April 19, 2018

Issue Spotlight

AMA, specialty societies ask CMS to reduce 2018 MIPS reporting period

The AMA, along with national physician specialty societies, recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) asking that the 2018 Merit-based Incentive Payment System (MIPS) reporting period be reduced from a full calendar year to a minimum of 90 consecutive days due to the lack of timely and direct notification about whether a physician is considered MIPS eligible.

In addition, there will be a further significant delay by CMS in updating the Quality Payment Program interactive website with 2018 information. The website is not expected to  be updated until the summer of 2018, at the earliest. The two delays combined make it extraordinarily difficult for physicians to meet the full-year quality data reporting requirements for MIPS this year. The letter also requests a reduced reporting period for future MIPS program years in order to reduce administrative burdens and ensure physicians have sufficient time to report after receiving performance feedback from CMS.

To determine whether they are eligible for the MIPS program, physicians must actively consult CMS' website. Previously, CMS had mailed letters to practices to inform them of their eligibility status, which many practices were waiting for this year. Without direct outreach by CMS to physicians and group practices, many will be left in the dark on their status.

Therefore, the AMA encourages practices to look up their MIPS eligibility at the CMS QPP website. The AMA is committed to working collaboratively with CMS to ensure MIPS recognizes the quality of care provided to Medicare beneficiaries rather than quantity of data reported, and will continue to advocate for timely notification by CMS on program changes to ensure successful participation.

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National Update

Register for MIPS group web interface, CAHPS for MIPS 2018 survey reporting

Registration is required for groups that intend to use the CMS Web Interface and/or administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-based Incentive Payment System (MIPS) survey for 2018.

Only groups of 25 or more eligible clinicians that have registered can report via the CMS Web Interface. Groups that participate in MIPS through the qualified registry, qualified clinical data registry, or electronic health record (EHR) data submission mechanisms do not need to register. For 2018, only groups of two or more eligible clinicians that have registered can participate in the CAHPS for MIPS survey. Visit the Quality Payment Program website to register. You will need a valid Enterprise Identity Management (EIDM) account. If you do not have an EIDM account, please create one as soon as possible. The registration period is from April 1–June 30, 2018.

Please note: If your group was registered to participate in MIPS in 2017 via the CMS Web Interface, CMS automatically registered your group for 2018. You may edit or cancel your registration at any time during the registration period. Automatic registration does not apply to the CAHPS for MIPS survey. For more information, visit the Quality Payment Program Resource Library to review resources on the CAHPS for MIPS Survey and the CMS Web Interface. 

Reminder: Participate in CMS Quality Measures Study to Receive Full Improvement Activity Credit in QPP

CMS is conducting the 2018 Burdens Associated with Reporting Quality Measures Study, as described in the Quality Payment Program (QPP) Year 2 final rule. Clinicians and groups who are eligible for the Merit-based Incentive Payment System (MIPS) that participate successfully in the study will receive full credit for the 2018 MIPS Improvement Activities (IA) performance category.

The study runs from April 2018 to March 2019. Clinicians do not need any outside knowledge of MIPS to participate in the study; rather the study team is interested in learning more about clinicians' experience participating in MIPS. Applications will be accepted through April 30, 2018. Clinicians will be notified in spring of 2018 if selected.

CMS is conducting this study to:

Participants will have to meet the following requirements in order to complete the study and receive full IA credit. For participants reporting as a group, their entire group will receive credit. For participants reporting as individuals, only the participating clinician will receive credit.

The data submitted must:

Clinicians can apply to participate in the study here.

Injectable opioids shortage management strategies available

Many medical practices, first responders, surgery centers and hospitals are experiencing difficulties in patient care due to acute shortages of injectable opioids, including hydromorphone, morphine and fentanyl.

The American Society of Health-System Pharmacists and the University of Utah Drug Information Service have developed a fact sheet outlining best practices for management and conservation, including information on inventory control, pharmacy operations and patient safety.

Guide available on patient access to health records

The Office of the National Coordinator for Health IT (ONC), a federal agency that regulates health information technology, recently released a guide to help patients better understand how to get, check and use their health records. 

Under the Health Insurance Portability and Accountability Act (HIPAA), patients have the right to see and obtain a copy of their health record from most health insurance plans and health care providers, including, physicians,  clinics, hospitals, pharmacies, labs and nursing homes. Federally certified EHRs (most EHRs in use today), must provide a way for patients to access and send their records. However, these "patient portals" can be challenging to use or only provide a subset of the patient's health record. 

The AMA has alerted this discrepancy between HIPAA's requirements and what is actually available via the EHR to the Office of Civil Rights (OCR), the federal agency that regulates HIPAA. The AMA is urging health IT vendors and policymakers to improve the usability and interoperability of EHRs, for both physicians and patients, to enable secure and seamless access to medical information.

Health record availability and access is also a measure in CMS' EHR Incentive Programs. To stay compliant with federal regulation, help patients engage with their records, and improve your chance for success in the QPP, the AMA recommends contacting your EHR vendor and requesting tools, tips or further information on enabling patient access through your EHR. 

House and Senate committees consider legislation to address opioid abuse

Last week, the House Energy and Commerce Subcommittee on Health and the Senate Health, Education Labor and Pensions (HELP) Committee held legislative hearings to consider policies to combat the opioid epidemic. This was the Energy and Commerce Committee's third hearing this year on this topic. The latest hearing focused on 34 bills pertaining to the Medicare and Medicaid programs, which were in addition to the 30 bills discussed at the previous hearings.

