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Jan. 17, 2020

Issue Spotlight

Physicians' voices needed in state legislatures in 2020

Health care policy debates need to include the trusted voices of physicians advocating for their patients, AMA President Patrice A. Harris, MD, MA, told hundreds of physicians and state medical society executives and staffers at the AMA State Advocacy Summit in Bonita Springs, Florida.

"The discussions in the halls of state legislatures and in Washington, D.C., and the executive branches in our states and actually also in the courts are filled with many voices but unfortunately not always filled with science and evidence," Dr. Harris said. "We are trusted in these conversations because we do our best at all times to rely on fact—to rely on the science—to give opinions that are evidence based and to always remember that we are, at the end of the day, advocating for our patients."

Dr. Harris described how, through its advocacy efforts and partnership with the nation's state and specialty societies, the AMA helped secure more than 140 state-level victories, including:

"Unfortunately, we are in an era defined by a profound distrust in American institutions," said Dr. Harris, an Atlanta psychiatrist. "In media and education, in technology and at every level of government—trust seems to have sunk to an all-time low. It is important to remember, said Dr. Harris, that "People still trust us. Their doctors."

Prior authorization
"We fight back against prior-authorization requirements because we see the negative impact on our patients and we know these requirements create unnecessary headaches and burdens for our practices," Dr Harris said. Payers continue to implement harmful policies that delay patient care and interfere with physicians' ability to practice medicine.

The AMA has supported federal legislation to streamline prior authorization in Medicare Advantage plans and to improve the process in states across the country. Efforts include using the FixPriorAuth.org website to capture hundreds of patient and physician stories that bring home the negative impact prior authorization has on patient care.

Surprise medical bills
"We work toward reasonable legislation and regulation on surprise billing because we don't want our patients stuck with bills that are unexpected and they cannot afford," Dr. Harris said. The AMA believes patients should only be accountable for normal in-network cost-sharing amounts and supports an independent resolution system for settling payment disputes between physicians and insurers.

The AMA has worked with state medical associations and national specialty societies to:

Learn more about the AMA's work to prevent surprise medical bills.

Health insurance coverage
"We continue our call for Medicaid expansion because we know it improves access to care and the health of our patients," Dr. Harris said. The AMA promotes Medicaid expansion to cover the uninsured in all 50 states and has opposed Medicaid work requirements in state legislatures and in the courts.

The AMA continues to seek opportunities to improve the Affordable Care Act and expand options to those who do not qualify for subsidized coverage. Learn more about the AMA vision on health care reform.

The opioid epidemic
Dr. Harris, who chairs the AMA Opioid Task Force, also touched on AMA advocacy efforts to help end the opioid epidemic while ensuring that patients in pain maintain access to the medications they need. "We speak up for our patients in chronic pain and those who have substance-use disorders because they deserve the same care and compassion as anyone with any other chronic disease," she said, adding that the AMA also advocates for "policymakers to enforce mental health parity laws."

The AMA has released an in-depth analysis of the opioid epidemic response by four states: Colorado, Mississippi, North Carolina and Pennsylvania. The report, "National Roadmap on State-Level Efforts to End the Opioid Epidemic; Leading-edge Practices and Next Steps," analyzes successful strategies used and lessons learned to guide policymakers and others in the months ahead.

E-cigarettes and vaping
When it comes the dangers of e-cigarettes and vaping, Dr. Harris said "half measures are never acceptable," echoing her recent comments on how a new Trump administration policy to limit flavors in some vaping products was "a step in the right direction, but does not go far enough."

At minimum, a total ban on all flavored e-cigarettes, "in all forms and at all locations," is prudent and urgently needed, she said.

Gun violence
Dr. Harris also noted the AMA's advocacy for common sense gun laws. The AMA supports the Bipartisan Background Checks Act of 2019, which the U.S. House of Representatives passed in February but has been stalled in the Senate. AMA advocacy efforts helped secure long-sought funding for gun-violence research by the National Institutes of Health and the Centers for Disease Control and Prevention.

