Sept. 25, 2020: National Advocacy Update

The AMA wrote to officials of the U.S. Department of Homeland Security on Sept. 23, urging the Department and the Office of the Inspector General to thoroughly investigate complaints about detained immigrants’ substandard living conditions and improper health care at U.S. Immigration and Custom Enforcement facilities, including one in Georgia.  In particular, the letter noted the fundamental importance of properly obtained informed consent and of ensuring that patients understand the information provided, especially if there is a language barrier.

Hear from AMA President Susan R. Bailey, MD about passing the somber milestone of 200,000 confirmed deaths to COVID-19. Our country this week passed the somber milestone of 200,000 confirmed deaths to COVID-19, an epic tragedy of lives cut short that touches communities in every state. These are not just numbers on a spreadsheet; these are moms and dads, spouses and children, beloved grandparents, favorite aunts, uncles and cousins. These include more than 1,000 physicians, nurses and other health care workers, as well as police officers and first responders. These are teachers and students, small-business owners, family breadwinners and civic leaders—the backbone of our local communities. The full measure of COVID-19’s impact may not be known for some time. And it’s possible, even likely, that the death toll from this pandemic has been severely undercounted from the beginning. But reaching 200,000 confirmed deaths is a staggering loss to consider. It exceeds the total number of American combat deaths since World War II. It surpasses the populations of Akron, Ohio, Little Rock, Arkansas, or Knoxville, Tennessee. At its apex earlier this summer, someone died from COVID-19 every 80 seconds. The virus has devastated families and entire communities, and brought immeasurable heartache to vulnerable populations, including seniors and those already struggling with chronic illness and other underlying In many cases, the families and friends of those who lost their lives could not be by their sides when they passed. The pain of this pandemic is further aggravated by the delays or cancellations of wakes, funerals, memorial services and other traditional methods of dealing with such a tremendous loss. There may be limits on in-person attendance, but there is no limit to the sorrow felt by survivors and all those who lose the chance to say goodbye. A Washington Post analysis published in August documented the fact that Blacks and Latinos are infected, hospitalized and dying from COVID-19 at far higher rates than white people—and are dying at significantly younger ages. Data collected by the Centers for Disease Control and Prevention continue to show significantly higher rates of COVID-19 infection, hospitalization and death among the Black, Latino and American Indian populations. Our AMA supports federal legislation to collect and disseminate comprehensive, standardized and transparent national demographic data that measures COVID-19 testing, treatment and outcomes by race, ethnicity, tribal affiliation, socioeconomic and disability status, and county. Doing so is essential to the tasks of optimal resource distribution in this pandemic and preventing disparities and inequities in our health care system going forward. Read the full story here.

The Department of Homeland Security (DHS) Office of the Inspector General (OIG) review of U.S. Customs and Border Patrol’s (CBP) Use of FY 2019 Humanitarian Funds and ongoing audit of CBP’s Policies and Procedures for Detained Migrants Experiencing Serious Medical Conditions found that CBP’s current contract for medical services will expire on Sept. 29. As of Sept. 22, CBP had not issued a solicitation for a new contract. As a result, the AMA joined 12 other health care organizations in raising concern surrounding the Administration’s lack of action, leaving less than a month for CBP to award a new contract for medical services. In the letter, the health care organizations voiced their collective concern regarding a potential lapse in medical services at CBP facilities in the middle of the COVID-19 pandemic. The letter firmly stated that, “ensuring the health and well-being of immigrants protects the health and well-being of us all. This [COVID-19] virus does not discriminate, and our response should not either. We must ensure that everyone has access to the health care they need.” This is not the first time the AMA has urged the Administration to ensure that conditions for those in CBP custody are consistent with evidence-based recommendations for appropriate care and treatment of children and pregnant women. In 2018, the AMA urged DHS to implement specific meaningful steps to ensure that all children and pregnant women in CBP custody receive appropriate medical and mental health screening and necessary follow-up care by trained providers. In 2019, the AMA supported federal legislation directed at ensuring adequate minimum standards for health care, water and nutrition, hygiene, sanitation and shelter.

Last week, President Trump signed a much-anticipated executive order aimed at lowering drug prices in the United States. The newest executive action, “Lowering Drug Prices by Putting America First,” includes initial steps to help ensure American patients do not pay more for prescription drugs than what is paid in other countries for those same products. The idea of creating “most favored nation” status for the United States was first proposed in 2018 by the CMS International Pricing Index (IPI) advanced notice of proposed rulemaking. That proposal was met with much opposition from the pharmaceutical manufacturer community, and CMS has not yet proceeded with additional rulemaking to advance the program. This most recent executive order directs CMS to create and test a Medicare payment model for certain high-cost prescription drugs and biologics where Medicare would pay no more than the most-favored nation price for those drug products. The model would test whether paying the most-favored nation price would help mitigate poor clinical outcomes and increased expenditures for Medicare patients. Any new payment model would require a formal rulemaking process prior to being put into practice. The most-favored nation executive order is the most recent in a flurry of executive activity on drug pricing. In recent weeks, President Trump has signed executive orders on drug rebates, state-based drug importation programs and the 340B program. Each will require additional rulemaking activity prior to finalization. The AMA is closely monitoring all Administration activity aimed at lowering drug prices to ensure financial relief for patients while maintaining access to essential prescription drugs.

If you participated in the Merit-based Incentive Payment System (MIPS) in 2019, performance feedback, including your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. This final score determines the payment adjustment you will receive in 2021, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS-eligible clinician in 2021. MIPS-eligible clinicians, groups and virtual groups (along with their designated support staff or authorized third-party intermediary), including alternative payment model (APM) participants, may request that CMS review the calculation of their 2020 MIPS payment adjustment factor(s) through a process called targeted review. The deadline to submit your request is Oct. 5 at 8:00 p.m. Eastern time. Some examples of previous targeted review circumstances include the following:

• Errors or data quality issues for the measures and activities submitted
• Eligibility and special status issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)
• Being erroneously excluded from the APM participation list and not being scored under the APM Scoring Standard
• Performance categories were not automatically reweighted even though you qualify for automatic reweighting due to extreme and uncontrollable circumstances

You can access your MIPS final score and performance feedback and request a targeted review by going to the Quality Payment Program website. CMS may require documentation to support a targeted review request that is under evaluation. If the targeted review request is approved, CMS may update your final score and/or associated payment adjustment (if applicable), as soon as technically feasible. Please note that targeted review decisions are final and not eligible for further review. For more information about how to request a targeted review, please refer to the 2019 Targeted Review User Guide.

The Medicare Access and CHIP Reauthorization Act provides annual incentive payments equal to 5% of the physician's Medicare claims for physicians who participate in Advanced APMs. The payments are made two years after the physician participates in the APM, so physicians who qualified as APM participants in 2018 are due to receive their 5% incentive payment this year. This month CMS issued the APM incentive payments to qualified participants, but there are many physicians whom CMS has been unable to locate, perhaps due to dislocations related to COVID-19. Check here to see if you are on the list of physicians CMS has been unable to locate. Any physician who participated in a Medicare Advanced APM during 2018 and believes they qualified for the 5% incentive payment but did not receive it should provide the missing billing information to CMS by going to this website no later than Nov. 10.

• Sept. 25, 2020: Advocacy Update spotlight on Congress providing much-needed relief to physicians working through the pandemic
• Sept. 25, 2020: State Advocacy Update 
• Sept. 25, 2020: Judicial Advocacy Update