With the final rule for Stage 3 of electronic health record (EHR) meaningful
use expected any day, physicians united last Thursday in calling for policymakers
to reevaluate the program and pause it until its prohibitive problems are fixed.
More than 40 national specialty societies joined the AMA in letters to Department
of Health and Human Services Secretary Sylvia Burwell and Office of Management and
Budget Director Shaun Donovan, warning that locking in Stage 3 rules for the meaningful
use program would inhibit high-quality patient care and undermine implementation
of Medicare payment reforms.
“If the administration finalizes the proposed
meaningful use Stage 3 regulation now, vendors will create software that will lock
in problematic technology, which physicians and patients will be living with for
years to come,” the letters state.
The letters point out that the
proposed Stage 3 regulation exacerbates the problematic policies of Stage 2, which
requires physicians to meet “one-size-fits-all” criteria, rather than
allowing them to focus on the clinical activities that would support patient care
in their practices.
The AMA urged the Centers for Medicare &
Medicaid Services (CMS) to make the Medicare bundled payment model for joint replacement
surgery to be voluntary across the country and allow for physician leadership and
CMS has proposed a mandatory bundled payment model for 75 localities that would
cover all surgical, hospital, post-acute and rehabilitation services until 90 days
after a joint replacement operation. CMS would calculate a discounted rate for the
episode and then reconcile total episode costs with hospitals where the surgery
occurred. CMS then would provide extra money to hospitals if total costs for episodes
are below the discounted rate and penalize those with higher costs.
The AMA’s comments recommend that CMS instead allow physicians to form
joint replacement teams with hospitals and rehabilitation providers, then work with
patients to develop a treatment plan for the entire episode of elective surgery
and recovery. The team would designate a jointly governed management organization
that could either pay providers based on their service claims or accept and distribute
a prospectively determined payment for the episode.
If CMS accepts the AMA’s recommendations,
patients all over the country could benefit from the reduced complications, shorter
recovery times, increased coordination, stronger patient engagement and improved
health outcomes that will be possible from redesigning care for joint replacements.
A number of national medical specialty societies and state associations recently
met with CMS to discuss implementation of the alternative payment model (APM) provisions
of the Medicare Access and CHIP Reauthorization Act (MACRA) at the AMA office in
Staff representing the societies expressed strong interest in developing APMs
and asked CMS for help and support to develop them for discrete conditions that
their members manage. AMA and medical society staff emphasized the following:
The group told CMS it also wants to hear from people who have already developed
CMS-approved APMs so that they can learn from their experience.
CMS plans to issue a request for information this
fall, seeking input from the public on criteria for APMs.
In advance of the 114th Congress—which is expected
to consider proposals to expand telemedicine services in Medicare, Medicaid, Veterans
Affairs and other federal health programs—the
AMA’s new policy on payment and coverage of telemedicine was promoted
on Capitol Hill.
SFMS member and AMA Board of Trustees Member Jack Resneck, Jr.,
MD, presented the AMA’s new telemedicine policy during two special congressional
events. Dr. Resneck took part in a September 15 staff briefing of the U.S. House
of Representatives hosted by the offices of Reps. Doris Matsui (D-California), and
Bill Johnson (R-Ohio). The following day, Dr. Resneck participated in a U.S. Senate
Special Committee on Aging roundtable titled “Harnessing the power of telehealth:
Promises and challenges?”
During these presentations, Dr. Resneck also
discussed the AMA's support for the Federation of State Medical Boards' efforts
to modernize and streamline the state-based licensure processes through an interstate
physician licensure compact.
Although the AMA believes that automating paper-based
prescription processes can help create a safer prescribing environment, in a
recent letter to the California legislature, the AMA expressed concern
with a proposed mandate for electronic prescriptions for controlled substances (EPCS)
in SB 1258. The proposed mandate aims to help provide a more secure, safer environment
to prescribe, dispense and track controlled substances, but it unfortunately does
not take into account the significant disruption that will occur in physician practices
because of the separate, distinct processes required for prescribing non-controlled
substances compared to controlled substances.