPS payment adjustment, unless they submit data for any of the MIPS performance categories by the submission deadline for 2017. The affected areas include:

 This policy does not apply to MIPS-eligible clinicians in MIPS alternative payment models (MIPS APMs) in 2017, such as the Medicare Shared Savings Program.

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State Update

Are you ready to strategize with some of the top state policy makers?

Registration for the 2018 AMA State Legislative Strategy Conference, held Jan. 4–6 in Fort Myers, Fla., is underway. This is your chance to learn more about the most pressing issues impacting medicine at the state level and develop cutting-edge advocacy strategies to deploy in state legislative advocacy.

Thursday will offer a series of strategy workshops where you can hone your advocacy skills and strategies with colleagues, state legislators, pollsters and grassroots directors.

Don't miss this opportunity to share your organizations' priorities, concerns and tactics with advocacy leaders from across the country, and to discuss the challenges and opportunities likely to be part of your upcoming legislative sessions.

Keynote speakers include Bruce P. Mehlman, well-regarded as an expert in developing strategies that achieve impactful policy outcomes, and Sam Quinones, nationally recognized journalist and author of Dreamland: The True Tale of America's Opiate Epidemic.

Make your hotel reservation by Dec. 12, and view the meeting agenda for additional details.

Registration is also open for the National Advocacy Conference. This year the AMA is offering a 20 percent discount if you register now for both the 2018 AMA State Legislative Strategy Conference and the AMA National Advocacy Conference. Register for both conferences and receive your discount. This offer ends on Dec. 18.

New study looks at opioid prescribing and rhinoplasty 

Patients who have rhinoplasty may need fewer opioids than they commonly are prescribed, according to a new study published in JAMA Facial Plastic Surgery in conjunction with the recent American Academy of Facial Plastic and Reconstructive Surgery Annual Fall Meeting. The study, "Opioid Use by Patients After Rhinoplasty," asked, "How many of the initially prescribed 20 to 30 tablets of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) do patients consume after rhinoplasty?"

Of the 62 patients in the study, 46 consumed 15 or fewer tablets, nine did not use the medication at all, and only three patients required a refill. Among the conclusions, the authors said that following the study results, "they now tailor pain-management regimens, decreasing the initial number of hydrocodone-acetaminophen tablets prescribed while maintaining patient satisfaction."

The study, which has been added to the AMA Opioid Microsite, can be found here.

NCOIL approves model bill on out-of-network care

The National Conference of Insurance Legislators (NCOIL) recently approved a model bill on out-of-network care that attempts to reduce the impact of unanticipated out-of-network bills on patients while still encouraging insurers to contract with physicians. The AMA has been working with NCOIL members and staff for many years in the development of this model, having testified before NCOIL's Health, Long-Term Care & Health Retirement Issues Committee on several occasions, submitting comments and testimony on drafts, and offering resources such as our own model bills for consideration and incorporation. The work has paid off. While the final NCOIL model bill is not perfect, it contains provisions addressing network adequacy, transparency of out-of-network coverage, the financial impact of out-of-network bills on patients, and one of the most debated issues—fair payment standards to physicians. For a copy of the model bill or if you have questions, contact Emily Carroll at

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Other News

CMS requests specialty feedback on possible RAC review topics

At an AMA-convened meeting with the Centers for Medicare and Medicaid (CMS) officials earlier this year, the medical specialty societies offered to provide feedback to Recovery Audit Contractors (RACs) on possible RAC review topics prior to the approved work being posted on the RACs website. CMS recently informed the AMA that it is moving forward with this process. The deadline for the first review is Dec. 8. Given the AMA's Interim Meeting and the Thanksgiving holiday, the AMA raised concern about the short deadline. As a result, CMS said that it will continue to take comments on the topics until later in December. The topics are listed on CMS' website.

Moving forward, the AMA will work with CMS to establish a process to allow ample time for input on new topics.

AMA responds to Innovation Center's new direction

In a comment letter responding to a Request for Information on a new direction for the Center for Medicare and Medicaid Innovation (CMMI), the AMA urged CMMI to support alternative payment models (APMs) that support more accurate diagnoses, treatment planning, care coordination, and outreach to high-risk patients to ensure they get preventive services. The AMA letter also encouraged CMMI to:

In response to CMMI's request for information on consumer-directed care and market-based innovation models, the AMA supports testing models involving direct contracting between patients and physician-led teams. In addition, the AMA stated that CMMI's highest priority should be expanding and accelerating the availability of APMs in which specialists can participate.

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Upcoming Events

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.

Jan. 24, 2018:
Cybersecurity is not just a technical issue—it's also a patient safety issue. As cybersecurity threats increasingly expose physicians and their patients to risk, the AMA has taken several steps to increase awareness and understanding of good cyber hygiene. Recently, a joint research effort between the AMA and Accenture found that: physicians recognize that it's not "if", but "when" they'll experience a cyberattack; physicians rely heavily on third-parties like health IT vendors for security support; and physicians want to share data, and as such, the health care industry needs to work together to create a secure environment for the good of the patient.

In this one-hour webinar, held from noon–1 p.m. CST, attendees will learn how the AMA is shaping the national cybersecurity conversation to focus on patient safety, how physicians can be empowered advocates for their patients, and how it's a shared responsibility to secure electronic patient information. Laura G. Hoffman and Matt Reid of the AMA will co-present. Register.

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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