In Focus: On the Ropes

CONCERN OVER SUNSHINE ACT

The American Society for Dermatologic Surgery Association (ASDSA) and the American Academy of Facial Plastic and Reconstructive Surgery have signed-on to a letter, along with the American Medical Association and several other national specialty organizations and state medical associations, requesting that the Center for Medicare and Medicaid Services' (CMS) exclude scientific peer-reviewed medical journal and textbook reprints from the Sunshine Act's reporting requirements.

According to the ASDSA November e-Advocacy News, the ASDSA believes “the regulations in this regard are contrary to both the statute and congressional intent and will potentially harm patient care by impeding ongoing efforts to improve the quality of care through timely medical education.”

The letter, which was sent to Secretary Kathleen Sebelius at the US Department of Health and Human Services states: “We are concerned that the final regulations could inadvertently prevent the timely distribution of rigorous scientifically reviewed medical information to clinicians and patients and thereby undermine efforts to improve the quality of care provided to patients.”

The letter points out that as part of the Sunshine Act, Congress outlined 12 specific exclusions from the reporting requirement, including “[e]ducational materials that directly benefit patients or are intended for patient use.” In its interpretation of the statute, CMS concluded that medical textbooks, reprints of peer-reviewed scientific clinical journal articles and abstracts of these articles do not directly benefit patients and are not for patient use.

The letter goes on to say, “We believe this conclusion is inconsistent with the statutory language on its face, congressional intent, and the reality of clinical practice where patients benefit directly from improved physician medical knowledge. The importance of up-to-date, peer-reviewed scientific medical information as the foundation for good medical care is well documented.

“Scientific peer-reviewed journal reprints, supplements, and medical text books have long been considered essential tools for clinicians to remain informed about the latest in medical practice and patient care. Independent, peer reviewed medical textbooks and journal article supplements and reprints represent the gold standard in evidence-based medical knowledge and provide a direct benefit to patients because better informed clinicians render better care to their patients.”

The full text of the letter is available at: http://bit. ly/1cOgHDg.

MEANINGFUL USE STAGE TWO UPDATE

The AMA recently applauded the Centers for Medicare & Medicaid Services' (CMS) decision to extend prep time for meaningful use stage two but urged the federal government to reconsider the pass/fail approach. In a statement Steven J. Stack, MD, Immediate Past Chair of the AMA, said, “The federal government's decision to extend Stage 2 of the Electronic Health Record (EHR) Meaningful Use program is a welcome reprieve that will provide physicians and vendors with an additional year to adequately prepare for Stage 3 of the Meaningful Use program. From the beginning, the AMA has urged the federal government to adjust the program's timelines to ensure a safe, orderly transition so electronic health records can be widely adopted and implemented throughout the health care system.”

Clinical Tip

EHRs and State Legislation: What You Need to Know Now

“While at the state level EHRs have historically not garnered very much legislative attention, last year the Massachusetts legislature passed a law mandating that all practitioners within the state be operational with an EHR. Failing to meet this standard could result in the state revoking a physician's license to practice,” writes Mark Kaufmann, MD, co-chair of the dermatology workgroup for CCHIT and member of the medical advisory board of Modernizing Medicine.

Dr. Kaufmann explains that the law states that as of January 1, 2015, all physicians in Massachusetts will need to demonstrate Meaningful Use of Electronic Health Records systems as a condition of licensure.

“It's fair to assume that 10 years from now, most physicians in the US will be using some form of EHR. The end game may indeed be better for everybody, but if the last decade is any indication, the nationwide implementation will continue to be rocky. The Massachusetts legislation, though seemingly a blip on the national healthcare radar, could represent a watershed moment in the regulatory narrative of Healthcare Information Technology.

“In terms of the specific law, at this point the hope is that before January 2015, a list of exclusions will be implemented that will exempt certain individuals from the law, such as physicians in solo or group practice who don't have any idea the law is even on the books. In the broader view, however, the quick passage of the law may prompt other state and possibly federal legislators to follow suit, which could spell trying times for physicians in the years ahead.”

Get the full story: http://bmctoday.net/practicaldermatology/2013/10/article.asp?f=state-ehr-legislation-a-new-precedent

He added that, “While the revised timeline for implementation is a positive step, we remain deeply concerned about the program's current pass/fail approach to demonstrating Meaningful Use. We continue to advocate strongly for greater flexibility in the participation requirements.”

In his statement, citing an October 2013 RAND Corporation study that the AMA commissioned, he explained that many doctors are not satisfied with EHRs because they interfere with a physician's ability to interact with patients face-to-face in a quality manner. “Physicians need well-designed systems that meet the Meaningful Use criteria and also help physicians as they move into new payment and care delivery models. We continue to urge the federal government to take these concerns into account when certifying systems,” he stated.

