National Advocacy Update (Updated October 13, 2015)

AMA 2008

Put Breaks on Meaningful Use, Physicians Tell CMS

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.

CMS Bundled Payment Model Needs to be Voluntary, Physician Led

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 greater flexibility.

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.

Specialties Call for Data Access and Flexibility in Alternative Payment Models

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 Washington, D.C.

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 CMS models approved to date often do not break down the barriers to improving care that exist in the current payment system.
  • CMS needs to be more transparent about its criteria and decision process on proposed models designed by specialty societies.
  • Physicians and other need more access to claims data so they can understand the full range of costs involved in managing patients’ conditions.

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.

SFMS Member Leads AMA Efforts to Urge Congress to Adopt New Telemedicine Policy

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.

AMA to California Legislature: Mandate e-Prescribing for Controlled Substances Would Cause Massive Disruption to Patient Care

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.