Excerpts from the May 2012 AMA Advocacy Update. For a pdf copy of the full report, click here. To view the most current national advocacy update, click here.
AMA Protects Physician Hospital Medical Staff
On October 24, 2011, CMS published a proposed rule to revise the Medicare Conditions of Participation (CoPs) for hospitals that included a number of troubling provisions. AMA strongly advocated to CMS senior staff that the provisions therein would have the effect of severely diluting the authority of hospital medical staffs and could threaten hospital patient safety and health.
As a direct result of AMA advocacy, the final rule—released this month—makes the following improvements:
- The proposed concept of a single medical staff for a multi-hospital system has been removed.
- The proposed concept of the privileging of physicians without appointment to the medical staff has been removed.
- A hospital’s governing body must now include at least one medical staff member.
- The proposed concept of credentialing for medical staff membership in accordance with “hospital policies and procedures” has been removed; the final rule defers to state law and “medical staff bylaws, rules, and regulations.”
- The mandatory inclusion of non-physician practitioners on medical staffs strongly proposed by several other groups (e.g., American Nurses Association, AARP) was not adopted.
House Passes Reconciliation Legislation
The House passed H.R. 5652, the “Sequester Replacement Reconciliation Act of 2012,” on May 10 by a vote of 218-199. This bill was a combination of the work of six House committees that were required by the FY 2013 Congressional Budget Resolution (H.Con.Res. 112) to produce legislation that would cut the federal deficit by a total of $261 billion over 10 years.
Of interest to physicians, the Judiciary Committee included in its portion of the bill the “Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act” (H.R. 5). The HEALTH Act, originally introduced by Rep. Phil Gingrey, MD (R-GA), contains a wide range of AMA-supported medical liability reforms, including a $250,000 cap on non-economic damages. The Ways and Means Committee achieved its required $53 billion savings in part by enhancing provisions to recapture overpayments of health insurance subsidies, which were created under the Affordable Care Act (ACA), and by repealing block grants to states for social services. The Energy and Commerce Committee met its $96.8 billion target in part by including medical liability reform provisions (that differ slightly from the Judiciary Committee approved language). The Energy and Commerce Committee also achieved savings through several changes to the ACA including repealing the prevention and public health fund, defunding the “Consumer Operated and Oriented Plan” (CO-OP) program, repealing the Medicaid maintenance of effort requirement for states, and repealing the direct appropriation for state exchange grant authority.
It is unlikely that the reconciliation measure will advance beyond the House. The Senate is not expected to consider a reconciliation bill because it is not expected to approve a budget resolution.
AMA Plus 100 State & Specialty Societies Comment on EHR MU Program
On May 7 the AMA together with 100 state and specialty societies submitted a comment letter to the CMS making several recommendations for how to improve the Electronic Health Record (EHR) Meaningful Use program in response to a proposed rule on Stage 2. Included among these recommendations the comments championed the need for a robust evaluation of Stage 1, avoiding high reporting measure thresholds, removing any measures that are outside a physician’s control, only requiring measures that are relevant to a physician’s practice, streamlining the number of requirements, including adequate exclusions, and reporting on six clinically relevant quality measures covering at least two domains. The comments also advocated for removing any “back-dating” of penalties and the overall need for greater synchronization among all Medicare reporting programs.
The AMA also submitted a comment letter the same day to the Office of the National Coordinator for Health IT (ONC) in response to a proposed rule on the standards vendors must meet for providing certified EHRs to physicians. The AMA continues to advocate strongly for a greater focus on EHR usability and patient safety issues.
Medicare Now Accepts Physician Enrollment Applications 60 Days in Advance
For years the AMA has been pushing CMS to expand the time frame physicians have to submit their enrollment application. Until recently physicians were only permitted to send their application to their Medicare contractor 30 days in advance of the “effective date” which is the later of: 1) the date a physician filed an application that is ultimately approved by Medicare; or 2) the date a physician began furnishing services at a new practice location. Under new guidelines CMS has extended this date to 60 days, with some exceptions. The change is effective May 14.
AMA Tackles Physician Concerns with UnitedHealth Group
The AMA Practice Management Federation Staff Advisory Steering Committee (Committee) and Federation workgroups held their annual in-person meeting on May 3, 2012. The goal of this meeting is to: 1) discuss how to best address national payer trends; and 2) develop a plan of action to address practice management issues within the physician practice. The Committee and Federation workgroups also held their annual meeting with UnitedHealth Group (UHG) on May 4, 2012, to address current issues physician members have with UHG. Since these meetings began in 2007, 55 issues have been resolved and the groups have collaborated on 48 issues that have seen improvement. This year’s meetings were held at the AMA headquarters in Chicago and were attended by 25 Federation staff members representing 14 state medical associations, one county medical association and six national specialty societies, along with 18 representatives from UHG. Future efforts between the AMA, Committee, Federation workgroups and UHG will focus on developing action plans for collaborative ways to contain rising U.S. health care costs and to educate physicians on delivery system innovations.