Scope of Practice
The AMA is leading the effort against inappropriate expansion of scope of practice by nonphysicians. "We engage in hundreds of scope of practice state battles because we believe physician-led health care matters," Dr. Harris said. 

This support of physician-led teams, which is based on the AMA's longstanding principle to protect the health and safety of patients, is the cornerstone of the AMA's scope of practice campaign. Our advocacy efforts, including leading the Scope of Practice Partnership, are having a positive impact in state houses across the country.   

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National Update

CDC begins the process of updating 2016 opioid prescribing guidelines

The Centers for Disease Control and Prevention (CDC) is in the process of updating its guidelines for prescribing opioids for treatment of chronic pain, which were issued in 2016. An initial step in this process was a draft evidence review by the Agency for Healthcare Research and Quality, to which the AMA provided comments in November. Now the CDC has turned to its Board of Scientific Counselors to form a new Opioid Workgroup to provide expert input on an update to the guidelines.

The Opioid Workgroup will be tasked with:

  • Reviewing the quality and implications of clinical and contextual evidence reviews
  • Reviewing each guideline recommendation statement and accompanying rationale
  • Considering specific aspects of each recommendation
  • Developing a summary, including points of agreement and disagreement, regarding the Opioid Workgroup's observations.

More information about the medical specialists and others who the CDC is seeking to have represented on the workgroup is available here. Persons who wish to be considered for nomination to the Opioid Workgroup should email a current curriculum vitae and contact information to NCIPCBSC@cdc.gov by or before Feb. 4.

MIPS eligible clinicians can start submitting data for 2019 through March 31

CMS has opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2019 performance period of the Quality Payment Program (QPP). Data can be submitted until 8:00 p.m. EDT on March 31.

The data submission period through CMS Web Interface for accountable care organizations (ACO) and pre-registered groups and virtual groups also opened on Jan. 2 and closes on March 31. Quality measures reported via Medicare Part B claims have been submitted throughout the 2019 performance period. Sign in to qpp.cms.gov for your preliminary feedback on Part B claims measure data processed to-date.

Clinicians in small practices (including those in rural locations), health professional shortage areas, and medically underserved areas may request technical assistance from organizations that can provide no-cost support. To learn more about this support, or to connect with your local technical assistance organization, please visit the Small, Underserved, and Rural Practices page on the QPP website.

Clinicians will follow the steps outlined below to submit their data:

  • Go to the QPP website
  • Sign in using your QPP access credentials
  • Submit your MIPS data for the 2019 performance period or review the data reported on your behalf by a third party.

To sign in and submit data, clinicians will need to register in the HCQIS Authorization Roles and Profile (HARP) system. For clinicians who need help enrolling with HARP, please refer to the QPP Access User Guide.

For questions please contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

Check your initial 2020 MIPS eligibility on the QPP website

You can now use the updated CMS Quality Payment Program Participation Status Lookup Tool to check on your initial 2020 eligibility for MIPS. Just enter your National Provider Identifier, or NPI, to find out whether you need to participate in MIPS during the 2020 performance period.

The 2020 Eligibility Tool Update for QPs/APMs will be updated in late 2020 to indicate final MIPS eligibility.

For more information:

If you have questions contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, consider calling during non-peak hours—before 10 AM and after 2 PM ET.

CMS issues 2018 results: 98% earn MIPS bonus

98% of eligible clinicians who participated in MIPS in 2018 will receive a positive payment adjustment in 2020, up from 93% in 2017. In response to AMA's strong advocacy for increasing the low-volume threshold and ensuring a level playing field for independent and small practices, participation rates among small and rural practices increased. 84% of small practices and 97% of rural practices will earn a bonus payment, up from 74% and 93% in 2017. Eligible clinicians earning a bonus will receive a payment adjustment ranging from 0.2% to 1.68% on their Medicare Part B covered professional services in 2020.

In addition, 183,306 clinicians participated in an Advanced Alternative Payment Model in 2018 and qualify for a 5% bonus payment in 2020, up from 99,076 in 2017. CMS provides more details about the 2018 results in a blog post and infographic.

