April 16, 2015
National UpdateWhat's in the SGR repeal legislation
The Medicare Access and CHIP Reauthorization Act was adopted Tuesday by a vote of 92 to 8 in the U.S. Senate. The bill previously cleared the U.S. House of Representatives by an overwhelming majority at the end of March.
Here are some of the highlights of what's included in this historic legislation:
- The SGR formula is repealed immediately. The 21 percent payment cut scheduled to take place April 15 was halted, and a positive payment update of 0.5 percent will take effect July 1. The 0.5 percent payment update will be applied through 2019. Claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21 percent cut was scheduled to take effect.
- Medicare's current quality reporting programs will be streamlined and simplified into one merit-based incentive payment system, referred to as "MIPS." This consolidation will reduce the aggregate level of financial penalties physicians otherwise could have faced.
- Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care.
- Incentive payments will be available for physicians who participate in alternative payment models and meet certain thresholds.
- Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.
While the bill supports physicians who choose to adopt new payment and delivery models, it retains Medicare's fee-for-service model. Participation in new models is entirely voluntary.
Additional information about provisions of the new legislation is available in a new frequently asked questions document (log in).
The Centers for Medicare & Medicaid Services (CMS) on March 20 released the Stage 3 proposed rule for meaningful use of electronic health records (EHR). The same day, the Office of the National Coordinator for Health IT (ONC) released a proposed rule for the next version of certified EHRs (Version 2015).
The rules represent a mixed bag for physicians, and comments are due for both rules by May 29. Following is an overview of the rules.
CMS' meaningful use Stage 3 rule:
The AMA continues to harbor a number of concerns with the overarching framework of the meaningful use program, including:
- The general pass/fail construct
- Increased thresholds or other added criteria that do not reflect the existing barriers—making it very challenging to meet certain measures
- The requirement to move to a full-year reporting period
ONC's certified EHR rule:
The ONC was responsive to a number of the concerns the AMA has pressed for repeatedly. These include proposals for:
- Creating greater transparency of certified EHRs
- Giving further clarity on vendor requirements to address privacy and security concerns
- Providing post-market surveillance to address how certified products are performing
- Improving data exchange, including provider directories, patient matching and the API concept to access common clinical data
While a number of the changes proposed by the ONC are promising, the AMA believes further emphasis needs to be placed on testing products during and after the certification process.
Earlier this week, the AMA sent out more information on these rules and requested feedback from the Federation. In order to inform the AMA's comments on these rules, please send your feedback to Terri Marchiori of the AMA no later than May 8.
CMS' meaningful use years 2015-2017 rule:
In addition, CMS on April 10 released a separate proposed rule to address years 2015-2017 of the meaningful use program. The AMA is still in the process of reviewing this rule but will provide a summary and ask the Federation for additional feedback in the near future.
Physicians' electronic health record (EHR) systems may be able to send and receive information to other EHRs, but the ability for information to be exchanged, incorporated and presented in a contextual manner still is lacking, physicians told the Office of the National Coordinator for Health IT (ONC) earlier this month.
In a letter to National Coordinator Health Information Technology Karen B. DeSalvo, MD, the AMA outlined key facets of achieving true interoperability between EHRs based on the ONC's interoperability roadmap:
- Prioritize cornerstone issues to lay a strong foundation
- Don't use a punitive approach
- Address cost and usability barriers
- Acknowledge the meaningful use program's impact
Read more about these recommendations at AMA Wire®.Medicare Advantage network rules strengthened
In response to joint recommendations from the AMA and other medical societies, the Centers for Medicare & Medicaid Services (CMS) finalized its draft requirements for Medicare Advantage plans to establish and maintain proactive, structured communications with physicians in their networks.
These communications should assess physicians' true availability and specifically include whether they are accepting new patients. They also should verify continued compliance with Medicare Advantage network access requirements.
Health plans also will have to implement protocols to effectively address complaints related to enrollees being denied access to a contracted provider, and health plans will be expected to update online directory information in real time.
