CMA physicians travel to D.C. to advocate on critical health care issues A California Medical Association (CMA) contingent of two dozen physician and medical student leaders recently traveled to Washington, D.C., to participate in the American Medical Association’s (AMA) National Advocacy Week. They met with 24 members of the California Congressional Delegation and top leadership of the Centers for Medicare and Medicaid Services (CMS) to advocate for many health care issues critically important to California physicians. While in Washington, California physicians focused on promoting the bipartisan Affordable Care Act (ACA) market stabilization bill that would reinstate the cost-sharing reduction payments and provide reinsurance funding, which together would reduce premiums by an estimated 20 percent. They also advocated for an immediate and permanent solution for the Deferred Action for Childhood Arrivals “Dreamers,” many of whom are medical students. They also insisted that the federal government needs to hold electronic health record (EHR) vendors accountable for interoperability. CMA physicians aggressively pushed Congress and CMS to provide more Medicare and Medicaid regulatory relief and expressed our significant frustrations with the 0.25 percent Medicare payment cut slated for 2019. Although the cuts initially proposed were much worse, the 0.25 percent cut will reduce by half the 0.5 percent payment update guaranteed to doctors in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMA warned Congress that physicians could not meet the difficult MACRA quality and EHR reporting requirements without adequate resources. CMA is urging Congress to restore the 2016 and forthcoming 2019 Medicare payment cuts, and to fund payment increases going forward. Much of the trip was dedicated to educating Congress and CMS about opioids. Congressional leaders are working on a comprehensive package to address the opioid crisis through prevention, treatment and law enforcement efforts. CMA physicians also met with the CMS Medicare Part D team to express serious concerns with the proposed regulations limiting initial opioid prescriptions to three days for acute pain. CMA thanks these physicians and medical students for taking the time away from their busy practices to travel to Washington, D.C., to meet with Members of Congress and CMS on some very important issues. April 5, 2018 CMA, General AMA, American Medical Association, Federal Legislative Advocacy 0 0 Comment Read More »
Patient outcomes shortchanged by prior authorization More than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey by the American Medical Association (AMA). The survey results further bolster a growing recognition across the entire health sector that prior authorization programs must be reformed. According to the AMA survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers—and nearly a third (30 percent) said they wait three business days or longer. “Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment,” said AMA Chair-elect Jack Resneck Jr., M.D., a dermatologist and health policy expert from the San Francisco Bay Area. “In practice, insurers eventually authorize most requests, but the process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care. In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden.” High wait times for preauthorized medical care have consequences for patients. More than nine in 10 physicians (92 percent) said that the prior authorization process delays patient access to necessary care; and nearly four in five physicians (78 percent) report that prior authorization can sometimes, often or always lead to patients abandoning a recommended course of treatment. In addition, a significant majority of physicians (84 percent) said the burdens associated with prior authorization were high or extremely high, and a vast majority of physicians (86 percent) believe burdens associated with prior authorization have increased during the past five years. The survey findings show that every week a medical practice completes an average of 29.1 prior authorization requirements per physician, which takes an average of 14.6 hours to process—the equivalent of nearly two business days. To keep up with the administrative burden, about a third of physicians (34 percent) rely on staff members who work exclusively on the data entry and other manual tasks associated with prior authorization. “The AMA survey illustrates a critical need to help patients have access to safe, timely, and affordable care, while reducing administrative burdens that take resources away from patient care,” said Dr. Resneck. “In response, the AMA has taken a leading role in convening organizations representing, pharmacists, medical groups, hospitals, and health insurers to take positive collaborative steps aimed at improving prior authorization processes for patients’ medical treatments.” In January 2017, the AMA with 16 other associations urged an industry-wide reassessment of prior authorization programs to align with a newly created set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other health care organizations have supported those principles. In January 2018, the AMA joined the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association in a Consensus Statement outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care. Please visit the AMA website to learn more about the organization’s ongoing efforts on prior authorization reform. April 5, 2018 Managed Care American Medical Association, Managed Care 0 0 Comment Read More »
