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Jan. 11, 2018

Issue Spotlight

Physicians contribute $2.3 trillion to U.S. economy: study

New research details the huge economic impact physicians have across the nation, contributing $2.3 trillion to the national economy and creating nearly 12.6 million jobs.

That wealth of data is contained in the AMA's latest economic impact report, which provides compelling insights into the jobs, revenues and taxes tied to physician productivity. The report, with in-depth data on all 50 states and the District of Columbia, captures 2015 economic activity of all the nation's nearly 750,000 physicians providing patient care, regardless of whether they are in office- or hospital-based settings. Explore this interactive map of physicians' impact across the country.

"The positive impact of physicians extends beyond safeguarding the health and welfare of their patients," said AMA President David O. Barbe, MD, MHA. "The AMA's economic impact study illustrates that physicians are strong economic drivers that are woven into their local communities by the commerce and jobs they create. These quality jobs generate taxes to support schools, housing, transportation and other public services in local communities."

Independent researchers at IQVIA, a well-respected research organization, calculated direct benefits as well as indirect benefits, such as all the business-to-business spending—for items like supplies, equipment and lab services. The report also measures the broad downstream economic activity of induced benefits, for example, when a doctor or staff member spends a paycheck at a local business. The study found that nationally:

"Through the care provided to their patients, physicians can have a positive and lasting impact on the health of their patients and the community as a whole. However, the breadth of a physician's impact reaches far beyond just the provision of patient care," the study notes. "Physicians also play a vital role in the state and local economies by creating jobs, purchasing goods and services, and supporting state and community public programs through generated tax revenues."

The Economic Impact Study is commissioned by the AMA Advocacy Resource Center as part of its mission to support state and national specialty societies' legislative advocacy work on behalf of physicians. The report gives policymakers concrete evidence demonstrating how their local communities tangibly benefit when they support legislation that helps physician practices thrive.

To learn more about physicians' economic impact in your state, visit PhysiciansEconomicImpact.org. Contact Annalia Michelman in the AMA Advocacy Resource Center with any questions or to receive a toolkit to help you use this resource in your advocacy work. This toolkit includes suggested messaging as well as customizable resources such infographics, an op-ed template and sample social media content.

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National Update

Review CMS validation criteria before submitting 2017 MIPS data

As physicians prepare to report their 2017 Merit-based Incentive Payment System (MIPS) data, they should review the Centers for Medicare and Medicaid Services' (CMS) validation criteria for quality, Improvement Activities (IA), and Advancing Care Information (ACI). Physicians and group practices have until March 31, 2018, to submit 2017 data. CMS web interface users—which includes groups with 25 or more clinicians and some alternative payment model (APM) entities—have a shorter timeframe to submit quality data. Their submission window opens Jan. 22, 2018, and closes March 16, 2018, at 8 p.m. Eastern time.

For purposes of quality reporting, physicians and group practices are highly encouraged to work with their electronic health record, qualified registry or qualified clinical data registry vendor to make sure they are following CMS' validation criteria, and that they are prepared to meet CMS' 2017 MIPS submission deadline to ensure successful participation on the practice's behalf. Of note, the ACI validation criteria contain suggested documentation for a Security Risk Analysis.

Further, while IAs are attestation-based, physicians are encouraged to retain documentation supporting their IA performance as outlined in the validation criteria. CMS suggests physicians retain MIPS documentation for six years. Due to the increasing need to reduce administrative burden, the AMA will encourage CMS to continue using attestation-based measures in IA and to identify opportunities for simplified measure reporting under ACI.

Please note that if you are participating in a MIPS APM or an advanced APM, work with your APM Entity to discuss any special considerations regarding your submission and performance feedback. For information on MIPS validation criteria and data submission, please review CMS' QPP Resource Library.

AMA submits comments on 2018 Quality Payment Program final rule

The AMA began the year by submitting comments to the Centers for Medicare and Medicaid Services (CMS) on the 2018 Quality Payment Program (QPP) final rule. The AMA, in its Jan. 2 letter, commended CMS on finalizing a number of policies that had been recommended by the Association for the 2018 performance year, including:

The AMA also supported changes within each QPP performance category such as CMS' policies within the Advancing Care Information (ACI) category to extend certified electronic health record technology (CEHRT) flexibility for 2018 and provide a new hardship exemption for small practices.

