July 12, 2018

National Update

CMS releases 2017 MIPS reports that determine 2019 pay adjustments

Physicians who participated in the Merit-based Incentive Payment System (MIPS) in 2017 may now review their MIPS final score and performance feedback on the Quality Payment Program (QPP) website portal. The payment adjustment they will receive in 2019 is based on this final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019. 

If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review through the QPP portal. Originally, CMS planned to grant 60 days for a targeted review, but due to AMA advocacy this timeframe has been extended through Sept. 30. The AMA continues to hear of problems with the feedback reports. We are monitoring the situation, and we will continue to bring issues to the attention of CMS.

The agency recommends submitting review requests as soon as possible to ensure that payment adjustments are applied correctly by Jan. 1, 2019. In order to review your 2017 performance report on the QPP website or file a targeted review through the portal, you must have an EIDM account. For more information on the targeted review process, see the targeted review user guide.

The following are examples of circumstances in which you may wish to request a targeted review: 

Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted.

AMA developed the CMS Targeted Review Resource to provide guidance on how to utilize the Centers for Medicare & Medicaid Services (CMS) targeted review process to dispute Medicare Incentive Payment System (MIPS) payment adjustments under the Quality Payment Program (QPP). While CMS has not yet announced the window for 2018, it is estimated that requests will be accepted from July 31 – September 30. Check the QPP website at  for updated information.

OCR highlights importance of software patching

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issues a monthly newsletter devoted to cybersecurity issues. The June 2018 newsletter focuses on providing guidance on software vulnerabilities and patching.

A first-of-its-kind survey of 1300 physicians conducted by the AMA and Accenture in 2017 found that phishing and viruses are the most common types of cyberattacks encountered by small practices. Viruses often appear as a result of software that is not regularly updated or "patched." The new OCR guidance includes common steps to include in effective patch management as part of your practice's security management program.

In addition to encouraging the federal government to issue additional guidance like this to physicians, the AMA continues to urge stakeholders—including health information technology vendors—to pay special attention to the needs of small and mid-sized practices, which often lack the resources that larger practices and health systems enjoy.

For example, the AMA has written to the Office of the Inspector General (OIG) recommending the creation of a safe harbor that would allow for the sharing of cybersecurity items and services between large systems and small practices. You can find OCR's past cybersecurity newsletters here and the AMA's webpage on cybersecurity here.

2017 Open Payments data released to the public in June

The Medicare Open Payments program collects and publicly reports information annually about payments that drug and device companies make to physicians and teaching hospitals for things like travel, research, gifts, speaking fees, and meals.

The CY 2017 Open Payments data was released to the public on the June 29. The public release followed a 45-day period for physicians to review their data and dispute errors and a 15-day data correction period. Please go to the AMA website for more information about the Open Payments Program and for instructions on how register to review your data. 

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State Update

Medicaid waivers blocked in Kentucky, Massachusetts

A federal judge has blocked new work requirements for Medicaid patients in Kentucky that were scheduled to go into effect on July 1. The new eligibility rules, contained in a waiver program called Kentucky HEALTH, would have required certain adult Medicaid beneficiaries to engage in at least 80 hours per month of community engagement activities, such as employment, education, job skills training and community service.

The state estimated that 95,000 low-income individuals could lose coverage under the program—a detail that the Court said CMS overlooked when it approved the state's request. In vacating CMS' approval of Kentucky's waiver, the Court said that CMS "never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid." CMS must now reconsider the waiver. The AMA opposes work requirements as a condition of Medicaid eligibility.

On the same day, CMS also disapproved controversial provisions contained in a Massachusetts Medicaid waiver proposal. Among other things, the waiver would have required Medicaid to adopt a closed formulary with minimum coverage of just one drug per therapeutic class, a provision that the state said was necessary to rein in prescription drug costs.

Under current law, the Medicaid Drug Rebate Program requires drug manufacturers to pay rebates to states and the federal government as a condition of having their products covered by Medicaid. In exchange, states must cover nearly all of the manufacturers' products. CMS disapproved the request, saying that Massachusetts would have to opt out of the Medicaid Drug Rebate Program altogether in order to exclude specific drugs from coverage. The AMA submitted comments on Massachusetts' proposal, expressing concern that the plan would hurt low-income patients.

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Judicial Update

If physicians face legal threat, AMA Litigation Center has their backs

If you can imagine checking your internet news feed to see if your work influenced the U.S. Supreme Court, then perhaps you have an idea what it's like to work for the Litigation Center of the American Medical Association and State Medical Societies.