Call for nominations: California Delegation to the AMA The California Medical Association (CMA) is seeking nominations for physicians to serve as at-large delegates and alternates to the American Medical Association (AMA) House of Delegates. Current delegates who are eligible for reappointment must submit an application for the 2018 term. They will not be reappointed if a form is not submitted. We are seeking physicians who are active CMA members and able to serve as delegates or alternates twice a year during the annual (June) and interim (November) meetings of the AMA House of Delegates for a two-year term beginning January 1, 2018. Service on the delegation entails both a commitment of time and a commitment to advocate for CMA’s interests, as well as a willingness to meet the basic responsibilities of the role set forth by AMA in its “Delegate Role and Responsibilities.” Please submit nominations to nominations@cmanet.org. Please indicate that the nomination is for the California Delegation to the AMA in the subject line. Every nomination must include: Completed nomination form Brief CV (less than five pages) Nominations must be submitted no later than 11:59 p.m. on Friday, February 23, 2018. The CMA Committee on Nominations will present its recommendations to the CMA Board of Trustees at its meeting on April 27, 2018, and appointments will be announced shortly thereafter. Contact: Brandon Marchy, (916) 551-2062 or bmarchy@cmanet.org. January 30, 2018 CMA, General AMA, American Medical Association, CMA Nominations 0 0 Comment Read More »
AMA urges quick action to stabilize individual insurance market With the window quickly closing to properly price individual insurance products for 2018, the American Medical Association (AMA) is urging President Trump and Congressional leaders to commit to continued funding for the cost-sharing reductions that are critical to stabilizing the individual market. AMA, along with other groups representing insurers, hospitals, health plan purchasers and physicians, sent a letter urging quick action to deliver short-term stability and affordable coverage while broader marketplace stabilization efforts are developed. Nearly 60 percent of all individuals who purchase coverage via the exchange receive financial assistance to make health care affordable. These subsidies reduce out-of-pocket costs for patients who might otherwise be unable to afford health care services despite being insured. The funding helps those who need it the most access quality care: low- and middle-income consumers earning less than 250 percent of the federal poverty level. If the cost-sharing subsidies are not funded, Americans will be dramatically impacted: Choices for consumers will be more limited, leaving individuals with fewer coverage options. Premiums for 2018 and beyond will go up by at least 15 percent, both on and off the exchange. Higher premium rates could drive out of the market those middle-income individuals who are not eligible for tax credits. If more people are uninsured, providers will experience more uncompensated care, which will further strain their ability to meet the needs of their communities and will raise costs for everyone, including employers who sponsor group health plans for their employees. Hardworking taxpayers will pay more, as premiums grow and tax credits for low-income families increase. The California Medical Association shares the sentiments of the letter and looks forward to working with Congress and the Trump Administration to take positive actions to stabilize the health care marketplace. April 19, 2017 General, Managed Care ACA, Affordable Care Act, AMA, American Medical Association, Health Insurance Exchange, Insurance 0 0 Comment Read More »
California medical students elected to AMA offices Two California Medical Association (CMA) medical students were elected to American Medical Association (AMA) offices at the interim meeting held in November in Florida. Karthik Sarma, an M.D./Ph.D. student at the David Geffen School of Medicine at UCLA was elected to the AMA Board of Trustees as the AMA Medical Student Section (MSS) representative. Helene Nepomuceno, a second-year medical student at the University of California, Irvine School of Medicine, was named chair-elect of the AMA MSS. Sarma has been a member of the California delegation to the AMA for the past five years. He is a leader in the fields of health information technology, medical education and payment reform. Sarma has provided compelling testimony on numerous occasions before the CMA House of Delegates and has been an excellent representative for the medical students. He has also been very active in medical student leadership at the AMA, starting with his service on the AMA-MSS Committee on Legislation and Advocacy. Talking about his role and the recent presidential election, Sarma says it is a good time for medical students to get involved in organized medicine. “I think it is essential for students to get involved with organized medicine because the decisions that are being made at the state and federal levels right now will have an enormous impact on the health care system that we will soon be practicing in as physicians," he said. "By making our voices heard, we can help bring about the type of changes that will result in a better system for our patients and our profession." Sarma has been the driving force in the AMA-MSS for broader consideration of health information technology issues. He led a successful campaign for the establishment of an AMA-MSS Health Information Technology Task Force and served as that group’s inaugural chair from 2014 to 2015. Since then, the task force has been formally adopted by the AMA-MSS as the Committee on Health Information Technology. This past year, Sarma was appointed as the medical