What issues should you follow closely in the year ahead? Crucial developments will emerge in health care regulations, legislation and the health insurance market—and many of them will profoundly impact your practice and patients. Taking a look ahead, we’ve identified nine of the top issues you’ll want to watch in 2016.
The elimination of the sustainable growth rate (SGR) formula with the passage of the Medicare Access and CHIP Reauthorization Act in 2015 was a giant leap forward for Medicare reform. The law paves the way for important payment reforms. The Merit-Based Incentive Payment System (MIPS) under development is intended to streamline the various reporting programs for physicians, and alternative payment models (APM) will support physicians in adopting new models of care. Shaping the MIPS so that it fixes the problems of the current system and is beneficial for both physicians and patients will be at the heart of Medicare reform efforts in the coming year. The AMA will continue its work, which includes a task force of physicians from various states and specialties who already drafted and delivered to the Centers for Medicare & Medicaid Services (CMS) 10 principles to guide the foundation of the MIPS, which will streamline requirements for quality, electronic health records (EHR) and resource use. The AMA also will offer additional resources to help physicians successfully participate in the new system. One resource you can check out already is the recently released the “Guide to physician-focused APMs,” which outlines barriers in current payment systems, presents the three characteristics of successful payment models and details seven physician-focused APMs.
EHR meaningful use program
This burdensome regulatory program is scheduled to move forward next year, following the Centers for Medicare & Medicaid Services’ (CMS) release of the meaningful use Stage 3 final rule late in 2015. The medical community immediately called on policymakers to put physicians back in control of their practices and put patients before bureaucracy after the rule was released and will continue these efforts this year. The AMA’s grassroots campaign Break The Red Tape is calling for physician-led and patient-focused medicine and pressing for a reset of Stage 3. Recommendations for the reset seek to alleviate meaningful use burdens and revise the program to improve flexibility, expand patient engagement and clear the way for increased health IT interoperability and innovation.
The nation’s largest health insurers have proposed mergers that would reduce competition in the health insurance market. If approved, this consolidation would have a damaging impact on patients and physician practices by reducing health care access, quality and affordability. In a letter to the U.S. assistant attorney general, the AMA urged the Department of Justice to block the proposed mergers and will continue to advocate to Congress and state policy makers to prevent this detriment to health care. Physicians also adopted new policy on the matter at the 2015 AMA Interim Meeting.
Provider networks and balance billing
Insurer networks are expected to continue narrowing, and out-of-pocket expenses for insured patients will continue to increase. In the face of these trends, the AMA will continue to work with states, the Department of Health and Human Services (HHS) and other groups to protect patients’ access to care and seek solutions to unanticipated out-of-network bills while preserving incentives for insurers to contract and physicians’ rights to fair payment.
Prescription drug abuse and addiction
A four-fold increase in opioid deaths in the last decade highlights the importance of the opioid overdose epidemic in the year ahead. The AMA Task Force to Reduce Opioid Abuse will continue to provide national leadership to stem this public health crisis. Solutions that need to be adopted this year include use of prescription drug monitoring programs, evidence-based prescribing, a reduction in the stigma associated with substance use disorder, enhanced access to treatment and expanded access to naloxone—the lifesaving medication that can reverse the effects of an opioid overdose.
Graduate medical education (GME) funding and student debt relief
Critical funding for graduate medical education (GME) is in danger of being cut. The AMA’s Save GME grassroots campaign will continue to urge Congress to maintain funding. Grassroots activities also will focus on simplifying student loan application processes and improving repayment rules as part of the Higher Education Reauthorization Act.
Prescription drug costs
The cost of prescription drugs has soared in recent years, making it challenging for patients to afford their necessary medications. Pharmaceutical spending growth has shown no signs of abating. In November, physicians voted at the 2015 AMA Interim Meeting to convene a task force and launch an advocacy campaign to drive solutions and make prescription drugs more affordable. The task force will develop principles to address pharmaceutical costs and support physicians and patients in local and national initiatives that will bring attention to rising prescription drug prices and help put forward solutions to make these drugs more affordable.
Health data security
Threats to health data security have been increasing over the past two years. A study found that 81 percent of health IT executives reported cyberattacks in that time span. Such endangerment of health data is expected to increase this year. With such private information so vulnerable to attack, appropriate protections for sharing and data storage must be a focal point for health IT. The AMA is working with the federal government to ensure better protections for health information.
Already a growing trend in care delivery, telemedicine will see more widespread use in the upcoming year. The AMA intends to advance the Interstate Medical Licensure Compact of the Federation of State Medical Boards, which facilitates state licensure for telemedicine. The AMA also will advocate for the removal of arbitrary barriers to telemedicine coverage under Medicare and promote AMA model state telemedicine legislation.
AMA Wire® will provide timely coverage of developments around these issues throughout the year ahead.