Administration releases draft principles for regulation of artificial intelligence

On Jan. 7, the White House Office of Science and Technology Policy (OSTP) released a draft memorandum outlining ten principles the administration intends to use to guide the regulation of artificial intelligence (AI) applications. These draft principles follow the White House's executive order "Maintaining American Leadership in Artificial Intelligence" issued in 2019. The principles, which are not health care-specific, aim to ensure "fairness, non-discrimination, openness, transparency, safety and security" of AI applications. The principles also appear to encourage restraint by regulators when it comes to AI, urging agencies to carefully weigh the costs and benefits of new regulation prior to implementing new oversight structures. The memo, which seeks to encourage continued innovation and development in this space, is open for public comment for 60 days. The AMA is carefully monitoring health care AI regulatory activity and is committed to ensuring that regulation of AI deployed into clinical practice is appropriate to ensure patient safety. More information on AMA policy on health care augmented intelligence is available here.

FTC seeks comment on impact of non-compete clauses

On Jan. 9, the Federal Trade Commission (FTC) held a public workshop examining the impact of non-compete clauses in employment contracts. The workshop featured presentations by a number of FTC staff and legal scholars, with the aim of facilitating discussion around the impacts of these clauses on competition and consumer protection. During the workshop, FTC staff put forth a number of ideas around how best to approach enforcement of these types of employment restrictions. In conjunction with the workshop, the FTC is seeking comment from the public on how best to approach enforcement and the impact these clauses have on employees and the public.

Comments are due to the FTC by Feb.10 and can be submitted here.

CMS clarifies 2020 is an Appropriate Use Criteria testing period

In response to a letter from the AMA outlining concerns regarding the Appropriate Use Criteria (AUC) program testing year, CMS has added a notice on its AUC webpage explicitly stating that 2020 is a testing period. The AMA had heard there was confusion and misinformation about whether AUC consultation was mandatory in 2020 and urged CMS to specify that this year is an Education and Operations Testing Period for the program. CMS clarified that there are no payment consequences associated with AUC during 2020. In addition to clearing up this confusion, AMA is urging CMS to increase its outreach and education to help physicians prepare for the AUC program.

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State Update

Victory for patients – New Jersey defeats advanced practice nursing scope legislation

In a successful finish to the 2019 legislative session, which ended Jan. 13, the Medical Society of New Jersey, with the support of the AMA's Scope of Practice Partnership, successfully defeated A.B. 854/S.B. 1961 that would have expanded the scope of practice of advanced practice nurses (APN). The legislation would have given APNs full signatory authority, allowing them to execute any document that requires a physician signature by law and would have allowed APNs to prescribe medications without any physician oversight. This win keeps important safety protocols in place for advanced practice nurses to work with physicians as part of the patient-focused health care team.

For more information about the SOPP, contact the AMA at ARC@ama-assn.org.

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Judicial Update

Top court turns down bid for damages-only medical liability retrial

A recent ruling from the Supreme Court of Georgia that rejected Shaw G. Evans' request for a damages-only retrial is a relief to physicians who told the state's high court that retrial only focused on the damages would open up physicians and hospitals to increased liability. Evans sought a retrial on damages because he believes the dollar amount awarded was too low.

"Allowing a separate jury to hear a damages-only trial has been proven to lead to excessive damages and injustice," the Litigation Center of the American Medical Association and State Medical Societies and the Medical Association of Georgia tell the court in an amicus brief they filed jointly in the case, Evans v. Rockdale Hospital. "A concern courts have identified with partial retrials is the prejudice to the parties that can result from the evidentiary decisions made in the retrial. Often the second jury cannot set damages without an understanding of the underlying breach."

The Georgia ruling didn't directly address Evans' request for a damages-only retrial. Instead, the court vacated the Court of Appeals of Georgia ruling that concluded that the jury award "shocked the conscience" by not awarding damages for pain and suffering and that Evans was entitled to a retrial that determined both liability and damages.

The high court ruling, aligning with the Litigation Center brief, says the lower court "could not substitute its judgment for that of the trial court on the fact-based question of whether the damages awarded were within the range authorized by a preponderance of the evidence." Justices on the high court wrote that "the Court of Appeals instead should have limited its review to whether the trial court, who saw the witnesses and heard the testimony, abused its discretion in denying the motion for a new trial."

