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Aug. 23, 2018

Issue Spotlight

Backlog of H-1B visas for physicians affects patients in need

On Aug. 9 the AMA sent a letter to U.S. Citizenship and Immigration Services (USCIS) imploring them to clear the backlog for conversion from H-1B visas so that foreign-trained physicians already practicing in the U.S. can obtain permanent resident status.

Currently there is a sizable backlog of international medical graduates, primarily from India and China. These doctors are actively practicing in the U.S. but waiting to receive their green card due to a massive backlog caused by per-country limitations imposed by law.

"These physicians play a critical role in providing health care to many Americans because they tend to choose primary-care specialties and work in areas of the country with higher rates of poverty," the letter said. "They are providing important medical services to communities in need. According to a recent report, about 20.8 million Americans live in areas where at least half of the physicians are foreign-trained."

Not only does the backlog present a problem for physicians who are currently waiting on their residential status, some of whom have been waiting decades, but workforce experts have predicted that the U.S. will face a physician shortage for both primary care and specialty physicians in the decade to come due to the growth of the aging population.

This will disproportionately affect areas of the country that are already experiencing a physician shortage.

"Currently, more than 85 million people live in parts of the U.S. that have been designated as primary health care professional shortage areas. An estimated 15,000 physicians are needed nationwide to remove this designation," the letter said. The six-year limit on H-1B visas, coupled with a USCIS policy, is creating additional roadblocks for these physicians who are sorely needed to serve some of Americas most underserved and sick patient populations.

At the 2018 AMA Annual Meeting, the House of Delegates adopted a new policy to advocate on behalf of clearing this backlog for physicians who have applied for permanent resident status. The AMA is continuing to track bill language added to the U.S. Department of Homeland Security (DHS) fiscal year 2019 House Appropriations Committee bill that is intended to provide additional flexibility related to the per-country caps on highly skilled workers under the H-1B visa program.

Earlier this summer, the AMA sent a letter to the director of USCIS urging the agency to expedite review of pending H-1B visa applications by non-U.S. international medical graduates who have accepted positions in U.S. Graduate Medical Education programs which begin on or before July 1.

The AMA received reports that USCIS was requesting additional evidence and in some cases denying visa applications that use data from the Association of American Medical Colleges (AAMC) Survey of Resident/Fellow Stipends and Benefits Report. Shortly thereafter, the DHS Office of Academic Engagement began working closely with USCIS to quickly resolve each of the remaining cases of medical residents applying for H-1B visas using wage data from the AAMC's Stipends and Benefits Report.

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National Update

CMS moves to allow step therapy in Medicare Advantage plans

On Aug. 7, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced that the agency would rescind previous CMS policy prohibiting the use of step-therapy protocols by Medicare Advantage plans. Starting in January 2019, Medicare Advantage plans will be allowed to use step therapy for all physician-administered drugs covered under Medicare Part B. The administration's new policy would also allow step-therapy protocols that span both Parts B and D, meaning a Medicare Advantage plan could require a patient to first try a drug covered under Part D before providing coverage for a Part B drug. According to the agency's announcement, this change in policy was made as part of the administration's plans to lower drug prices. 

The AMA has serious concerns about the agency's change of policy given its potential for significant impact on patient access to critical therapeutics and increased administrative burdens on physician practices. The AMA is working closely with physician specialty organizations and state medical societies to limit the potential negative impacts of this policy shift.

Significant changes proposed for accountable care organizations

CMS has issued a proposed rule outlining the future direction of the Medicare Shared Savings Program. The proposal replaces the current approach of four numbered accountable care organization (ACO) tracks with two categories, basic and enhanced, that have different levels of financial risk and other features for ACOs within the two categories. The rule also includes requirements for ACOs to advance through the categories over time.

Existing regulations allowed track 1 ACOs, which can earn shared savings but are not required to repay Medicare a share of so-called losses, to remain in track 1 for six years, but under the proposed rule, new ACOs would only be exempt from repaying losses for two years. To promote greater program stability, ACOs would have five-year agreements with CMS instead of three-year agreements.

For the first time, CMS is proposing that risk scores could increase to a limited degree for ACO patient populations, a change which AMA has been seeking. A more controversial proposal would vary requirements for ACOs depending on their total revenues, which if finalized would likely subject hospital-led ACOs to steeper financial risk requirements than physician-led ACOs that do not include hospital participants. CMS also proposes to reduce the percentage of savings that ACOs are eligible to receive, and to count incentive payments made to ACOs under the Quality Payment Program as part of ACOs' Medicare expenditures. A 60-day public comment period on the proposal closes Oct. 16.

Drug pricing legislation would help remove barriers to care

The AMA sent a letter on Aug. 9 to Senator Susan Collins, R-Maine, in support of addressing the varied causes driving prescription drug pricing. As amended, "The Patient's Right to Know Drug Prices Act of 2018" which she introduced to the Senate would prohibit health insurers and pharmacy benefit managers from using "gag clauses" that prohibit pharmacists from sharing lower-cost medication options with patients.