student member of the AMA Council on Medical Service, where he has used his experience to help write reports on diverse issues including pharmaceutical pricing, inmate health care and mobile medical apps. Sarma's term on the AMA Board of Trustees will begin next June. Nepomuceno has been an invaluable asset to CMA, lending her policy analysis and communication skills to the CMA House of Delegates and as a member of CMA's Committee on Membership, Finance and Governance. She has served as an alternate delegate to AMA for the past year. Her distinctive personal attributes include sensitivity to the needs of her peers and an ability to serve as a bridge between leaders and the greater community. She has demonstrated a dedication to fairness, inclusion and teamwork that sets her apart as the kind of leader who lifts others up. Through devoted and persistent outreach and engagement of her fellow students, Nepomuceno and her peers have built the UC Irvine medical student chapter of CMA into one of the strongest and most active chapters in the state. Nepomuceno said she is coming to her new role in organized medicine focused on how medical students can advocate for their patients and the profession of medicine on the political stage. “Organized medicine has allowed me to participate in something much larger than myself or my immediate community. I believe emphatically that advocacy is an important component of any plan to change the world, and that the physician is the ultimate patient advocate," said Nepomuceno. "Physicians have the privilege of caring for people at their most vulnerable, and it is imperative that physicians continue to protect our patients’ interests by shaping our evolving health care system. There has perhaps never been a more important moment for advocacy, political action and engagement. When it sometimes feels like one voice is too small, together, our collective voices are powerful.” December 13, 2016 General American Medical Association, Medical Students, Physician Leadership 0 0 Comment Read More »
AMA delegates affirm commitment to health insurance coverage for all Americans At the interim meeting of the American Medical Association (AMA) House of Delegates this weekend in Florida, delegates from the California Medical Association and more than 170 state and specialty medical societies from across the country affirmed their commitment to health insurance coverage for all Americans. “Using a comprehensive policy framework that has been refined over the past two decades, AMA will actively engage the incoming Trump Administration and Congress in discussions on the future direction of health care," said Andrew W. Gurman, M.D., AMA president. "AMA remains committed to improving health insurance coverage so that patients receive timely, high-quality care, preventive services, medications and other necessary treatments." AMA has long advocated for health insurance coverage for all Americans, as well as pluralism, freedom of choice, freedom of practice and universal access for patients. The same core principles and priorities will guide future AMA advocacy efforts regarding the Affordable Care Act. Click here to read the AMA Vision on Health Reform. November 21, 2016 General American Medical Association, Health Care Reform 0 0 Comment Read More »
AMA introduces new MACRA payment model evaluator The American Medical Association (AMA) has introduced a new online tool to help physicians evaluate the various new Medicare payment models and improve their opportunities for success under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will go into effect in 2017. The AMA Payment Model Evaluator is a free interactive tool offering initial assessments to help physicians determine how their practices will be impacted by MACRA. Once physicians or medical practice administrators fill out the online questionnaire, they will receive guidance on participating in the MACRA payment model that is best for them. They will also receive relevant educational and actionable resources. To help physicians understand the MACRA payment reforms, and what they can do now to start preparing for the transition, the California Medical Association (CMA) has created a MACRA resource center. There you will find an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, AMA and the Centers for Medicare and Medicaid Services. View the CMA resource center at www.cmanet.org/macra. October 14, 2016 Medicare American Medical Association, AMA, MACRA, Medicare 0 0 Comment Read More »
AMA to award $50k for best ideas to create a healthier nation Do you have an idea that could help shape 21st century medicine? The American Medical Association (AMA) is helping physicians and medical students bring their cutting-edge health care ideas to reality with the launch of the AMA Healthier Nation Innovation Challenge. “New ideas for better care emerge every day from physicians and medical students on the front lines of medicine,” said AMA President Steven J. Stack, M.D. “AMA wants to support these health care innovators and help them succeed in moving their new ideas from the concept phase into day-to-day practice.” AMA invites all U.S. physicians, residents and medical students to enter the AMA Healthier Nation Innovation Challenge with their best ideas to improve the health of the nation by May 16. Prizes will be awarded for the best solutions that emerge from three categories: Making technology work for learning: What innovation would help transform physician education? Advancing digital health: What innovation would help patients live longer, healthier lives? Evolving digital medicine: What innovation would help physicians improve their