Read more here.

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Other News

Claim APM incentive payments from 2017

The Centers for Medicare & Medicaid Services (CMS) has published a list of nearly 3,000 physicians who are eligible to receive alternative payment model (APM) incentive payments based on their APM participation in 2017, but whom CMS has been unable to find in order to make the payments to them. Physicians whose practices participated in APMs during 2017 but who have not yet received their lump sum incentive payment should review the list and follow the instructions for providing contact and banking information to CMS to claim these payments. Even physicians who are no longer with the practice or whose group no longer participates in the APM may be entitled to payments based on their 2017 participation. The deadline to respond with the needed information is Feb. 28, 2020. Additional information on the incentive payments is available in this brief CMS fact sheet.

Webinar helps physicians decide if Primary Care First is right for them

More than 200 physicians and other individuals participated in a live webinar on Jan. 6 to hear directly from the CMS staff implementing the new Primary Care First alternative payment model and have their questions answered before the Jan. 22 application deadline. The webinar was co-hosted by the AMA, American College of Physicians (ACP), and American Academy of Family Physicians (AAFP). Recordings of the webinar are available here in audio only and here with the slide deck – neither require sign-in.

In addition, the societies have developed a question-and-answer document based on that portion of the webinar.

Many attendee questions focused on the expected impact of the model on their practice revenues, which is key to deciding whether to apply to participate. The webinar directs physicians to resources available from CMS, materials developed by the AAFP and ACP, and an AMA analysis comparing Primary Care First and the existing Comprehensive Primary Care Plus model. Together, these materials can help physicians estimate the model's impacts on their own practices and decide if it is right for them.

New podcast on changes to E/M office visits: How to prepare in 2021

Recorded at the AMA's interim meeting, co-chairs of the CPT/RUC Workgroup on Evaluation and Management (E/M) Barbara Levy, MD and Peter Holloman, MD describe the new CPT framework for reporting office visits.

Listen here.

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Upcoming Events

Register now for the 2020 National Advocacy Conference

The National Advocacy Conference gives you the opportunity to connect with industry experts, political insiders and members of Congress about current federal efforts to improve health care in addition to visiting Capitol Hill to advocate on crucial health care issues affecting you and your patients. This year's speakers include Sekou Andrews, an inspirational speaker and creator of "Poetic Voice", John King, CNN Chief National Correspondent and Deborah Roberts, an award-winning ABC news correspondent.

Register today and click here for more info on the speakers and agenda.

Ready to jump in the race? Start with the 2020 AMPAC Candidate Workshop

Thinking about running for public office? The 2020 AMPAC Candidate Workshop is designed to help physicians take the leap from the exam room to the campaign trail. The workshop will be taking place Feb. 28 – March 1 at the AMA office in Washington, DC.

The curriculum is targeted to AMA members, their spouses, residents, medical students and medical society staff who want to learn more about what it takes to be an effective candidate.

You will learn:

  • How and when to make the decision to run
  • The importance of a disciplined campaign plan and message
  • The secrets of effective fundraising
  • What kinds of media advertising are right for your campaign
  • How to handle the inevitable crises that emerge for every campaign
  • The role of your spouse and your family
  • How to become a better public speaker

Registration fee is $250 for AMA members and $1000 for non-members. Airfare and hotel accommodation not included, but a discounted room block at the Hyatt Regency Capitol Hill is available.

Space is limited so register by Feb 3.

Register today for the Rx Drug Abuse and Heroin Summit

The Rx Drug Abuse & Heroin Summit is the largest and most-recognized conference committed to addressing the opioid crisis. Government officials, first responders, law enforcement personnel, clinicians, physicians, nurses, educators, public health and prevention officials and families and people in recovery are represented. The conference agenda is designed with timely and relevant information to address what is working in prevention, treatment and law enforcement. This year's summit will take place in Nashville, TN, April 13-16.

Register today and save an additional $50 with code ALUM.

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