The HELP Committee released a bipartisan discussion draft entitled the "Opioid Crisis Response Act of 2018" prior to its hearing, which contains multiple proposals to address the opioid crisis across several agencies. The HELP Committee is expected to mark up this bill on April 24 and the Energy and Commerce Committee is expected to consider opioid legislation later this spring.

Additionally, on April 11, the House Committee on Ways and Means issued an opioid white paper analyzing the responses it received to a request of information. The white paper quoted part of AMA's response regarding how traditional provider payment systems frustrate efforts to combat the opioid epidemic by not supporting non-face-to-face services. (The AMA's response to the Committee's request for information was covered in the March 22 issue of Advocacy Update.)

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State Update

New AMA model state legislation

The AMA Board of Trustees last week approved several new AMA model state bills. AMA staff will soon hold a call with the nation's medical societies to go into more detail about the model bills.

The "Pharmaceutical Costs Transparency Act" would help improve affordability of drugs for patients.  The black-box nature in which pharmacy benefit managers (PBMs) operate is frustrating and costly to physicians, pharmacists, and patients. For example, a PBM's drug formulary may force consumers to spend more on their cost sharing for a drug than what they would have spent if they purchased the drug without insurance. 

So called "gag clauses" in pharmacy-PBM contracts can bar pharmacists from telling consumers about less expensive options, such as not using their insurance. In addition, "clawback" provisions can allow PBMs to take back the difference between a higher copay amount and a lower negotiated rate. This model bill prohibits these practices.

The "Ensuring Access to High Quality Care for the Treatment of Substance Use Disorders Act" would increase access to medication assisted treatment (MAT). This is a revision to an existing model bill to provide current data and add new provisions to help promote treatment in a wide variety of settings.
This model bill provides that all relevant administrative delays used by health insurers would be prohibited, ensures parity compliance and reliance on evidence-based guidelines for the treatment of substance use disorders, updates language concerning formularies, and adds correctional facilities and drug courts to the entities that must provide MAT. The updated model bill also addresses requirements for network adequacy and includes patient protections for out-of-network care as well as enforcement mechanisms from relevant state entities.

The "Joint Regulation of APRNs Act" establishes a structure by which a state can create a joint regulatory board composed of members of the boards of medicine and nursing, tasked with licensing and regulating APRNs. In addition to establishing the legislative framework for this joint regulatory scheme, the model bill includes an Appendix with sample language to utilize in drafting regulations that result from the model being signed into law.

The "Team Based Care Act," first released in 2014, requires nurse practitioners to practice as part of a physician-led patient care team. Based on landmark Virginia legislation, the model bill defines a "patient care team" as a multidisciplinary team of health care providers actively functioning as a unit with the management and leadership of the team handled by one or more patient care team physicians for the purposes of providing health care to a patient or group of patients.

Within these teams each member has specific responsibilities related to the care of the patient or patients and shall provide health care services within the scope of his or her usual professional activities. The model bill also establishes a process through which NPs gain the authority to prescribe certain controlled substances. The model bill was revised to reflect the new Joint Regulation of APRNs Act and to incorporate modifications Virginia made to its model since adopting its landmark legislation.

To receive a copy of these or other AMA model bills, email the AMA Advocacy Resource Center.

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Upcoming Events

April 24: Simplifying MIPS
With many feeling overwhelmed by the complexity of the Quality Payment Program (QPP), physicians struggle to answer one key question: "Where do I start?" To help assuage this concern, the AMA has released the MIPS Action Plan, which  breaks down the complexity of the Merit-based Incentive Payment System (MIPS) track of QPP into specific, actionable steps. In this one-hour webinar—April 24, noon–1 p.m. CDT—attendees will learn how to use this tool to create or validate their strategies for MIPS implementation in 2018. Chris Botts, AMA Care Delivery and Payment Manager, will be the presenter. Register.

April 25: Integrated community approach to diabetes prevention
In this 90-minute webinar at noon CDT, "Population Health Management: Addressing the Diabetes Epidemic with an Integrated Community-based Intervention," attendees will learn how Mission Health, a member of a large Accountable Care Organization (ACO), established a partnership with the YMCA of Western North Carolina to expand access to diabetes prevention, diabetes self-management, and lifestyle modification coaching to successfully improve their diabetes outcomes, while reducing the total cost of care for the target population.

The webinar will detail the steps the partners undertook to target the population, establish baseline performance metrics, solidify community-level YMCA access points, integrate ambulatory and community YMCA operations, define outcome tracking, and strategy for long-term financial sustainability of the model. Register.

April 27: Population management in a practice setting
Christine Rash-Foanio, PharmD, is a clinical pharmacist in ambulatory internal medicine and managed care at the University of Illinois Hospital and Health Sciences Center and clinical assistant professor at the University of Illinois at Chicago College of Pharmacy.

In this webinar—1–2 p.m. CDT—she will focus on why practices should consider implementing population health management strategies. This webinar will help participants increase understanding of the tools and strategies on how to implement population health management in practice, and troubleshoot barriers to doing so. Register.

May 2: Closing the referral loop
In this webinar—noon–1 p.m. CDT—learn the findings and lessons you can apply today from the Closing the Referral Loop pilot project, which was managed by PCPI and the Wright Center for Graduate Medical Education. The presenters will outline the practice and workflow changes that were critical to improving the closed referral rate from 40 percent to 75 percent.

The presentation will review the Closing the Referral toolkit and discuss the value of Care Compacts, the role of the referral coordinator, and the use of Health Information Service Providers to improve communication between clinical practices. The toolkit provides a number of resources and sample documents. Register.

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