This piece of legislation would also ensure that the Federal Trade Commission (FTC) will have the necessary authority to combat anti-competitive pay-for-delay settlement agreements between manufacturers of biological reference products and follow-on biologicals. This bill is in keeping with AMA's previous advocacy efforts for the prohibition of pharmacy gag clauses and expanded FTC authority to combat pay-for-delay agreements.

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State Update

Free opioid overdose prevention toolkit now available in Spanish

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a Spanish translation of the updated Opioid Overdose Prevention Toolkit. The toolkit is a free resource which offers strategies to health care providers, communities and local governments to help develop practices and policies that prevent opioid-related deaths.

Recourses in the toolkit are specifically tailored for interdisciplinary collaboration and can be used by community members, prescribers, patients and families as well as those recovering from opioid overdose.

New Truth in Advertising survey results available

The AMA is pleased to release new public opinion survey data to support the AMA "Truth in Advertising" (TIA) campaign, which is designed to ensure health care providers clearly and honestly state their level of training, education and licensing.

To ensure patients know which "doctor" is providing their care, the AMA model law, the Health Care Professional Transparency Act:

  • Requires all health care professionals to clearly and accurately identify themselves in all writings, advertisements and other communications.
  • Requires all health care professionals to wear, during patient encounters, a name tag that clearly identifies the type of license they hold.
  • Prohibits advertisements or websites advertising health care services from including deceptive or misleading information.

The new TIA survey results confirm that patients:

  • Remain confused about who is a medical doctor or doctor of osteopathic medicine.
  • Strongly prefer that a physician perform certain medical procedures.
  • Overwhelmingly support legislation to ensure clarity and transparency in health care advertising.
  • Agree that only licensed medical doctors or doctors of osteopathic medicine should be able to use the title "physician."

Full survey results are available for download. Also available for download is an updated TIA campaign booklet including survey results, model legislation, a template op-ed, talking points and descriptions of the 21 laws adopted since the inception of the campaign.

Please contact AMA Senior Legislative Attorney Kristin Schleiter (kristin.schleiter@ama-assn.org) for more information about the AMA Truth in Advertising campaign and for support in passing the Health Care Professional Transparency Act in your state.

Free CME for physicians registered with DEA in West Virginia

The Drug Enforcement Administration (DEA) is hosting two regional one-day Practitioner Diversion Awareness Conferences (PDAC) on Sept. 29 and 30. The diversion of pharmaceutical controlled substances is a growing problem and the PDAC aims to assist physicians and other health care professionals in identifying and preventing diversion activity. This is a free event, but physicians who want to attend must have a DEA registration to prescribe, administer or dispense controlled substances in West Virginia.

Topics covered include:

  • Methods of diversion and effective controls for controlled substances.
  • Disposal, return of patient meds, and options for patients.
  • Prescriptions for controlled substances.
  • The opioid epidemic and the practice of legitimate medicine.

Learn more by reading the full agenda.

The conferences will be held at the Charleston Marriott Town Center in Charleston, West Virginia. Attendees will receive a certificate from the Federation of State Medical Boards which they can redeem for continuing medical education credit.

Register.

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Other News

All six Quality Payment Program podcasts now available

All six of the latest podcasts produced in partnership with ReachMD for the "Inside Medicare's New Payment System" series are now available. Topics include:

  • How costs are measured under the Merit-based Incentive Payment System (MIPS)
  • What hospital workers need to know about MIPS
  • What are your quality reporting options?
  • What to know about upgrading your electronic health records

All episodes are available here.

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Upcoming Events

Aug. 31: Help ID issues key to medicine's future
Your participation in this 15-minute survey sponsored by the AMA Council on Long Range Planning and Development will help identify and better understand important issues relevant to the practice of medicine and the health care environment that the AMA may need to address in the future. The participation deadline is Aug. 31. Take the survey today.

Sept. 15: NIH seeks ideas for genomics initiative
The National Institutes of Health's National Human Genome Research Institute has launched a new round of strategic planning—part of its Genomics 2020 initiative. The goal is to identify paradigm-shifting areas of genomics that will expand the field into new frontiers and enable novel applications to human health and disease. Physicians, scientists, health professionals, faculty and organizational leaders are invited to help inform this planning process. Take the survey.

Sept. 21: Register for 2018 AMPAC Campaign School
This date marks the deadline to register for the 2018 AMPAC Campaign School scheduled for Dec. 6–9 at the AMA office in Washington, D.C. The school is targeted to AMA members, their spouses, residents, medical students and medical society staff who want to become more involved in the campaign process. The AMPAC Campaign School is designed to give you the skills and strategic approach you will need out on the campaign trail. Our team of political experts will teach you everything you need to know to run a successful campaign or be a sought-after volunteer. Email  politicaleducation@ama-assn.org for more information. Apply today.

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