practice? Proposed solutions will appear online where physicians, residents, medical students, nurses, patients, hospital staff, health leaders and investors can review and provide feedback on the ideas. Five solutions that receive strong validation from site visitors will compete for the top prizes in front of a live audience and a panel of judges at the AMA Healthier Nation Innovation event in Chicago on June 11. “Through its ongoing work, AMA is providing opportunities for physicians to engage in innovation and share their ideas, expertise and real-world perspective on the effectiveness of technology in medical practice settings,” said Dr. Stack. “From solutions for revitalizing medical practices to new ideas for providing high-quality care through digital health, AMA is striving to ensure physician-led innovation is a key driver in making the health system work better for everyone.” To learn more about the AMA Healthier Nation Innovation Challenge, visit www.innovatewithama.com. April 22, 2016 General Health Care Innovations, American Medical Association 0 0 Comment Read More »
AMA publishes online Zika resource center for physicians On Monday, the World Health Organization (WHO) declared an international public health emergency as the spread of the Zika virus has moved into more than 20 countries in Latin America. This rare move by the WHO signals the seriousness of the outbreak and gives countries powerful new tools to fight it. The WHO is concerned about a possible link between Zika virus and microcephaly, a condition that causes babies to be born with brain damage and unusually small heads. Reported cases of microcephaly have risen sharply in Brazil, where Zika is raging, rising from 150 reported cases of microcephaly in 2014 to 4,180 cases in 2016. Researchers have yet to establish a direct link. To keep physicians up-to-date on this growing concern, the American Medical Association (AMA) has created an online Zika Virus Resource Center as a clearinghouse for timely, credible information from WHO, the Centers for Disease Control and Prevention, the Journal of the American Medical Association and other respected sources of health information. Providers can visit the AMA's Zika Resource Center at www.ama-assn.org/go/zika. Currently available resources include: Education for physicians about the risks and symptoms of the Zika virus How providers can detect the Zika virus Treatment of symptoms and effects of the virus Continuous updating of information about the infection, with maps of Zika-infected areas Tools for communicating clearly and factually with patients, their families, and the media about exposure risks and potential preventive measures, particularly as new evidence becomes available February 3, 2016 General Maternal and Child Health, Public Health, American Medical Association, WHO, Zika Virus 0 0 Comment Read More »
AMA publishes guide to physician-focused alternative payment models The legislation that repealed the Medicare sustainable growth rate—the Medicare Access and CHIP Reauthorization Act (MACRA)—created major new opportunities to advance alternative payment models (APM). Starting in 2019, MACRA will provide a 5 percent annual bonus payment to physicians who participate in APMs and it exempts them from participating in the fee-for-service meaningful use and quality reporting programs (MACRA's Merit-Based Incentive Payment System). In addition to accountable care organizations, medical homes and bundled payments for hospital-based episodes, MACRA also provides for the development of “physician-focused” APMs. The American Medical Association (AMA) worked with Harold Miller at the Center for Healthcare Quality and Payment Reform to develop a “Guide to Physician-Focused Alternative Payment Models,” which describes seven different APMs that can help physicians in every specialty redesign the way they deliver care in order to improve patient care, manage health care spending and qualify for APM annual bonus payments. The seven APMs include: Payment for a High-Value Service Condition-Based Payment for Physician Services Multi-Physician Bundled Payment Physician-Facility Procedure Bundle Warrantied Payment for Physician Services Episode Payment for a Procedure Condition-Based Payment The seven APMs described in the guide have been designed to be able to meet the MACRA eligibility criteria for APMs; however, this will require validation from the Centers for Medicare and Medicaid Services in the future rulemaking process. Under each APM, physicians would take accountability for specific aspects of spending and quality they can control or influence. Physicians will be required to accept some downside financial risk. However, unlike many APMs that have been implemented to date, the physician-focused APMs would not place physicians at financial risk for costs they cannot control. Importantly, each of the APMs in this report would give participating physicians the resources and flexibility they need to redesign care systems so they can successfully improve care and manage spending for the particular patients, conditions and episodes for which they would be accountable. In addition to describing the APM designs, the guide also provides examples of how the APMs are being used by different specialties and how they could be applied to diverse patient populations, including cancer care, cardiovascular care, chronic disease management, emergency medicine, gastroenterology, maternity care and surgery. Click here for more information. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. January 15, 2016 Medicare AMA, American Medical Association, Medicare, Alternative Payment Models (APM) 0 0 Comment Read More »