The AMA was pleased that CMS finalized its network adequacy proposals despite opposition from most industry stakeholders regarding costs and administrative burdens. In addition, CMS Acting Administrator Andrew Slavitt responded to the medical societies' recommendations that stated CMS will consider these recommendations for: (1) a special election period for Medicare Advantage enrollees who change plans as a result of network narrowing and (2) a retrospective analysis of whether patients affected by network narrowing were disproportionately sicker and/or older.
Issue SpotlightSGR repealed thanks to united voice of medicine
Following years of advocacy by the nation's physicians standing up for their patients and their practices, the U.S. Senate Tuesday evening followed the U.S. House of Representatives' lead and passed the Medicare Access and CHIP Reauthorization Act, a law that immediately repealed the Medicare sustainable growth rate (SGR) formula.
Although six amendments were considered on the floor, none reached the threshold required for passage. As a result, the Senate's version of the bill was identical to the version the House passed by an overwhelming margin of 392-37 on March 26.
This achievement was made possible by the united voice of medicine in an overwhelming and ultimately successful grassroots advocacy campaign to eliminate the SGR once and for all. Thank you for your hard work!
We encourage you, in turn, to express your appreciation to your senators and representatives who voted for this new law. It is complex legislation that reflects bipartisan compromise, so the vote was not an easy one for many of them. Your recognition of their effort will be appreciated.
See how your members of Congress voted: View the House votes and Senate votes online.
The AMA will be sharing educational material about the legislation in the days ahead.
Our work is not done. Now that Congress has repealed the SGR formula, we can devote more attention to advancing the AMA's strategic initiatives and related efforts to improve the health of the nation. Our advocacy will focus on helping physicians pursue new delivery and payment models, reducing regulatory burdens on physicians and securing greater insurance coverage for diabetes prevention programs, among other issues. We will need your continued help to achieve these shared goals.
State UpdateCalifornia bills support Medicaid access to care
As part of advocacy efforts to increase access to Medicaid services, the AMA and the California Medical Association recently expressed support for two bills that will increase physician payments in Medi-Cal, California's Medicaid program, to Medicare levels.
Low payment rates can significantly affect a physician's ability to accept Medicaid patients into his or her practice. Without adequate payment, physicians may not have the financial capacity to continue participating in the program. As a result, beneficiaries are likely to face barriers to care, resulting in more frequent emergency department visits, delayed treatment of chronic conditions and poorer health outcomes.
Increasing payment levels "will have a significant impact on the availability of Medi-Cal participating physicians and the health of Medi-Cal patients," AMA Executive Vice President and CEO James L. Madara, MD, wrote in a recent letter.
The AMA continues to advocate in all states for an increase in Medicaid payments to physicians and improvements and innovations in Medicaid that will deliver health care services more effectively. The AMA Advocacy Resource Center has tools, availability and resources to assist medical associations in their support of Medicaid-related legislation. Visit the AMA's Medicaid campaign Web page or contact Annalia Michelman of the AMA for more information.
North Dakota became one of the most recent states to enact legislation that will increase the availability of naloxone to prevent death from opioid overdoses when Governor Jack Dalrymple signed S.B. 2014 into law April 8.
The North Dakota Medical Association (NDMA) and the AMA supported the bill because it provides common-sense liability protections for health care professionals and individuals who seek to help people who are at risk of, or who are experiencing, an opioid overdose.
The new law also allows for the prescription of naloxone to an individual patient at risk of experiencing an opioid-related overdose and a family member, friend or other individual in a position to assist an individual at risk of experiencing an opioid-related overdose.
"The most important reason for the AMA's support is that naloxone saves lives," AMA Executive Vice President and CEO James L. Madara, MD, said in a letter (log in).
"Since 2013, the NDMA has been involved with a state-wide taskforce—along with other health care organizations, law enforcement, the attorney general's office, state legislators, educators, government agencies, substance abuse rehabilitation centers and insurance providers—which focuses on reducing the abuse of pharmaceutical narcotics in our communities," NDMA President Steven P. Strinden, MD, said.
