AMA Advocacy with the Administration
Administrative Simplification
The AMA is committed to addressing and advocating for solutions to the ongoing problems in the claims management revenue cycle that contribute to increased complexity and expense.
Antitrust Reform
The AMA is urging the Federal Trade Commission (FTC) and the Department of Justice (DOJ) to shift the focus on current physician antitrust policy to remove obstacles that prevent physicians from forming clinically integrated networks that can jointly negotiate with health plans for the purposes of participating in quality improvement programs and HIT initiatives. The AMA is also urging the DOJ to increase its oversight of health insurer consolidation.
AMA White Paper proposes an effective Antitrust reform remedy
DEA Issues
Learn more about the issues associated with DEA's oversight of prescriptions of controlled substances including AMA advocacy efforts to permit e-prescribing of controlled substances which is currently not permitted, and guidance from the DEA on orally prescribing controlled substances in emergency situations.
FDA Issues
Learn more about the recent FDA initiatives including an initiative to work with manufacturers of extended-release and high-potency opioids, like Oxycontin, to develop a Risk Evaluation and Mitigation Strategy or REMS, and direct to consumer advertising for prescription drugs.
FDA Plans for Opioids
Recently the FDA announced an initiative to work with manufacturers of extended-release and high-potency opioids, like Oxycontin, to develop a Risk Evaluation and Mitigation Strategy or REMS. May 4-5 the FDA organized four stakeholder meetings to discuss potential elements of a REMS for these products, including a meeting for prescribers. AMA and specialty participants asked many questions of FDA officials and urged the agency to ensure that the REMS does nothing to impair patient access to needed pain medications. Some participants noted that it is already difficult to find physicians willing to prescribe Schedule II opioids to manage their patients' pain. FDA officials were urged to: seek a REMS focused primarily on educating physicians and patients; provide positive incentives rather than penalties; allow substantial opportunities for physician involvement in designing the educational programs; avoid restricted distribution; and work to prevent unintended consequences such as an increase in use of immediate-release opioids that are not included in the REMS or undertreatment of pain. On May 27-28, the FDA is convening a public meeting on the opioid REMS.
Joint comment letter to FDA on opioids REMS development from AMA and 15 specialties
January 29, 2009 comment letter on Direct-to-Consumer Advertising
Health IT
Health information technology (Health IT) encompasses a wide range of products and systems, including software, hardware and infrastructure, that are used to support the collection, storage and exchange of patient data throughout the clinical practice of medicine. Health Information Technology (Health IT) is a term that encompasses a huge range of products and systems. There are many public and private initiatives currently promoting and developing effective Health IT.
HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prompted new Federal regulations which require physicians to ensure they are protecting the privacy and security of patients' medical information and using a standard format when submitting electronic transactions, such as submitting claims to payers.
Payers who conduct business electronically need to be aware of two significant changes concerning standard transactions and code sets. On January 16, 2009, the Department of Health and Human Services (HHS) announced two new compliance deadlines.
Medicare Fee for Service Physician Payment
The AMA is working to fixed the flawed Sustainable Growth Rate formula and prevent the looming 21% physician Medicare cuts.
Medical Liability Reform
As a result of AMA Advocacy, in September, 2009, President Obama directed the HHS Agency for Healthcare Research and Quality (AHRQ) to implement a $25 million state-based demonstration project on Medical Liability Reform and Patient Safety. The demonstrations will help states and health care systems to test models that meet four goals:
- Put patient safety first and work to reduce preventable injuries;
- Foster better communication between doctors and patients;
- Ensure that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits; and
- Reduce liability premiums
Learn more about the need for medical liability reform
The first grant program is funding for one-year planning grants to create plans for development, implementation and evaluation of approaches that focus on medical liability reform and patient safety. These are one-year grants for up to $300,000 each. The second program is funding for three-year demonstration projects to allow States and health systems who are ready to go to develop, implement, and evaluate medical liability models that focus on patient safety and reform the medical liability system. These are three-year grants for up to $3 million dollars each.
