Sept. 18, 2014

National Update

Expert panel outlines 8 priorities for improving EHR usability

It's no secret that many physicians are unhappy with their electronic health record (EHR) systems, thanks in large part to cumbersome processes and limited features that get in the way of patient care. Now a panel of experts has called for EHR overhaul, outlining the eight top challenges and solutions for improving EHR usability for physicians and their patients.

This new framework (log in) for EHR usability—developed by the AMA and an external advisory committee of practicing physicians and health IT experts, researchers and executives—focuses on leveraging the potential of EHRs to enhance patient care, improve productivity and reduce administrative costs.

As part of its Professional Satisfaction and Practice Sustainability initiative, the AMA will use this framework to work with physicians, vendors, policymakers, health care systems and researchers to drive EHR improvements that can advance the delivery of high-quality, affordable care.

Read more at AMA Wire® to learn more about the eight solutions this group identified to address the biggest challenges.

Physicians to ONC: How to strengthen 10-year interoperability framework

In comments submitted last week on the 10-year interoperability framework of the Office of the National Coordinator for Health IT (ONC), the AMA advocated for an enhanced plan for making electronic health record (EHR) systems and other health IT more interoperable.

Achieving interoperability remains at the forefront of AMA advocacy efforts, given the value for patient care that comes from being able to securely exchange patient health information with other physicians and health care providers. Despite overly burdensome meaningful use requirements that call for physicians to exchange data, EHRs and other health IT systems still lack the ability to interoperate. The AMA is aggressively seeking interoperable and higher-performing EHRs and has offered recommendations for how interoperability can be achieved, including recent testimony to an ONC workgroup.

The AMA's comments on the ONC interoperability framework were submitted to an ONC Wiki page, addressing each ONC "building block." The AMA highlighted the need for successfully identifying patients and physicians during data exchange, creating a more streamlined and focused ONC certification process, establishing a more robust process for testing EHRs, and placing greater emphasis on data security and education.

Congressional committee holds hearing on lab-developed tests

The AMA earlier this month submitted a statement for the record (log in) for a U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Health hearing titled "21st-century cures: Examining the regulation of laboratory-developed tests (LDT)." The focus of the hearing was on the Food and Drug Administration's (FDA) July 31 notification to Congress that it intends to issue draft guidance on a framework for oversight of LDTs.

In its statement, the AMA questioned the FDA's legal authority to regulate LDTs. Additionally, the AMA raised the issue of whether the agency may implement the significant changes it proposed simply by issuing a guidance document, rather than going through the usual comment rule-making process, including an economic impact analysis.

The AMA agrees that additional oversight is warranted for certain high-risk LDTs, such as those for which incorrect results can harm patients or test methodology is neither transparent nor well understood. However, the FDA's proposal could have considerable ramifications, including preventing physicians from providing the most appropriate and clinically necessary medical care, severely limiting patient access to lifesaving tests, and slowing innovation and integration of personalized medicine into modern medical practice.

AMA supports Indian Health Service Advance Appropriations Act of 2013

A recently introduced federal bill would address some of the serious cash-flow problems the Indian Health Service (IHS) faces. The AMA on Sept. 3 sent a letter of support (log in) to Sen. Lisa Murkowski, R-Alaska, and a letter of support (log in) to Rep. Don Young, R-Alaska, regarding S. 1570/H.R. 3229, the Indian Health Service Advance Appropriations Act of 2013.

This legislation would allow the IHS and the Indian Health Facilities Accounts to receive advance appropriations, which would protect the IHS from cash-flow problems that regularly occur at the start of the fiscal year as a result of delays in enactment of annual funding legislation. Adopting advance appropriations for IHS would allow tribal health administrators to continue treating patients without worrying about if, or when, funding would be available. It also would enable improved budgeting, recruitment and retention, provision of services, facility maintenance, and construction efforts.

Back to Top

Issue Spotlight

Hydrocodone reclassification: What physicians need to know

For physicians who prescribe hydrocodone combination products, prescribing these medications to the patients who need them to alleviate pain just became more complicated. Make sure physicians in your organization know what's at stake and how they should prepare for this change by sharing the information below within your communication vehicles.

6 things you need to know about hydrocodone reclassification
A new rule from the Drug Enforcement Administration (DEA) taking effect Oct. 6 reclassifies hydrocodone combination products as Schedule II controlled substances, prohibiting refills and establishing other restrictions that will require major changes to prescribing practices.

Following are the six key points you need to know so you can take appropriate action over the next few weeks:

1. Refills aren't allowed for prescriptions that are written beginning Oct. 6. Be prepared to issue new hard-copy or electronic prescriptions for patients. Note that eScripts can only be used if state law permits and the prescriber is certified to ePrescribe Schedule II substances. Pharmacies also must be certified to accept eScripts for controlled substances.

2. Prescriptions issued before Oct. 6 won't necessarily qualify for refills; plan to issue new ones. Although the DEA rule allows refills of prescriptions issued before Oct. 6 until April 8, 2015, other factors could prevent patients from getting those refills.

Several states have published notices that they will treat hydrocodone combination product prescriptions issued before Oct. 6 in the same way they will handle prescriptions issued after the rule's implementation date. In addition, any state laws that are more stringent than the DEA rule will govern refills. Meanwhile, some pharmacy quality and safety processes may not allow refills for prescriptions issued before Oct. 6, and some health insurers will not pay for those refills.