A slew of Supreme Court decisions traditionally are released in late June. The decisions released late last month included two cases the AMA worked on: One involving issues of medical ethics and regulating free speech, and another addressing antitrust issues in a way that could affect where physicians are allowed to refer patients.

In addition, the Litigation Center is also involved with cases before 13 state supreme courts.

Read more at AMA Wire.

AMA's legal team helps protect medical liability reforms

Medical liability reform is a high state legislative priority for the AMA. Not surprisingly, then, it is also a high priority for the Litigation Center for the American Medical Association and State Medical Societies.

Evidence of this is the Litigation Center's involvement  in five active tort reform-related cases before the state Supreme Courts of Kentucky, Michigan, Nevada, Oregon and Texas.

And evidence of the Litigation Center's success is the recent Wisconsin state Supreme Court 5–2 ruling that the state's $750,000 cap on awards for noneconomic damages did not violate the state constitution.

The Wisconsin cap on noneconomic damages is one component of a three-part strategy that has stabilized the state's medical liability environment.

Read more at AMA Wire.

Voter-backed Nevada tort reform faces court challenge

The Supreme Court of Nevada will decide the fate of a portion of the state's medical liability reform that has helped stabilize insurance rates for physicians and encouraged doctors to move to the Silver State and stay there to provide care.

The state's highest court is considering the constitutionality of a law that allows juries to hear whether a medical liability plaintiff's medical bills were paid by a third party, such as a health insurance company. Under the law, jurors considering monetary awards in medical liability cases can choose whether to award a plaintiff economic damages for money the insurance company already paid to settle medical bills.

Read more at AMA Wire.

No easy calls in high court case on crisis pregnancy centers

The U.S. Supreme Court's 5–4 ruling in a case pitting claims of free speech against patients' right to transparency regarding care shows how the matter at the heart of National Institute of Family and Life Advocates (NIFLA) v. Becerra has closely divided even the nation's highest court.

The court examined whether California's 2016 Reproductive Freedom, Accountability, Comprehensive Care and Transparency (FACT) Act requiring licensed "crisis pregnancy centers" (CPCs) to post a notice informing women of state aid for health services, including contraceptive counseling and abortions, violates the CPC staff's First Amendment freedom of speech guarantee.

The AMA's decision to get involved in the case was not easy, but ultimately the Association decided to support the state of California, basing the arguments in its amicus brief on medical ethics and a patient's right to informed consent. Those intricacies of the case were explored during a session hosted by the Litigation Center of American Medical Association and State Medical Societies at the 2018 AMA Annual Meeting.

Read more at AMA Wire.

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Other News

4th podcast episode on virtual groups now available

The fourth in a series of six podcasts produced in partnership with ReachMD on Medicare payments is now available. This week's episode is an interview with Senior AMA Attorney Ashley McGlone on virtual groups. Listen here.

AMA Global Health Challenge: Vote for your favorite video today!

Students and residents who are passionate about global health care disparities compete for a chance to serve underserved populations with Timmy Global Health in Ecuador, Guatemala or the Dominican Republic. View the top 10 finalist videos and vote for your favorite video today.

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Upcoming Events

July 25: Webinar: EHRs—Usability and optimization
Electronic health records have transformed health care over the last decade. While they have improved some aspects of clinical practice, they are still often associated with physician burnout and patient safety concerns. This webinar, noon–1 p.m. CDT—will provide an overview of the AMA's initiatives focused on improving the usability of EHRs through research, guiding principles and collaboration. It will also cover resources and best practices available to physicians and practices to support optimization. Register.

Aug. 8–29: AMA webinar series on patient and family engagement
Under the umbrella of our "Share, Listen, Speak, Learn" engagement series, the AMA introduces a miniseries in partnership with Project Patient Care. By engaging patients as partners in their own care physicians are able to eliminate preventable harm and ensure that every patient gets the right care at the right time. These hour-long webinars, held weekly from Aug. 8–29, will address aspects of person and family engagement, including embedding shared-decision making into practice, interoperability of e-tools, supporting patient activation, self-management and health literacy and systemizing medication management. Learn more and register.

Aug. 8–Dec. 12: Opioid safety series
Opioids are prescribed to relieve pain. They can also have a soothing, euphoric effect. However, opioid misuse, overdose, and deaths have been increasing at disturbing rates. An average of 115 Americans die every day from an opioid overdose. These hour-long webinars will discuss topics that take a deeper dive into safely managing patients with opioids, topics such as patient screening and use of pain contracts, prescription drug monitoring programs, non-pharmacologic approaches to pain management, psychologically-integrated approaches to pain management, and patient and family perspectives. Learn more and register.

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