Read the Latest Issue of STATLINE
June 9, 2015
In This Issue:
- Pathologists Advocate for Changes to Modernized AMA Ethical Code
- CMS Adopts New Medicare Shared Savings Rule Creating Track 3 Option for ACOs
- Register for the CAP's Proposed Medicare Physician Fee Schedule Webinar
- Pathologists Granted Automatic Exemption to EHR Penalty
- View Pictures and Tweets from Pathologists on Capitol Hill
Pathologists Advocate for Changes to Modernized AMA Ethical Code
The CAP and pathologists called for more changes to strengthen the modernized American Medical Association (AMA) Code of Medical Ethics during the 2015 AMA Annual Meeting in Chicago.
Pathologists engaged with physician leaders on proposed revisions to the Code of Medical Ethics and represented the specialty on a variety of issues. The CAP delegation discussed important key issues with candidates for AMA leadership positions and provided testimony on resolutions debated by the AMA House of Delegates during the meeting.
The College encourages members to strengthen pathology's voice at the AMA by becoming a member of the association. The size of the CAP's delegation at the AMA is representative of the number of CAP members who are also AMA members. View the AMA'S website for more information about becoming a member.
CAP member William Valentine Harrer, MD, FCAP, testified that the College still had concerns with the latest version of the AMA Code of Medical Ethics. The CAP and the Pathology Section Council engaged with the AMA Council on Ethical and Judicial Affairs (CEJA), which is tasked with modernizing the code.
Earlier drafts would have negatively impacted pathologists and the medical profession, and the CAP worked to change those provisions. However, more changes are needed to several sections that involve consultation, referral, and second opinions; fees for medical services; and fees for nonclinical and administrative services.
Dr. Harrer urged the CEJA to include the CAP's comments in the modernized code. Other physicians recommended that the code was not ready to be finalized. Further discussion and deliberation on the code of ethics will continue at the AMA Interim Meeting in November.
AMA delegates considered new action regarding physician self-referral that would have directed the AMA to aggressively preserve the in-office ancillary services (IOAS) exception to the Stark Law. The CAP had opposed a resolution. It was ultimately decided to reaffirm the AMA's existing policy instead of adding new advocacy directives.
PAMA Problematic for Pathologists, Laboratories
From the Pathology Section Council, CAP member Daniel Zedek, MD, FCAP, provided testimony during the AMA meeting on troublesome policies in the Protecting Access to Medicare Act of 2014 (PAMA).The law includes flaws in the Medicare Local Coverage Determination (LCD) process and the expansion of the misvalued code initiative.
Dr. Zedek urged the AMA to undertake advocacy to strengthen transparency and appeal process on LCDs. Medicare Administrative Contractors (MACs) who develop LCDs should be required to:
- Conduct open Carrier Advisory Committee meetings whenever a MAC proposes to limit or preclude coverage of services to Medicare patients.
- Require MACs to include the rationale and all evidence considered not only in a final LCD, but also at the outset of the process when a draft LCD is released.
- Strengthen the appeal rights of MAC decisions so that MAC decisions can be overruled when not supported by the medical evidence.
- Prohibit regional MACs from simply rubberstamping LCDs adopted by other regional MACs to prevent the LCD process from being used to establish National Coverage Determinations.
PAMA also expanded existing criteria for examining Medicare physician fee schedule codes as misvalued. Through the Centers for Medicare & Medicaid Services' (CMS) new authority, the CMS has stated that hospital cost data could be useful to supplement the resource cost information developed under the current methodology and is a valid reflection of the costs of providing care. However, hospital cost data does not accurately reflect the practice costs of providing physician services and should not be used to place a cap on physician payment, Dr. Zedek said.
Further, PAMA gave the CMS the broad and unlimited authority to collect an unrestricted amount of practice cost information for furnishing services on the physician fee schedule, including time, overhead and physician accounting details. This authority compromises the role of the AMA and specialty societies to identify and provide recommendations on misvalued physician services.
Reduce EHR Reporting Burden and Confusion
The House of Delegates considered a resolution that would direct the AMA to engage with the CMS, electronic health record (EHR) developers, commercial payers, and other stakeholders to develop common definitions, metrics, and formatting for the reporting of quality performance outcomes. The CAP advocated that these standards be applicable to all specialties.
"We do not have an issue with the AMA Pay-for-Performance Principles and Guidelines. However, our experience is that when stakeholders try to develop unified definitions, metrics, standard fields and formatting for reporting quality performance and outcomes data, they are usually focused on primary care and rarely work for diagnostic specialties," Dr. Zedek said. "The modification proposed is our attempt to be pro-active instead of trying to make changes to standards, definitions and metrics after they have been developed."
AMA CEO: United Voice Will Improve Nation's Health
The AMA urged doctors to craft a "culture of innovation and collaboration" across all aspects of health care to propel physicians to continue shaping the future of medicine.