CMS 2014 MEDICARE PHYSICIAN FEE SCHEDULE RELEASED

The Centers for Medicare & Medicaid Services (CMS) announced that it finalized payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare. According to CMS, the care coordination policy is a milestone, and demonstrates Medicare's recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015. The final rule sets payment rates for physicians and non-physician practitioners paid under the Medicare Physician Fee Schedule for 2014 and addresses the policies included in the proposed rule issued in July. CMS projects that total payments under the fee schedule in 2014 will be approximately $87 billion.

According to CMS, the 2014 payment rates increase payments for many medical specialties with some of the greatest increases going to providers of mental health services including psychiatry, clinical psychologists, and clinical social workers.

CMS is finalizing a process to adjust payment rates for test codes on the Clinical Laboratory Fee Schedule (CLFS) based on technological changes. Currently, the payment rates for test codes on the CLFS do not change once they have been set (except for changes due to inflation and other statutory adjustments). This review process will enable CMS to pay more accurately for laboratory tests on the CLFS.

The final rule also includes several provisions regarding physician quality programs and the Physician Value-Based Payment Modifier (Value Modifier). As CMS continues to phase-in the Physician Value-Based Payment Modifier, for 2016 CMS is finalizing its proposals to apply the Physician Value Modifier to groups of physicians with 10 or more eligible professionals, and to apply upward and downward payment adjustments based on performance to groups of physicians with 100 or more eligible professionals. Only upward adjustments based on performance (not downward adjustments) will be applied to groups of physicians with between 10 and 99 eligible professionals.

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Why the AMA Says it's Time to Repeal the SGR

In this video, the AMA provides data on the impact of the SGR and the cost of repeal, stating that it's time for Congress to be fiscally responsible and pay the bill. “By acting now, Congress can preserve access to care for people on Medicare. And reduce Medicare spending by hundreds of billions of dollars,” the video states. “Each year over the past decade Medicare's physician payment formula the “SGR,” has called for increasingly steep cuts.”

The video explains that since 2002, Congress has stepped in to stop these cuts 12 times, including four times in the past year, comparing this to someone making minimum payments on a credit card bill and never really paying the bill. The result is larger cuts to physician payment formula every year, and annual increases for the cost of solving the problem. “It's gotten so bad that freezing payments will cost taxpayers nearly $300 billion over 10 years,” the AMA video explains. “If this keeps up, the cost of eliminating the Medicare payment formula will be a half trillion dollars in five years.”

See the whole video from the AMA at Modern Aesthetics TV Search Key: AMA

CMS reports that it is also finalizing several related proposals to the Physician Quality Reporting System (PQRS) for 2014, including a new option for individual eligible professionals to report quality measures through qualified clinical data registries. In 2014, quality measures will be aligned across quality reporting programs so that physicians and other eligible professionals may report a measure once to receive credit in all quality reporting programs in which that measure is used. Additionally, CMS is better aligning PQRS measures with the National Quality Strategy and meaningful use requirements, and transitioning away from process measures in favor of performance and outcome measures. Finally, certain data collected in 2012 for groups reporting certain PQRS measures under the Group Practice Reporting Option (GPRO) will be publicly reported on the CMS Physician Compare website in 2014.

The final rule is on display at the Federal Register and was published on December 10, 2013. More information about the final rule can be found at: http://www.ofr.gov/ inspection.aspx?AspxAutoDetectCookieSupport=1

According to the American Academy of Dermatology Association (AADA), overall, services provided by the dermatology specialty will see a two percent reduction in Medicare payments, although the impact of the fee schedule will vary significantly according to individual practice patterns and mix of services. The rule does not reflect that Congress has not yet addressed repealing and replacing the sustainable growth rate (SGR) formula used to calculate physician payment rates. In addition to changes to physician payment rates instituted by CMS through the physician fee schedule, physicians are facing an additional 24 percent across-the-board Medicare rate cut on Jan. 1, 2014, due to the flawed SGR formula. The Conversion Factor will then be reduced from $34.0230 in 2013 to $27.2006 in 2014.

The AADA said it is working with key legislators to repeal the flawed SGR formula and pave the way for reasonable, comprehensive payment reform that protects Medicare beneficiary access to physician services. To help with this effort, the AADA is calling on all members to log on to the AADA Dermatology Advocacy Network at http://www.aad-dan.com/register.aspx to submit a letter urging Congress to repeal the SGR before Jan. 1, 2014.