3. Prescriptions can't be called in or faxed. Make sure to plan ahead for any patients who may need refills. The new rule prohibits pharmacies from filling prescriptions delivered over the phone or via fax, so you'll need to issue written scripts.

The only exception to this rule is emergency treatment, which would allow physicians to call in a limited quantity of the medication to cover the emergency period only. Pharmacies are required to report prescribers to the DEA if they make such a request and do not give the pharmacy a written prescription within seven days.

4. Allied health professionals might not be able to write prescriptions for these drugs going forward. Check your state's restrictions around Schedule II substances to confirm whether any non-physician members of your team who have prescriptive authority will be able to continue issuing prescriptions for hydrocodone combination products. You may need to modify your collaborative practice agreements accordingly.

5. Multiple prescriptions may be issued at one time under certain circumstances. The new rule does allow a patient to receive prescriptions that would total a 90-day supply, if the prescriber has determined it is appropriate to see the patient only once every 90 days. Each prescription must include written instructions that specify the earliest date it may be filled.

In addition to sound medical judgment and established medical standards, make sure to base your practice's policy on issuing multiple prescriptions on relevant federal and state laws.

6. Patients should be notified of the new requirements and processes. Make sure your patients understand that their new prescriptions will not be refilled and are aware of the procedures they will need to follow going forward.

Download a printable fact sheet (log in) containing this information as well as details about how the new rule will impact patients and pharmacists for a convenient office reference or handout.

The AMA and other groups have warned the DEA about the potential unintended consequences of reclassifying hydrocodone combination products since the agency made the proposal early last year. Eliminating phoned-in prescriptions and refills could make it difficult for some patients to get the pain relief they need, especially patients in nursing homes and those with persistent pain and disabilities.

Visit the AMA's Web page on combating prescription drug abuse and diversion under "federal agency and administration activities" to learn more about this advocacy work.

Back to Top

State Update

Medical licensure to be streamlined under new interstate compact

Physicians who wish to practice in multiple states could soon see a speedier process with fewer administrative and financial burdens as they pursue state medical licensure, thanks to an interstate compact released Sept. 5 by the Federation of State Medical Boards.

The new model legislation, which has been in the works since 2013, is designed to make the licensure process more efficient for physicians while ensuring high standards of patient safety. The compact also is anticipated to help increase access to care for patients in rural and other underserved populations via the responsible practice of telemedicine.

"The interstate compact … aligns with our efforts to modernize state medical licensure, allowing for an expedited licensing pathway in participating states," AMA President Robert M. Wah, MD, said in a statement.

Read more at AMA Wire.

Six more states join NGA Policy Academy to Reduce Rx Drug Abuse

The National Governors Association (NGA) this week held its first planning meeting with six states in the second round of its Policy Academy to Reduce Rx Drug Abuse. The AMA joined officials and representatives from Michigan, Minnesota, Nevada, North Carolina, Vermont, Wisconsin, several federal agencies and other stakeholders to discuss state-based strategies to combat prescription drug abuse and advance treatment and prevention.

While much of the discussion at the meeting centered on prescription drug monitoring programs, significant emphasis was placed on increasing access to treatment, supporting the availability of naloxone and engaging stakeholders to determine the most relevant data sources for a state to use in developing and evaluating policy. As it did for the first policy academy (log in), the AMA will continue to provide the NGA with input about state efforts, including the importance of working with state medical societies to advance state-based solutions.

Back to Top

Judicial Update

Case could leave doctors vulnerable to repeat, delayed lawsuits

A case coming before the Supreme Court of the United States holds in the balance whether lawsuits and heavy fines can be brought indefinitely against physicians who provide services under Medicare and other federal health care programs.

In KBR v. United States of America Ex Relator Benjamin Carter, petitioners are seeking to overturn earlier court decisions that would eliminate the existing six-year limit on pursuing "false claims" under the federal False Claims Act and would allow repeat lawsuits to be filed.

The AMA filed a friend-of-the-court brief alongside four other organizations, calling on the U.S. Supreme Court to consider the ramifications of earlier court rulings on the matter.

"If affirmed, the combined effect of these rulings will invite private plaintiffs and the government to pursue indefinitely and repeatedly any claim involving alleged fraud against the government," the brief states. "This elimination of all repose is not only contrary to law but would impose significant burdens on businesses, hospitals and other health care providers."

The brief points out that physicians could be "forced to defend against stale, repetitive and frequently meritless claims." This task would require significant costs in maintaining records for an indefinite period, planning for unknown contingencies and defending against inappropriate suits.

For physicians who don't have sufficient documentation to mount a proper defense or who otherwise decide to settle, the financial damages are considerable.

Under the federal False Claims Act, the penalty for each claim is between $5,000 and $10,000, adjusted for inflation, plus three times the amount of damages "sustained by the federal government." If information was misrepresented on multiple Medicare claims, for instance, penalties would apply to each claim—regardless of how small the billed amount was.

The case is expected to be argued this winter.

The AMA long has expressed concern over ambiguities in the False Claims Act, a Civil War-era statute being used to raise inappropriate claims, and previously has filed several court briefs reflecting concerns over this law.

Back to Top

Upcoming Events

Feb. 23-25:
The AMA's National Advocacy Conference will take place in Washington, D.C. Visit the conference Web page to view highlights from the 2014 event, including a brief video.

Back to Top