"When we work together as a profession, we can accomplish incredible things. The SGR win is proof of the importance and of the effectiveness of aligning our efforts and aligning our voices," said AMA Executive Vice President and CEO James L. Madara, MD, in his address Saturday at the 2015 AMA Annual Meeting. "Dealing with change, one has to have the mentality of a marathon runner—quick out of the gate, measured in approach."
Partnerships to create these new approaches for health care include:
- A new multi-year partnership with the Centers for Disease Control and Prevention: Prevent Diabetes STAT: Screen, Test, Act—Today™, which will develop tools to help physicians across different specialties and practices treat patients with diabetes.
- A technology hub dedicated to improving professional satisfaction and practice sustainability through research, data and analytics.
- The Accelerating Change in Medical Education initiative, which has awarded 11 medical schools each $1 million grants to develop innovative changes in medical education
CMS Adopts New Medicare Shared Savings Rule Creating Track 3 Option for ACOs
As the Medicare Shared Savings Program (MSSP) continues to expand, a new track created by the CMS will give Medicare accountable care organizations (ACOs) the opportunity to seek higher rates of shared savings and utilize new care coordination tools.
The changes in the final MSSP rule released June 4 update a 2011 regulation that launched the program. The College monitors the ACO program and continues to keep members apprised of the impact of new developments on pathologists. The CAP members who work in a facility that is currently—or will be—part of an ACO are encouraged to join the CAP ACO network. For more information, or if you have a question about ACOs, please email us.
The CMS had proposed the MSSP regulation in December 2014 and the CAP provided a comprehensive analysis of the regulation for its members. According to the CMS, the final rule will improve the overall program. The regulation:
- Creates a new Track 3, a two-sided risk model which includes higher rates of shared savings in exchange for taking on financial risk for losses, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools
- Allows ACOs in Track 1, the one-sided model to continue in that model for a second 3 year term
- Refines and changes the methodology under which beneficiaries are attributed to their ACO
- Streamlines the data sharing between the CMS and ACOs to help physicians and hospitals access data on their patients in a secure way for quality improvement and care coordination
- Establishes a waiver of the three-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3
- Refines the policies for resetting ACO benchmarks so groups maintain incentives to improve patient care and generate cost savings, while the CMS promises further improvements to the benchmarking methodology later in 2015.
Currently, more than 400 ACOs are participating in the MSSP that serves over 7 million Medicare beneficiaries. The CMS estimates that at least 90% of the existing MSSP ACOs will renew their participation under the new rule.
Register for the CAP's Proposed Medicare Physician Fee Schedule Webinar
Sign up for the College's July 8 webinar "Understanding the 2016 Medicare Physician Fee Schedule Proposed Rule." Throughout this hour-long panel discussion, CAP experts will explain the changes proposed by the CMS regarding the 2016 fee schedule. The proposed fee schedule is expected to be published in late June or early July.
The proposed fee schedule will contain reimbursement changes affecting pathologists. During this session, attendees will learn about the proposed rule's pathology-related policies, the potential impact on pathologists, and the CAP's advocacy efforts to impact CMS' proposal prior to its finalization.
Pathologists Granted Automatic Exemption to EHR Penalty
Pathologists will receive an automatic exemption from the 2016 Medicare electronic health record (EHR) penalty and will not be required to file a formal application, the Centers for Medicare & Medicaid Services (CMS) stated in instructions to physicians.
Working with Congress and the Medicare agency, the CAP has secured for pathologists full relief from Medicare penalties under the EHR meaningful use program in 2015 and 2016. Pathologists classified in Medicare's enrollment system as under the specialty "Pathology (22)" will be granted an automatic exemption from the 2016 payment adjustment, the CMS said.
The CME has detailed instructions for those eligible for the hardship exemption. Physicians without an automatic exemption but qualify for a hardship must file an application by July 1. Since pathologists receive an automatic exemption, they do not need to file the application.
In 2014, more than 100 federal lawmakers had urged the CMS to grant pathologists full relief from Medicare penalties under the program requiring physicians to demonstrate meaningful use of an EHR. The CAP facilitated meetings between pathologists and their representatives and senators, and encouraged them to sign on to letters to the agency. Many of the meaningful use program's requirements and measurements do not fit or apply to a pathologist's scope of practice. Achieving meaningful use standards is very difficult, or impossible, for most pathologists.
View Pictures and Tweets from Pathologists on Capitol Hill
The 2015 Policy Meeting May 4-6 brought together pathology leaders from across the country to advocate with their members of Congress on regulatory issues that affect pathologists and patients.
During the Policy Meeting, attendees participated in sessions focused on learning how to use social media to engage with—and communicate pathologists' advocacy issues—to policy influencers and elected officials. The Policy Meeting culminated with the CAP's Annual Hill Day on May 6. Members met with their members in Congress and staff to advocate on issues affecting how pathologists deliver diagnostic medical care. For some members, this meant meeting their representative or senator for the first time; for others, Hill Day was a chance to reconnect and engage with their elected officials. And, many captured these meetings on Twitter and other social media platforms.
View the social media recap of the CAP Policy Meeting on Storify.