While the AMA supported many of the policies finalized in the rule, it also expressed extreme disappointment that CMS chose to reverse its earlier decision and will assign the Cost performance category a weight of 10 percent in 2018. The AMA expressed its continued belief that the two measures physicians will be judged on in 2018 are highly flawed, often irrelevant, and jeopardize access to care for patients with high-cost conditions.

The AMA also expressed concerns regarding the methodology used for creating quality measure benchmarks, and provided detailed feedback on alternative methodologies that CMS could use to establish the benchmarks. The AMA will continue to work with CMS throughout 2018 to improve the QPP.

Top issues in health care to watch for in 2018

The AMA has outlined its legislative and regulatory priorities for 2018, which are grounded by its mission, policies and long-standing goal of influencing a legal and regulatory environment that supports a healthier nation.

These issues include:

CMS issues guidance on information-blocking attestation

Late last year, CMS released guidance on the information-blocking attestation requirement for the Advancing Care Information (ACI) component in MIPS. All physicians participating in ACI must show that they are meeting this requirement by attesting to three statements about how they implement and use certified electronic health record technology (CEHRT). 

To earn an ACI score, physicians have to act in good faith when implementing and using CEHRT to exchange electronic health information. The AMA views this attestation requirement as overly burdensome and was successful in alleviating the need for physicians to provide documentation showing they have acted in good faith. Per this guidance, physicians must only attest to complying with these requirements. 

Furthermore, the AMA was successful in seeking clarification that physicians will not be held responsible for outcomes they cannot reasonably influence or control. For instance, it will not be viewed as data blocking if a physician's EHR is down for maintenance or if data are unavailable due to an EHR malfunction. Physicians participating in the ACI component of MIPS are encouraged to review this guidance from CMS. It is also recommended that physicians alert their EHR vendors to these requirements as many of them directly relate to EHR performance, setup and function.

DOL releases proposed rule on Association Health Plans

On Jan. 4, 2018, the Department of Labor (DOL) released a proposed rule regarding Association Health Plans (AHPs) in response to President Trump's Executive Order 13813 (Promoting Healthcare Choice and Competition Across the United States). In the proposed rule, DOL broadens the definition of "employer" under the Employee Retirement Income Security Act of 1974 (ERISA) to include AHPs. By treating the AHP itself as an employer that is sponsoring a single health insurance plan for its employer members, the AHP will be regulated as a group health plan under ERISA. Employer membership in the AHP can be based on common industry (e.g., employers being in the same trade, industry, or line of business) and on geography (e.g., same state or same metropolitan area), and it can include sole proprietors and their dependents.

DOL also proposed that the AHPs must follow the same non-discrimination provisions that any other ERISA plan must follow, including not being able to adjust an individual's premiums based on a health factor like a medical condition or health status. However, AHPs, like other group plans, will be able to make benefit package decisions that could disproportionately impact individuals with pre-existing conditions. Furthermore, if an AHP qualifies for large group market coverage, the AHP will not be required to cover essential health benefits and premiums may vary based on non-health factors like age, gender and occupation.

As described in the proposal, AHPs are a type of "multiple employer welfare arrangement" or MEWA. In 1983, Congress provided an exception to ERISA's broad preemption provision for regulation of MEWAs under state insurance laws. Thus, for example, state insurance laws that regulate solvency, benefit levels or ratings apply to the proposed self-funded AHPs as long as the state law is not inconsistent with ERISA. The AMA is reviewing the proposed rule and plans to submit comments by the March 6 deadline.

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State Update

CDC: Guidelines' dose threshold not meant for treating opioid-use disorder

The Centers for Disease Control and Prevention (CDC) recently clarified to the American Society of Addiction Medicine (ASAM) that the dosage thresholds in the CDC Guidelines for
Prescribing Opioids for Chronic Pain were not meant to and should not apply to doses for opioid agonists or partial agonists used for opioid-use disorder treatment.

Please consider sharing this information directly with your state prescription drug-monitoring program (PDMP) administrator as well as medical, nursing, pharmacy and other relevant licensing boards.