"This legislation came from that group and is a key step to creating more public awareness and access to appropriate care—all while preventing needless deaths," Dr. Strinden said. "NDMA was proud to support this legislation and was happy to witness resounding support and understanding from North Dakota's legislative body."
Other NewsPQRS group practice reporting option available until June 30
Practices consisting of two or more eligible professionals (EP) that would like to participate in the 2015 Physician Quality Reporting System (PQRS) under the group practice reporting option (GPRO) have until June 30 to register as a GPRO.
Practices with two or more EPs do not have to participate as a GPRO and may participate as individuals in PQRS.
Upon GPRO registration, a practice must indicate whether it plans to participate in PQRS under the following options:
- Qualified PQRS registry.
- Electronic health record (EHR).
- Web interface (for groups with 25 or more EPs only).
- Consumer Assessment of Health Providers and Systems for PQRS survey via a CMS certified survey vendor (as a supplement to another GPRO reporting mechanism). A GPRO with a 100 or more EPs must report through this system.
If a practice would like to participate in PQRS through a qualified clinical data registry, it should not register as a GPRO (the qualified clinical data registry option is only available to EPs participating as individuals).
In addition, if a practice would like to participate as a GPRO and submit data via its EHR system, the practice should consult with its EHR vendor before registration because some EHR vendors will not support the PQRS GPRO EHR option.
A practice cannot change its GPRO designation with CMS once the registration period closes, so it is important for practices to consider all the options. If a practice is participating in PQRS as an individual, it does not need to register.
Practices can access the registration system using a valid Individuals Authorized Access to the CMS Computer Services (IACS) account. Step-by-step instructions for obtaining an IACS account with the correct role are provided on the PQRS GPRO registration Web page, as are instructions for registering to participate in the 2015 PQRS GPRO option.
Under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services (CMS) is required to publicly report on an annual basis items of value that are given to physicians and teaching hospitals.
Preceding the public data release, physicians are given a brief window of time to review their data and dispute errors. CMS announced April 6 that physicians could begin registering in the Open Payments System and reviewing their 2014 data.
Disputes that are initiated by May 20 will be flagged in the public data release scheduled to take place June 30. Visit the AMA website for step-by-step instructions on how to register and review the Open Payments data.
Physicians can share their registration experience with the AMA by sending an email to OpenPayments@ama-assn.org. Responses will be used in the AMA's ongoing advocacy efforts.
In order to advance ongoing advocacy efforts on payment issues, the AMA, American Dental Association (ADA) and Medical Group Management Association (MGMA) are conducting a provider survey seeking information regarding health plan use of "virtual" credit cards and automated clearing house electronic funds transfers (ACH EFT).
Similar to direct deposit offered by many employers, ACH EFT is a standard form of payment that enables health plans to deposit claims payments directly into a physician or other provider's designated bank account. A provision in the Affordable Care Act requires all health plans to offer claims payments via ACH EFT upon request, and they may not incentivize the use of nonstandard payment methodologies such as virtual credit cards.
The AMA, ADA and MGMA have been growing increasingly concerned that some entities are charging excessive fees for these payments or are issuing virtual credit card payments instead of using ACH EFT. Virtual credit cards are used increasingly by health plans and some vendors. They involve sending the practice (via fax, mail or email) a single-use number that needs to be keyed into a credit card point of sale system in order to receive contractual payments. This payment methodology, which is often implemented without notifying the practice or allowing them to choose, results in lost revenue and increased administrative burdens.
The survey should take no more than five minutes to complete and will strengthen ongoing efforts to protect the interests of physicians and other providers regarding electronic claims payments. The survey will remain open until May 8.
For more information about health care electronic payments, visit the AMA's EFT toolkit.
AMA Board of Trustees Member Patrice Harris, MD, will be speaking at the annual meeting of the Federation of State Medical Boards regarding the recently released Interstate Medical Licensure Compact and model policy on the use of opioids in treatment of chronic pain.
AMA Board of Trustees Member Jack Resneck, MD, will participate in a plenary session, "Examining Diagnosis and Treatment by Telemedicine: What Is Safe?," at the American Telemedicine Association's Annual Meeting.