National Advocacy Update (Updated October 16, 2013)
AMA Submits Recommendations to Senate Finance and House Ways & Means Committees on Repealing the SGR
On Oct. 30, the Senate Finance Committee and the House Ways and Means Committee released a bipartisan, bicameral discussion draft proposal that “would permanently repeal the SGR update mechanism, reform the fee-for-service (FFS) payment system through greater focus on value over volume, and encourage participation in alternative payment models.” The AMA submitted recommendations to the committees on Nov.11, to build upon and strengthen the draft proposal to best achieve the shared goal of developing a new, more stable Medicare payment and delivery system that supports high-quality care. The AMA will continue its advocacy efforts with the committees and all members of Congress to shape and advance legislation this year to eliminate the SGR.
AMA Advocates on 2014 Medicare Physician Payment Rule
One month before the November 1 legal deadline for the final 2014 Medicare physician payment rule, the AMA is continuing its aggressive advocacy to eliminate the Medicare proposal capping physician office payments at the hospital outpatient or ambulatory surgery center rates. AMA comments on the proposed rule urge other important revisions as well, including backing off changes to the PQRS. The proposal triples minimum reporting requirements from three measures to nine and bumps up the minimum number of measures reported in each group from four to six. The AMA also has serious concerns about the rush to implement the VBM. In 2013, application of the value modifier was limited to groups of 100 or more eligible professionals, but the 2014 proposal applies it to groups as small as 10 professionals while doubling the potential pay cut from 1-2%. A substantial number of physicians could then face a 2% PQRS penalty and an additional 2% penalty for the value modifier in 2016.
On a more positive note, the AMA commends CMS for its decision to recognize complex chronic care management services beginning in 2015, building on the work of the CPT® Editorial Panel and Relative Value Scale Update Committee (RUC).
California NP Independence Bill Fails to Pass Committee
AMA support and resources, combined with the tireless advocacy efforts of the California Medical Association, led to the defeat of legislation that would have given nurse practitioners more autonomy to practice on their own without physician supervision. The bill (SB 491) would have allowed nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe potentially dangerous, addictive drugs without supervision. The AMA stood in strong opposition of this legislation by sending letters to members of the California Senate, urging them to oppose this bill. A generous grant from the AMA Scope of Practice Partnership to the California Medical Association established the California Coalition for Patient Access and Quality Care, comprised of physician groups, patient advocates, media outlets, and legislators who support physician leadership of the health care team. The AMA expects this bill to return in future years, and will stay vigilant in its insistence that the future of health care is coordinated, integrated, team-based care.
AMA Launches "FixMedicareNow.org" to Target SGR Repeal
The AMA has embarked on a grassroots campaign that will ramp up this fall to put concerted pressure on members of Congress to once and for all repeal Medicare’s Sustainable Growth Rate (SGR) formula for physician reimbursement. An important component of this effort will be an interactive website— FixMedicareNow.org. The site will engage both patients and physicians in the campaign to repeal the SGR, and also educate policymakers on Capitol Hill on the urgent need to do so. Moreover, the site will function as a recruitment tool, enlisting Americans from all walks of life and all over the country to sign-up and join the campaign via social media channels and a variety of online marketing efforts; an advocacy platform that integrates grassroots alerts and calls to action for activists to email, call, and utilize social media to spur lawmakers to act; and an interactive information portal that will house videos, online info-graphics, and other resources that effectively make the case for SGR repeal.
Revised 1500 Health Insurance Claim Form Released
The National Uniform Claim Committee (NUCC), for which the AMA is the Secretariat, released an updated Health Insurance Claim Form, version 02/12. The NUCC updated the 1500 claim form to accommodate several changes, including the need to accept ICD-10 codes. The AMA continues to oppose the move to ICD-10, a federal mandate that will require ICD-10 starting October 1, 2014. It nonetheless remains a federal mandate. The updated 1500 claim form allows physicians to identify the version of the diagnosis code set being report, i.e., ICD-9 or ICD-10, expands the number of diagnosis codes that can be reported from 4 to 12, and improves the accuracy of certain data reported.
Medicare anticipates implementing the 02/12 1500 claim form as follows:
- 1/6/2014: Medicare begins receiving and processing paper claims submitted on the 02/12 1500 claim form.
- 1/6 - 3/31/2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old 08/05 1500 claim form.
- 4/1/2014: Medicare receives and processes paper claims submitted only on the 02/12 1500 claim form.
A sample of the 02/12 1500 claim form is available on the NUCC website.