In Focus

AMA CALLS FOR CMS TO FIX MEANINGFUL USE PROGRAM

The American Medical Association (AMA) released a statement that it is appalled by news from the Centers for Medicare and Medicaid Services (CMS) that more than 50 percent of eligible professionals will face penalties under the Meaningful Use program in 2015, a number the AMA says is worse than anticipated.

The statement went on to read:

“The Meaningful Use program was intended to increase physician use of technology to help improve care and efficiency. Unfortunately, the strict set of one-size-fits-all requirements is failing physicians and their patients. They are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden.

“The AMA supported the original HITECH legislation and we have provided extensive and constructive feedback to the Administration to help fix the Meaningful Use program, but few changes have been made. In light of the dismal number of eligible professionals meeting Meaningful Use, we hope that the Administration will now move forward with the solutions we put forth in our Blueprint to make the program more successful and better enable physicians to provide quality care for their patients.”

“The penalties physicians are facing under the Meaningful Use program are part of a regulatory tsunami facing physicians, apart from the flawed Sustainable Growth Rate formula, that could include cuts from the Physician Quality Reporting System (PQRS), the Value-based Modifier Program (VBM) and the sequester, further destabilizing physician practices and creating a disincentive to see Medicare patients. According to the Administration, only half of eligible physicians participated in PQRS in 2013, meaning many will incur penalties from both the Meaningful Use and PQRS programs.

“The overlapping and often conflicting patchwork of laws and regulations must be fixed and aligned to ensure physicians are able to move to innovative payment and delivery models that could improve the quality of care.”

Responding to a coalition of medical societies, including the American Academy of Dermatology Association (AADA), the CMS announced its intent to modify the meaningful use requirements for electronic health records. The announcement from CMS came one week after the coalition called for a 90-day reporting period, which is now under consideration as CMS works on proposed regulation. The AADA said it recognizes a significant portion of dermatologists are solo and small-group practitioners and plans to seek member input as it develops a response to a proposal.

CLINICAL TIP

OPTING OUT OF MEDICARE

Frustrated with problems encountered with electronic health records (EHRs), many physicians have made the decision to opt out of using EHRs in their practices. Even those who participate in Medicare may conclude that the incentives for EHR use do not justify the challenges and expense of using electronic records.

Other physicians are going a step farther and opting out of Medicare altogether. The Association of American Physicians and Surgeons offers guidance on opting out and staying out of Medicare, including sample forms and patient contracts.

You can access the resources here:

http://www.aapsonline.org/index.php/article/opt_out_medicare/

The process is fairly straightforward, but current participating physicians need a bit of planning. Per the AAPS, “In the words of CMS, ‘Participating physicians and practitioners may opt out if they file an affidavit that meets the criteria and which is received by the carrier at least 30 days before the first day of the next calendar quarter showing an effective date of the first day in that quarter (i.e., January 1, April 1, July 1,October 1).' [From CMS Benefit Policy Manual (Rev. 147, 08-26-11) Sec. 40.17] Note that a participating physician must give his or her carrier 30-days' prior notice by sending in the opt-out affidavit with an effective date of the beginning of the next quarter.”

Keep in mind that you will need to maintain your “optout” status by re-filing an affidavit every two years.

DID YOU KNOW?

• Opted out physicians aren't bound by restrictions on certain self-referrals.
• Individuals within a group practice can opt out.

HHS SETS GOALS AND TIMELINE FOR SHIFTING MEDICARE REIMBURSEMENTS FROM VOLUME TO VALUE

In a meeting with leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell announced measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.

HHS has set a goal of tying 30 percent of traditional, or feefor- service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.

To make these goals scalable beyond Medicare, Secretary Burwell also announced the creation of a Health Care Payment Learning and Action Network. Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs. HHS will intensify its work with states and private payers to support adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare. The Network will hold its first meeting in March 2015, and more details will be announced in the near future.

Many health care providers today receive a payment for each individual service, such as a physician visit, surgery, or blood test, and it does not matter whether these services help – or harm – the patient. In other words, providers are paid based on the volume of care, rather than the value of care provided to patients. Today's announcement would continue the shift toward paying providers for what works – whether it is something as complex as preventing or treating disease, or something as straightforward as making sure a patient has time to ask questions.