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Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
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ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
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Over the past year, ACP was successful in advancing significant policy reforms on behalf of internal medicine physicians, related subspecialists, and their patients.
These achievements were the result of considerable effort, not only on the part of ACP, but also in collaboration with other allied organizations and coalitions, in both the legislative and regulatory spheres.
Because of ACP advocacy, Medicare will now reimburse physicians for a series of new CPT codes in the areas of chronic care management, non-face-to-face prolonged services, behavior health integration and psychiatric care. This will enable physicians to bill Medicare for services that previously would not have been covered. In many instances, physicians have already been providing such services – in varying degrees – to their patients without being justly compensated so these new codes represent a big step forward in recognizing the time they devote to their patients.
ACP advocated with the Centers for Medicare and Medicaid Services (CMS) to authorize payment for certain services that were not being covered or even recognized by Medicare; in some cases these were services already being provided to patients by physicians and yet they still could not bill or be reimbursed for them. Because of ACP advocacy, CMS subsequently agreed to allow payment for the following new services and codes:
Because of ACP advocacy, federal judges blocked two separate health insurer mergers that would have resulted in decreased choice of health plans and increased costs for patients and employers; had the mergers been approved, the merged companies would have been able to impose narrow networks that would reduce patient access to physicians and hospitals and dictate contract terms to physicians, effectively preventing physicians from negotiating over provisions of health services with those insurers. The courts ruled against the mergers on the basis that they would result in a stifling of competition in the market and less consumer choice—as ACP argued. While subject to appeal, these rulings represent significant wins for consumers and employers alike and ACP applauded the decisions.
In 2016, ACP sent letters to the U.S. Department of Justice and aggressively advocated to oppose the mergers of Aetna and Humana and also Anthem and Cigna. On Jan. 23, 2017, a federal judge blocked Aetna’s merger with Humana after finding that the health insurers’ $37 billion deal would leave seniors with fewer and costlier options for private Medicare coverage. The merger risked irreparably harming competition within the Medicare Advantage market, and would hand Aetna and Humana a near monopoly across the nation, wrote U.S. District Court Judge John D. Bates in a verdict issued that day. A similar ruling came down from a federal judge on Feb. 8, 2017 blocking a proposed $54 billion deal for Anthem to acquire Cigna.
While ACP is committed to pushing for even more relief for physicians from unnecessary paperwork and documentation requirements, much progress was made in 2016 to reduce administrative burdens in the EHR Meaningful Use Program and in the reporting of chronic care management services, but also advancements to develop interoperability standards and the sharing of patient data, as permissible under law. Much of ACP’s advocacy on reducing administrative burdens on physicians has centered on health information technology (Health IT) and the myriad of federal regulatory and administrative requirements placed on physicians and others who must operate this technology. Electronic Health Records (EHRs) lack standards that are needed for systems to be able to talk to each other in a way that is meaningful. In many instances, physicians are required to input data into these records that have little to no clinical value. The costs associated with the systems that support EHRs can be exorbitant. And, there is a need for EHR developers and vendors to do more to improve the usability, functionality, and interoperability of their products. Physicians contend with these hassles on a daily basis but 2016 brought some marked improvements in this area.
Through a series of comment letters to CMS and to Congress, as well as direct person-to-person member advocacy through Leadership Day, ACP aggressively pushed for some much-needed improvements to EHR interoperability and usability and brought attention to some unanticipated administrative burdens associated with some CPT codes. ACP subsequently applauded actions taken by Congress through enacted legislation or CMS through the rulemaking process to reduce administrative burdens, including:
With the elimination of Medicare’s physician payment system, the Sustainable Growth Rate (SGR), in 2015 and its subsequent replacement to a new payment and delivery system under the Medicare Access and CHIP Reauthorization Act (MACRA), now the Quality Payment Program (QPP), physicians had to begin preparing in 2016 for major changes to their practice environments. The roll-out of MACRA and other CMS payment model initiatives in 2016 meant practices had to learn how to navigate under these new reforms, which will continue to unfold in years to come. Physicians had to reassess their practice environment, determine what payment structure best fit their needs, either under an alternative payment model (APM) or the Merit-based Incentive Payment System (MIPS). CMS also unveiled new, expanded initiatives that brought opportunity to practices, like through the Comprehensive Primary Care + Program, in which ACP actively urged its member practices in eligible states to participate. Unlike the days of the strict SGR payment formula where physicians only saw a one-sized fits all approach to payments that brought with it yearly threats of significant payment cuts, 2016 ushered in these new value-based payment systems that offer physicians and their practices more choice, control, and flexibility.
“Pick Your Pace”: As advocated by ACP, in October 2016, CMS finalized regulations implementing the QPP, and included some much-needed flexibility to practices in when they transition to QPP. “Pick your Pace,” as it is known, allows physicians to choose from among four options in which to transition to QPP based on what works best for them and their practices. As long as physicians choose one of the four options, they will be protected from negative adjustments in 2019 and even have the opportunity for positive adjustments.
