While there was much uncertainty amid efforts to reform some of the more troublesome regulations and reduce their impacts on patient and provider alike, some good news has finally emerged. The AMA and their various partners among many states have worked to reach consensus among the various industry advocacy groups and organizations among a number of areas needing reform: drug prices, improved EHR usability, insurance abuse and other critical issues. Overall, over 85 victories were won in areas as diverse as reducing gun violence, securing a greater degree of regulatory relief and improving physician reimbursement, according to AMA President, Barbara L. McAneny, MD.
Below are eight major areas where we’ve made some major gains, while targeting new challenges, including the way home health care providers could be reimbursed – or not. Below are eight examples of how physician advocacy has again worked to bring about desired and positive results.
1. Reducing the incidence of gun violence
Much of the credit for the recent federal ban on bump stocks and one of the biggest wins of the past year belongs to AMA’s partners/ advocates, including AFFIRM, a group led by physicians committed to researching and recommending action on gun violence. Going forward, the AMA intends to continue to state and federal policymakers not only fund research into preventing gun violence but to strengthen and implement various pro-active measures, such as background checks, including mental health screenings, that could prevent injuries and death from firearms.
2. Stopping the opioid epidemic
Improving access to medication-assisted treatment (MAT) coverage for opioid use and abuse disorders in Pennsylvania was another key win for mental health advocacy groups. Prior authorization for MAT in Pennsylvania will now be eliminated, with more funding allocated for multidisciplinary pain-relief care and other treatments for this and other substance-abuse disorders. Increased enforcement of substance-use disorder and mental health parity laws will also continue to be advocated.
3. Improving access to healthcare, especially for children
Perhaps one of the most significant wins for 2018 was the push to secure funding for the Children’s Health Insurance Program (“CHIP”) for 10 more years and expand Medicaid in four more states. What’s ahead: health advocates plan continued promotion of Medicaid expansion while advocating for policies that will help stabilize the health insurance market and make coverage more widely available.
4. Drug price transparency and industry competition
A key win for 2018 was the enacting of federal legislation as well as state bills that prohibit “gag” clauses and allow pharmacists to share lower-cost choices with patients.
This is intended to help foster healthy competition among manufacturers, with wider availability and pricing for consumers. Looking ahead, in 2019 the TruthinRX.org campaign will heighten awareness and support among more grassroots organizations to pursue drug-pricing legislation that meets AMA’s advocacy objectives.
5. Fighting insurance fraud and abuse
Among last year’s top priorities for the AMA was taking on fraud and abuse among insurers, particularly activities directed toward the more vulnerable segments of society, including the chronically-ill, elderly and lower-income. Anthem, one of the nation’s largest insurers and guilty of policies which put patients and providers’ incomes at risk, was one of the biggest targets.
The AMA and its partners convinced Anthem to drop their planned modifier 25 policy which would have resulted in more than $100 million reductions in physician reimbursement. In addition, advocacy groups, including the AMA, have opposed Anthem’s efforts to retroactively deny emergency department care coverage.
Moving forward into 2019, AMA other advocacy groups will continue to monitor and tackle insurance abuse whenever it surfaces.
6. Putting the brakes on prior authorizations
Hand in hand with insurance abuse is the bane of most practices – that of pre-authorization. A key win for the AMA was the creation of a consensus statement intended to “right size: prior authorization, and which was agreed to by multiple stakeholders within the industry. Also launched was the AMA’s new website “FixPriorAuth.org” as part of a new grassroots advocacy program.
Goals for the rest of 2019 include working to reduce the overall volume of pre-authorization requirements as well as the number of physicians and other providers subject to those requirements.
7. Improvements to physician payment from Medicare
Not surprisingly, some of the biggest wins went to providers, starting with the prevention of the E/M code changes that were proposed earlier by the CMS and other organizations (and which we previously covered in depth). Another major win was the securing of multiple changes in improving Medicare physician payment policies, such as the Quality Payment Program (QPP).
Moving into 2019 will see the AMA and others continue to be advocates with the CMS and Congress for continuing improvements, especially to the QPP.
8. Regulatory relief is on the horizon
With the elimination by Congress of the requirement of increased stringency of the federal electronic health record program, the AMA continues working for streamlining and simplifying the numerous regulations imposed on physicians and other providers and facilities.
And one not so win...
Home health care providers may be in trouble
There has been a downside to some of the cry for budgetary reforms, however, as new troubles have surfaced for those home health care providers: the Medicare Payment Advisory Commission (MedPAC) has proposed cutbacks in providers’reimbursement that would see rates cut by as much as five percent. If enacted, the Partnership for Quality Home Healthcare, a coalition made of hospital and community-based home healthcare agencies warns of the potential negative effects on our most vulnerable of populations: our elderly, chronically ill and disabled citizens. With the shift form hospital-based to home-based care trending, this could hurt seniors’ access to home healthcare.
To keep up with the changes ahead, whether in home healthcare or other specialties, it is more important than ever to partner with a trusted billing and practice management service. M-Scribe has been helping practices of all sizes with revenue cycle management as well as many additional services since 2002. To learn more, contact us at 888-727-4234 or by email for a free analysis of your practice’s needs and goals.