Dec. 14, 2017

Issue Spotlight

Pick your pace for 2017 MIPS reporting

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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National Update

AMA weighs in with tax reform conference committee

Last week both the House and Senate moved to go to conference on H.R. 1, the Tax Cuts and Jobs Act. The Conference Committee will work to reconcile the differences between the House and Senate-passed versions of the bill. The AMA sent a letter to the conferees highlighting areas of the two bills of importance to the physician community.

Specifically, the AMA urged the committee to adopt the Senate language that would maintain the tax deductibility of high medical expenses. The Senate bill would also lower the percentage of a person's adjusted gross income that qualified medical expenses must exceed in order to claim the deduction from 10 percent to 7.5 percent for 2017 and 2018. In addition the letter urges the conferees to maintain the deduction for student-loan interest and the exemption from taxation for qualified tuition reductions. The AMA also urged the committee to not include language in the final bill that would repeal the individual responsibility provisions of the Affordable Care Act.

Late on Wednesday, Dec. 13, it was announced that the tax bill conferees had reconciled their differences and legislative language was being drafted for passage by the House and Senate. However, no official summary of the agreement was available at press time.

AMA statement on proposed Aetna-CVS merger

"This proposed $69 billion transaction—one of the largest merger deals in the history of American health care—would have long-term impact on the markets for health insurance and pharmaceutical benefit management services. These markets are already dominated by few participants with large market shares, including Aetna in health insurance and CVS in pharmaceutical benefit management. The AMA is committed to reviewing all issues triggered by this proposed merger to preserve the benefits of competition, including increased access and choice, lower prices and higher quality care for patients."

—David O. Barbe, MD, MHA, president, American Medical Association

House committee approves student-loan legislation

On Dec. 12, the House Education and Workforce Committee approved H.R. 4508, the PROSPER Act. The bill streamlines the financial aid and loan repayment programs available to undergraduates, parents and graduate students and caps the loan amounts available with annual and lifetime limits. 

Importantly, it would eliminate the Federal Direct Loan Program which provides an array of repayment options that meet the needs of medical students who come from diverse backgrounds and have a high student debt burden. It would also eliminate the Public Service Loan Forgiveness program which forgives the debt of medical students who make 120 monthly payments while working for government organizations or qualified non-profit entities serving communities in need.

Due to concerns about the negative impact of these provisions on the looming physician shortage and the ability of medical students to repay their loans with the new annual and lifetime caps, the AMA submitted a letter to committee leadership. The Senate Health, Education, Labor and Pensions Committee will consider its Higher Education Reauthorization Act in March 2018. The AMA is committed to working with committee leadership in the House and Senate to address its outstanding concerns with this legislation.

8 in 10 doctors have experienced a cyberattack in practice

Physicians, overwhelmingly, are finding themselves the target of cyberattacks that disrupt their practices and put patient safety at risk.

A staggering 83 percent of physicians told AMA researchers that their practices have experienced a cyberattack of some type. The 1,300 physicians surveyed also said not enough cybersecurity support is coming from the government that will hold them accountable for a patient information breach. These and other findings are contained in a first-of-its-kind survey from the AMA and management consulting firm Accenture. The data (infographic) provide new depth—and an often overlooked physician voice—to the discussion on how best to protect patients in a complex health care system that is increasingly connected and vulnerable to cybercriminal exploitation.

"The important role of information sharing within clinical care makes health care a uniquely attractive target for cyber criminals through computer viruses and phishing scams that, if successful, can threaten care delivery and patient safety," said AMA President David O. Barbe, MD, MHA. "New research shows that most physicians think that securely exchanging electronic data is important to improve health care. More support from the government, technology and medical sectors would help physicians with a proactive cybersecurity defense to better ensure the availability, confidentially and integrity of health care data."

A June 2017 report by the congressionally mandated Health Care Industry Cybersecurity Task Force found "health care cybersecurity is a key public health concern that needs immediate and aggressive attention," and that, "most importantly, cybersecurity attacks disrupt patient care." The 88-page document underscores the risk to medical care delivered in smaller settings, which are especially vulnerable to attacks by cybercriminals.