Critical Improvements under the MIPS Pathway: Physicians will be able to choose between two payment pathways under the new Quality Payment Program (QPP), either the MIPS or APM pathway, depending on their practice structure. Most physicians will fall under MIPS during the first payment year, which begins in 2019 (based on performance in 2017). MIPS essentially streamlines existing Medicare quality programs including the Physician Quality Reporting Program (PQRS), the Value-Based Payment Modifier (VM), and the Medicare EHR Incentive Program (MU) into one program. Physician payments under MIPS will be based on a composite score using four weighted performance categories [Quality at 60% + Advancing Care Information/(i.e. EHRs) at 25% + Improvement Activities (i.e. clinical) at 15% + Cost (i.e. resource use) at 0]. Thanks to ACP advocacy, CMS incorporated into the final QPP regulations our recommendations to simplify and reduce burdens on physicians and their practices. These included:
The Comprehensive Primary Care Plus (CPC+) Model: In April 2016, CMS unveiled the CPC+, which is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ is a five-year model, to begin in January 2017, that includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options. Come 2017, it will support nearly 5,000 primary care practices in 20 regions, and serve millions of Medicare beneficiaries. ACP applauded the CPC+, and further advocated that CMS allow participating clinicians in the CPC+ to also participate in the Medicare Shared Savings Program (MSSP), which consists of groups of doctors and other health care providers who band together under Accountable Care Organizations (ACOs) and voluntarily work together with Medicare to improve the quality of care to Medicare Fee-for-Service beneficiaries and reduce unnecessary costs. Thanks to ACP advocacy, CMS agreed to allow dual participation by primary care practices in CPC+ and MSSP. In addition, new participants in CPC+ would be considered Advanced APMs for the 2018 performance period under QPP. And, since CPC+ participating practices must have enhanced capabilities such as those that promote access, care management, comprehensive care and care coordination, and patient engagement, this affords practices care management payments and performance incentives based on the enhanced care offered to patients.
Through a series of bipartisan bills, legislation was enacted to improve access to care, and treatment for those suffering from mental and behavioral health conditions, opioid addiction, and the Zika virus, a mosquito-borne virus that grew to epidemic proportions in 2016 and ravaged populations around the globe. Enacted legislation included vital funding for research, initiated and expanded grant programs for treatment for these afflictions, and increased awareness as to the enormous toll of these conditions on the nation’s public health. ACP’s advocacy included active engagement with Congress to advance these measures. Physicians continue to be on the front lines in caring for many patients who present with these afflictions. Thanks to much-needed reforms in 2016, their patients will see greater access to care and treatment for these conditions.
ACP actively engaged Congress, through letters, meetings, and coalition efforts to educate lawmakers about the growing need to address the opioid crisis, improve access to mental and behavioral health services (especially in the primary care setting), and fund research efforts to stem the spread of the Zika virus. This prompted congressional action and subsequent progress was made in addressing these issues through legislation that was enacted into law.
In 2011, the state of Florida passed a law that restricted physicians' ability to discuss firearm safety with patients. Under its provisions, doctors could be punished with a fine of up to $10,000, and could lose their medical licenses for discussing firearms with patients. That Florida law violated physicians’ First Amendment rights and directly contradicted ACP’s long-standing policy that seeks to protect the doctor-patient relationship. Shortly thereafter, a group of individual physicians and medical specialty societies, including ACP’s Florida chapter, joined together to file a lawsuit against the state of Florida challenging this law. Known as Wollschlaeger v. State of Florida, or the “docs vs. glocks” case, ACP’s Florida chapter joined the local chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and others in bringing this lawsuit against the state based on the contention that physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors, or disclosing information to the patient, which may affect their health, the health of their families, sexual partners, and others who may be in contact with the patient. After several years of on-going advocacy and battling this out in the lower courts, the ACP Florida chapter and its co-plaintiffs emerged victorious when a federal court overturned the Florida law on Feb. 16, 2017. The national ACP joined in amicus curiae (“friend of the court”) briefs supporting the plaintiff’s case along the way. This represents a big achievement for ACP and for physicians who can now freely discuss with their patients ways to prevent injuries and deaths, including those associated with having unsecured firearms in their home. Since 2011, 14 other states have considered legislation similar to Florida’s, but none of the proposals have passed.
The Feb. 16 ruling of the United States Circuit Court of Appeals for the 11th Circuit said that doctors could not be threatened with losing their licenses for asking patients if they owned guns and for discussing gun safety because to do so would violate their free speech. ACP strongly opposed Florida’s Firearms Owners Privacy Act and joined eight other medical specialty societies in signing an Amicus Brief urging the U.S. Court of Appeals for the 11th Circuit to uphold a lower court decision that ruled the law unconstitutional. The plaintiffs, including the Florida Chapter of the American College of Physicians, individual Florida doctors, the Florida Pediatric Society/Florida Chapter of the American Academy of Pediatrics, and the American Academy of Family Physicians, Florida Chapter, sued the state of Florida for its unconstitutional intrusion on physicians’ constitutional right to speak freely to patients about the risk of unsecured firearms in the home; the national ACP joined in an amicus brief to the court supporting the plaintiff’s case.
A June 17, 2014 article published in the Annals of Internal Medicine said, it is estimated that each year, firearms kill more than 33,000 people in the United States. These deaths include homicides, suicides, and unintentional fatalities. The number of non-fatal firearm injuries in the United States is more than twice the number of fatal firearm injuries, with 73,883 non-fatal firearm injuries documented in 2011. ACP has long recommended that physicians ask about gun ownership as a normal part of screening patients, including it on a long list of health questions about drug and alcohol use, smoking, exercise and eating habits. The College believes that constitutional issues addressed by the court decision are much bigger than guns. It affirms a basic constitutional principle that the government should not be allowed to tell physicians what they can and can’t discuss with their patients, consistent with evidence-based standards of care.