National Advocacy Update (Updated May 17, 2013)
AMA Advocates to NCPDP on Electronic Prior Authorization
As payers increase their use of prior authorization, the AMA continues to seek ways to streamline this process for physicians. Part of AMA’s efforts include working with the National Council for Prescription Drug Programs (NCPDP), the body that maintains the electronic transaction standards associated with several electronic prescribing (e-prescribing) functions. The AMA participates regularly in meetings with NCPDP and most recently attended a meeting this month where draft electronic Prior Authorization (ePA) changes to the NCPDP Script standard, which has been used in pilot by various prescription benefit manager organizations, were approved. The AMA has been strongly advocating for a standardized end-to-end ePA solution. While there have been improvements over the prior versions, there is still more work to be done, and the AMA will continue to advocate for a fully standardized solution. New work was initiated related to: prescription refill notifications and changing the prescribed medication or treatment, prescription filled notification processes for physicians, formulary and benefit modifications to the standards, electronic signatures and rebate standards. AMA staff will continue to advocate on behalf of physicians and provide additional updates.
Senate Finance Committee Seeks Input on Physician Payment Reforms
Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT) issued a letter on May 10 to the physician and provider community stating that, “this year, physician payment reform and SGR repeal remain a top priority for the Committee.” The letter seeks input on specific ways to improve the current Medicare physician fee schedule and fee-for-service (FFS) system “to ensure that it makes appropriate payments for physician services, reduces unnecessary utilization, and improves quality while also easing the transition to new payment models.” The letter acknowledges that the committee’s focus differs from the policy development process in the House of Representatives in order to avoid duplication. The deadline for submitting comments is May 31.
The Finance Committee also held a hearing on May 14 entitled, “Advancing Reform: Medicare Physicians Payments,” which focused on short-term improvements to the Medicare payment system to help ease the program’s transition toward alternative, performance-based payment models.
Rx-360 Campaign Targets Rouge Drug Sellers
A nonprofit consortium, Rx-360, has launched a new campaign to alert physicians to drug sales offers and promotions by sellers of counterfeit, unapproved, substandard, contaminated, and otherwise bad medicines. The campaign uses fax and email messages like those used by rogue sellers, such as “Great Discounts on Medicines! 100% Guaranteed. Quality Medicines from FDA Approved Manufacturers.” The fact sheet then notes that, although such offers may seem attractive, physicians may be targets for purchasing fake products that pose a threat to patient safety. The fact sheet also provides advice on how to determine if a product is legitimate, how to verify internet pharmacies, and how to report counterfeiting and adverse drug events.
Integrated Healthcare Association Supports AMA's Guidelines for Reporting Physician Data
Another key stakeholder in the health care industry, the Integrated Healthcare Association (IHA), has pledged support of the AMA’s Guidelines for Reporting Physician Data. IHA is a statewide multi-stakeholder leadership group that promotes quality improvement, accountability and affordability of health care in California. IHA joins a growing list of more than 60 organizations that have joined AMA to pledge support for “using the Guidelines to create data reports that physicians can easily understand and use to enhance data-driven decision-making.” The Guidelines and a full list of the organizations that support its use, including organizations such as UnitedHealth Group, Midwest Business Group on Health and National Committee on Quality Assurance (NCQA), can be found on the AMA website. We urge you to support the Reporting Guidelines to help physicians receive the data they need from health plans and other reporting bodies.
Click here to pledge support. For additional information on these Guidelines and other associated resources, please contact Tammy Banks at tammy. banks@ama-assn.org or (312) 464-4792.
Aetna Extends Compliance Deadline for Surgical Pathology Policy Due to AMA/Federation Efforts
The AMA, in collaboration with 23 Federation members, has been urging Aetna to scrap a new policy requiring in-office surgical pathology labs to be accredited by the College of American Pathologists (CAP), American Osteopathic Association (AOA), or The Joint Commission programs, in addition to certification pursuant to the Clinical Laboratory Improvement Amendments (CLIA). The AMA heard from numerous Federation organizations on the administrative and financial burden this new requirement would have on practices, and Aetna offered no explanation or relevant data as to why this change would be necessary. The physician organizations sent a letter to Aetna in late August urging the insurer to suspend its policy in order to examine the necessity and impact of these changes on physician practices. While the response letter from Aetna stated that it would not be rescinding the policy, the insurer has responded to AMA/Federation concerns regarding the original unrealistic deadline for compliance. Aetna announced that it is extending the time that physicians have to comply from January 2013 to April 2013. The AMA and Federation will use this valuable time to educate physicians on the new policy and work with Aetna and the accrediting groups to ensure that physician have adequate time to comply with the requirements.