Read more at AMA Wire.

AMA testifies on drug supply chain

AMA Board of Trustees Chairman Gerald Harmon, MD, testified on Dec. 13, before the House Energy & Commerce Subcommittee on Health at a hearing entitled, "Examining the Pharmaceutical Supply Chain." Other witnesses included major associations within the drug supply chain. Dr. Harmon highlighted the importance of patients receiving the right treatments at the right time, and that the burdens physicians and patients face often hinder access.

In his testimony, he noted that the increasing cost of pharmaceuticals has led public and private payers to develop regulatory valves for patients to access necessary medications. Among these are prior authorizations, step therapies and non-standardized forms and appeals processes that physicians and patients endure to ensure that medications are received promptly. Not having timely access to pharmaceuticals can prevent patient adherence to treatment regimens and can lead to further medical complications and greater cost to the health care system. The AMA will continue to work with Congress to address physician regulatory burdens and policies that will ensure patients have access to timely medications.

FDA seeks creative approaches to opioid epidemic

The AMA commended Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, for recent comments on the opioid epidemic in which he endorsed the need to expand use of medication-assisted treatment (MAT) for opioid-use disorder, including for people being held in the criminal justice system. The commissioner also highlighted the need to overcome stigma and insurance barriers in order to make MAT more readily available to patients, and noted that public insurance plans in all states do not yet cover all of the FDA-approved medications that treat opioid use disorder.

The FDA has also announced a public hearing to be held on Jan. 30, 2018, to discuss possible interventions at the point of prescribing that would be intended to reduce prescribing of opioids. At the hearing, the FDA's Opioid Policy Steering Committee will receive stakeholder input on strategies to change prescribing patterns by requiring special documentation in order to prescribe quantities of opioid analgesics above an amount that is determined to be routinely required for particular conditions, such as dental pain or surgery. The hearing will also explore whether a nationwide prescription-history database should be developed, as well as the role that unit-of-use packaging and mechanisms for returning unused pills could play in addressing the epidemic.

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State Update

Registration closing soon: AMA State Legislative Strategy Conference

Register now for the 2018 American Medical Association State Legislative Strategy Conference, held Jan. 4–6 in Fort Myers, Fla. 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, JD, widely regarded as an expert in developing strategies that achieve impactful policy outcomes, and Sam Quinones, nationally recognized journalist and author of Dreamland: The True Take of America's Opiate Epidemic.

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. To register for both conferences and receive your discount, click here. This offer ends Dec. 18.

Physicians: Share your story on the AMA Opioid microsite

A new feature on the AMA Opioid microsite encourages physicians to "Share Your Story" on the ways in which they are responding to the nation's opioid epidemic. Each "Share Your Story" opportunity will focus on one of the six recommendations of the AMA Opioid Task Force.

The first question addresses the Task Force's focus on increasing access to treatment, asking:

What administrative barriers (e.g. prior authorization, step therapy) have you experienced in your practice when trying to provide multidisciplinary and/or multimodal pain care or comprehensive treatment for a substance use disorder?

Future editions of AMA Advocacy Update will include additional questions related to the Task Force recommendations.

New research highlights patient variability, surgical care and opioid prescribing

A new study in the Journal of the American College of Surgeons found that post-discharge opioid use is best predicted by opioid use the day before discharge for patients admitted to the hospital. The study, which reviewed bariatric, benign foregut, liver, pancreas, ventral hernia and colon surgery, found that 85 percent of patients were prescribed an opioid, and only 38 percent of prescribed opioid pills were taken.

Based on the findings, the authors said that 85 percent of patients' home opioid requirements would be satisfied using the following guidelines:

The authors said that their proposed guideline "is an improvement over the legislative requirement of a '7-day supply' because it removes the ambiguity associated with that requirement and takes patient variability into account."

The study also is available on the AMA Opioid microsite.

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Judicial Update

State high court halts new way to bring liability lawsuits

The Kentucky Supreme Court has knocked down an attempt to allow hospitals to be sued for negligent credentialing.