State medical associations are not eligible to apply for grants on their own directly. Those eligible to apply are states and "health systems". Medical associations can be a "component" of a health system if in coalition with them. Criteria listed to qualify address both patient safety and MLR reform and are drafted broadly. The language does not limit the type of reforms that may be considered—applicants will have wide discretion and flexibility in designing their patient safety and medical liability innovations that meet specified criteria (i.e., health courts, early offer programs, and administrative-type programs may all be considered if they meet the patient safety and medical liability objectives.)
The grant application period opens December 27th and will close January 27th. Funding decisions will be made within four months.
Both grant announcements are available at the following links:
- Medical Liability Reform and Patient Safety Planning Grants (R21)
- Medical Liability Reform and Patient Safety Demonstration Projects (R18)
An Advisory Subcommittee has been established to advise AHRQ on the review criteria in the announcement or clarify additional issues for applicants. William Hazel, MD, an AMA Trustee and an orthopedic surgeon, serves on the Subcommittee.
Medicare Advantage and Part D
Medicare Contracting Reform
As a result of a provision in the Medicare Modernization Act of 2003 (MMA), the Centers for Medicare and Medicaid Services (CMS) has been charged with significantly altering the way they award contracts to carriers and fiscal intermediaries. Understand how this will impact your process and what you need to know about this transition.
Medicare Enrollment
The Medicare enrollment process is a critical area of the program as it serves as the gateway into the program. Before physicians can bill Medicare they must submit an enrollment application to their Medicare contractor and have it successfully processed. Learn about the latest changes to the process and how to get your application processed successfully.
Patient Safety
In 2005 the AMA lead the passage of the Patient Safety and Quality Improvement Act (Public Law 109-41 109th Congress). The AMA will continue to lead physicians' efforts to measurably improve patient safety by working to ensure the law's implementation and to advance other measures, including voluntary reporting systems with strong confidentiality protections.
On November 21, 2008, HHS issued the final rule that establishes the authorities, processes, and requirements for implementing the Patient Safety and Quality Improvement Act of 2005 (the Patient Safety Act). The final rule captures the intent of the Patient Safety Act; to create a voluntary reporting program through which health care providers can share information relating to patient safety events with patient safety organizations (PSOs) on a privileged and confidential basis in order to improve patient safety and the quality of care. The final rule reiterates that this voluntary program is not federally funded but sets forth the framework by which health care providers may voluntarily report information to PSOs, on a privileged and confidential basis, for the collection and analysis of patient safety events. The final rule indicates that the Agency for Healthcare Research and Quality (AHRQ) will implement and oversee the process for certification and listing of PSOs and that the Office of Civil Rights (OCR) will investigate and enforce compliance with the confidentiality requirements.
April 11, 2008, AMA comments submitted to the Agency for Healthcare Research and Quality (AHRQ) on the proposed rule for implementing the Patient Safety law that establishes a federal framework for physicians, hospitals, and other health care professionals and entities to voluntarily report patient safety work product to patient safety organizations (PSOs) on a privileged and confidential basis. Read the letter
Quality Improvement
The AMA is actively involved in discussing and engaging the Administration and Congress regarding implementation of various quality measurement and improvement programs and activities.
Recovery Audit Contractors
Congress created the recovery audit contractors (RAC) program to help the Centers for Medicare and Medicaid Services (CMS) identify improper payments made by Medicare. The RAC contractors are private entities that are retained by the government to identify overpayments or under payments made to physicians and other healthcare providers, as well as, to recoup overpayments or return underpayments. The RAC was created by Congress first as a demonstration program and was subsequently expanded as a permanent, nationwide program.
The AMA remains deeply opposed to the bounty hunter-like program. During the initial stages of the demonstration program, CMS only rewarded the RACs for locating overpayments. However, thanks to significant AMA advocacy CMS also began rewarding these contractors for locating underpayments as an improper payment could also have resulted in a physician being underpaid. Several other changes were made to the expanded program as a result of AMA advocacy but the program remains a burden for physicians.
Red Flags Rule
On October 30, 2009 the Federal Trade Commission announced that the Red Flags rule is delay until June 1, 2010. The AMA has been urging the FTC and Congress that physicians are not "creditors" and should not be subject to the rule. The AMA is pleased that the FTC has granted another delay. Learn more about the FTC's decision.
AMA letter to the Federal Trade Commission on the Red Flags rule