The CDC issued the clarification in a letter to the ASAM after the society alerted the agency that physicians and patients were experiencing denials of care resulting from the inclusion of buprenorphine for the treatment of substance-use disorder in calculations for Morphine Milligram Equivalents.

The AMA and ASAM are working together to widely share the CDC letter. The goal is to ensure that all health care professionals and other relevant stakeholders are aware that any dosage thresholds contained in MME dosing calculators, PDMPs or other forms should not, in the CDC's words, "guide dosing of medication-assisted treatment for opioid-use disorder." The CDC added that "the conversion factors for drugs prescribed or provided as part of medication-assisted treatment for opioid-use disorder should not be used to benchmark against dosage thresholds meant for opioids prescribed for pain."

If you have questions, please contact Kelly Corredor (email to kcorredor@asam.org), ASAM Director of Advocacy and Government Relations.

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Other News

New video series shows value of electronic prior authorization

A new AMA three-part video series offers guidance on how practices can reduce administrative burdens through electronic prior authorization (ePA) technology. The series is geared toward physicians and their staff, policymakers and legislators interested in ePA. It highlights the significant practice hassles and disruptions in care delivery that prior authorization requirements create. It also describes the key role automation can play in improving the process for prescription drugs.

The first video, titled "The Prior Authorization Burden," leverages results from the 2016 AMA Prior Authorization Physician Survey to establish the extent of the prior authorization problem. The survey found that practices complete an average of 37 prior authorization requests per physician per week, which consume an average of two full business days of physician and staff time.

The second video, "Simplifying Prior Authorization with ePA," illustrates how ePA software integrates with practices' current e-prescribing systems; provides a step-by-step demonstration of the ePA process; and explains how ePA can improve practice efficiency, speed up authorization approvals, and increase patient medication adherence.

The third video, "A Better Way: ePA and Beyond," offers tips on how practices can get started with ePA, as well as describes the AMA's broader advocacy efforts to achieve meaningful reforms in prior authorization programs.

To access the videos and other AMA prior authorization resources, visit ama-assn.org/prior-auth.

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Upcoming Events

Jan. 17–Jan. 23:
Join this digital community discussion series, "IMG Visa Discussion Series: Part I, Pre-Residency" to learn more about what type of visa you need before, during, and after residency. Part one of this IMG Visa Discussion Series will focus on J-1 and H1-B sponsored visas, review the basic requirements for J-1 and H1-B sponsored visas, and the Educational Commission for Foreign Medical Graduates role. You will also learn what visa you should obtain for your family, what pitfalls to avoid when applying for your visa and how to remain compliant once you do obtain a visa.

Jan. 24:
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,1–2 p.m. EST, 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. Click here to register. CME is available.* Also join a discussion online in the AMA Reinventing Medical Practice digital community, where you can ask your cybersecurity questions and get answers after attending the webinar.

*The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The AMA designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Feb. 12–14:
Registration is open for the AMA National Advocacy Conference being held in Washington, D.C., at the Grand Hyatt Washington.

Feb. 14:
This one-hour webinar, noon–1 p.m. CST, will help you learn more about the All of Us Research Program, led by the National Institutes of Health and a cornerstone of the larger Precision Medicine Initiative. All of Us is an ambitious effort to gather data from 1 million or more people living in the United States, reflecting the broad diversity of this country. Dara Richardson-Heron, MD, chief engagement officer for the All of Us Research Program will describe the program and provide perspective on its importance. Register.

Feb. 21:
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. Attendees of "Developing a quality improvement culture in a practice setting," a one-hour webinar held from 1–2 p.m. EST, will learn about what is needed to develop a QI culture in your office so that your team may achieve future success in QI projects. Meghan Kwiatkowski, MAIO, Senior Practice Transformation Advisor will be the presenter. Click here to register.

March 2–4:
Ever wonder how doctors get elected to Congress or state legislatures? 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 February 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 information visit AMPAC online. To apply, simply fill out the online registration form or email questions to: politicaleducation@ama-assn.org.

April 2:
Physicians and practice staff are invited to join the AMA and HITRUST at a cybersecurity workshop April 2 from 6–8:30 p.m. EST in Cleveland. Dinner will be provided. Learn more and register today.

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