In a 6-0 decision, justices rejected a new cause of legal action that would make hospitals in the commonwealth liable for negligence in credentialing independent contractor physicians with staff privileges who may later be named in a liability claim. Critics of the legal maneuver, which is a plaintiff patient's option in some states, say that it is both unnecessary and would cause problems—including creating a serious access obstacle by leaving patients with fewer options to receive care.

Had the court upheld the 2-to-1 appeals court ruling establishing the cause of action, "it would make it more difficult for physicians to be able to be credentialed by hospitals, and then potentially health plans and others, at a time that—especially health plans—are looking to narrow their networks, and it would just give them another reason to do so," said Patrick T. Padgett, Executive Vice President of the Kentucky Medical Association. For patients, those more restricted networks, "would limit their choices and it would limit their ability to see a physician, so it would be an access- to- care issue."

The KMA filed a 14-page, friend-of-the-court brief in the case. Financial assistance for the amicus brief was provided by the Litigation Center of the American Medical Association and State Medical Societies, which supports those state societies in precedent-setting cases relevant to physicians.

Read more at AMA Wire.

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Other News

CMS unveils health-plan compliance reviews for administrative simplification

In order to ensure compliance with the administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA), the Centers for Medicare and Medicaid Services (CMS) recently announced plans to pursue proactive compliance reviews of health plans and clearinghouses. To date, CMS has enforced compliance with the HIPAA-mandated standard electronic transactions entirely through a complaint-driven process, which can be cumbersome for practices and raise concerns about possible health plan retribution.

The new Department of Health and Human Services (HHS) HIPAA Administrative Simplification Optimization Project Pilot will launch in January 2018, with health plan and clearinghouse volunteers submitting electronic transaction files for review and testing by HHS.  Following the completion of this pilot, HHS will roll out a proactive compliance review process through the Administrative Simplification Optimization Program to enforce the HIPAA transactional requirements throughout the industry.

The development of additional methods to ensure health plan and clearinghouse adherence to electronic standards will help physicians save time and money, and the new HHS program aligns with the AMA's previous advocacy on this issue, which has called for review audits and other mechanisms to enforce compliance with electronic standards. For more information on electronic transaction compliance, access the AMA's educational resource, "Compliance in standard electronic transactions: Responsibilities of health plans and physicians."

Registration is now open for the 2018 AMPAC Candidate Workshop

Ever wonder how doctors get elected to Congress or your state legislature? Considering a run for office yourself? Then the AMPAC Candidate Workshop is for you. This one-and-a-half-day workshop—held March 2-4 in Washington, D.C.—will provide you with the skills and strategic approach you will need to make a run for public office. You will also learn how to run a winning political campaign.

Registration is now open. The deadline to register is Feb. 2. The program fills up quickly, so do not delay. The registration fee is $250 for AMA members, $1,000 for non-members, and is waived for students and residents. For more information visit AMPAC online. To apply, simply fill out the online registration form or email your questions to:

How to reduce barriers to physician-focused APMs

A new brief explores AMA policy recently adopted on reducing barriers to the development and implementation of alternative payment models (APMs). Read about what the AMA is doing to address these barriers to payment reform, and how the AMA is proactively shaping implementation of the Medicare Access and CHIP Reauthorization Act to help physicians succeed in the practice models of their choice.

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Upcoming Events

Through Dec. 15:
Research shows almost 50 percent of physician and provider directories contain incorrect physician information, which can impede timely, affordable, patient-focused care. New federal and state regulations are addressing this issue by requiring payers to improve directory accuracy. Join the AMA and other thought leaders on this discussion regarding proactive ways to maintain and update accurate data in your insurance providers' directories.

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 by Dec. 18 to 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 by Dec. 18 to receive your discount.

Feb. 21, 2018:
Quality improvement (QI) looks different for every practice, and there are a number of models that can be applied to help your practice implement QI processes and practices. Equally as important as having the tools that you need, however, is developing the culture of quality improvement. In this 1-hour webinar, held from 1–2 p.m. CST, "Developing a quality improvement culture in a practice setting," attendees will learn about what is needed to develop a QI culture in your office so that your team may achieve future successes in their QI projects. Meghan Kwiatkowski, MAIO, Senior Practice Transformation Advisor will be the presenter. Click here to register.

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