Following an AMA letter of support, the U.S. House Energy and Commerce Committee on Tuesday approved a bill that would eliminate the Independent Payment Advisory Board (IPAB).

The IPAB is a group of 15 appointees that would have the considerable power to implement harmful, across-the-board Medicare payment cuts but very little accountability. The AMA continues to argue that it would only add to the problems caused by the broken Medicare physician payment formula. The AMA sent its letter supporting the repeal bill last week.

“[T]he Energy and Commerce Committee took an important bipartisan step in preventing further indiscriminate cuts that we know do not work,” AMA President Peter W. Carmel, MD, said in a statement. “We look forward to continuing to work with members of Congress to strengthen Medicare for patients and physicians.”

Visit http://www.elabs10.com/ct.html?rtr=on&s=x8pbgr,xkae,2ke5,ltaj,dsjc,fjh8,4kzp to read the letter.

The payroll tax extension legislation that was passed by Congress and signed by the President on Dec. 23, 2011 (Public Law 112-078) delayed the 27.4% Medicare pay cut due to the SGR formula for two months.  It also extended the floor on the work geographic practice cost index (GPCI) and certain other policies. The Centers for Medicare & Medicaid Services (CMS) has confirmed to the AMA, however, that all of the other changes that were included in the Medicare physician payment final rule for 2012 will still take effect.  Physicians should not expect that payment rates will remain unchanged.  As detailed in a memo sent to the Federation (http://www.ama-assn.org/resources/doc/washington/2012-medicare-physician-payment-schedule-analysis.pdf ) on Nov. 4, 2011 following release of the final rule, numerous changes are being made in the relative value units, GPCIs, electronic prescribing and quality reporting programs, and multiple procedure payment rules for 2012.  All of these changes will take effect as scheduled for dates of service beginning Jan. 1, 2012.

In addition, although P.L. 112-078 provided for a zero percent update to the Medicare conversion factor, the final rule indicated that there would be a 0.18% increase in the conversion factor for budget neutrality and this change will also be effective Jan. 1, 2012.  The budget neutrality increase is due to CMS adoption of the RVS Update Committee recommendations for misvalued codes.  The 2011 conversion factor was $33.9764.  The 2012 conversion factor will be $34.0376.

CMS also has indicated that because Congress acted so late in 2011 to prevent the SGR cut, claims must still be held for a period of time to allow CMS time to develop the new payment rate files and the Medicare claims administration contractors time to install and test the files.  CMS expects that most if not all contractors will be ready to process claims under the revised rates on or before Jan. 18, 2012, which is the end of the 10-business-day claims hold period previously announced, but contractors’ time frames may differ.  Contractors are expected to have the new rates posted to their web sites by Jan. 11th.

Finally, CMS published in the Jan. 4, 2012, Federal Register a correction notice (http://edocket.access.gpo.gov/2012/pdf/2011-33757.pdf ) to the 2012 final rule that modifies the relative values for a number of services.  The agency also posted to its web site a revised relative value file (http://www.cms.gov/PhysicianFeeSched/PFSRVF/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=descending&itemID=CMS1255291&intNumPerPage=10 ) reflecting both the corrections and the legislation that stopped the 27.4% cut.
 

Physicians have until Nov. 1 to apply for an exemption and avoid financial penalties for failing to comply with Medicare's ePrescribing requirements. The AMA urges all physicians who have doubts about whether they met the program's requirements in the first six months of 2011 to review the allowed exemptions carefully and submit an online application for each of the exemption categories for which they qualify as soon as possible.

Under the Centers for Medicare & Medicaid Services (CMS) ePrescribing rule, physicians are required to have issued and reported at least 10 electronic scripts (e-scripts) by June 30 to avoid being penalized. The penalty reduces all their Medicare Part B claims paid under the 2012 fee schedule by 1 percent.

In November 2010 CMS made a sudden decision to require physicians to meet this criteria by June 30 in order to avoid 2012 penalties, and the AMA continually stressed that this last-minute requirement was unreasonable.

On Aug. 31, CMS released a final rule that allows qualifying physicians to avoid the 1 percent penalty by applying for one or more of six new ePrescribing penalty exemptions through a Web-based tool:  https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234   (Note: If you have difficulty accessing the online application, email QualityNet at qnetsupport@sdps.org which runs the portal for CMS.)

Although the final rule does not include an additional reporting period in 2012, it does reflect several other significant improvements the AMA requested. For example, the regulation provides more flexibility under the exemption categories so that more physicians can qualify to avoid the 2012 ePrescribing penalty.

In addition, CMS extended the application deadline for one month to Nov. 1. However, physicians are encouraged to apply for an exemption as soon as possible to avoid claims reprocessing.  Physicians who found it difficult to meet the 10 e-script requirement during the first six months of this year can apply for one of the following exemption categories by Nov. 1:

• Your practice is located in a rural area without high-speed Internet access.
• Your practice is located in an area without sufficient available pharmacies for ePrescribing.
• You are registered to participate in the Medicare or Medicaid electronic health record (EHR) incentive program and you adopted certified EHR technology by Oct. 1, prior to requesting an exemption.
• You are unable to ePrescribe because of local, state or federal laws or regulations. (CMS confirmed that physicians who mainly prescribe narcotics but cannot submit these prescriptions electronically because of certain limitations can apply for this exemption category.)
• You do not prescribe on a regular basis.
• There were too few opportunities for you to report the ePrescribing measure because of limitations of the measure's denominator. For example, you do prescribe electronically but your e-scripts are not related to qualifying visits or services.
Learn more about the steps physicians should take now to avoid the Medicare ePrescribing penalty.  http://www.ama-assn.org/ama/pub/physician-resources/health-information-technology/incentive-programs/cms-eprescribing-incentive-program.page 
 

Events in Washington, D.C., pose enormous threats to the future of medicine and patient care.  The AMA is urging every physician in this country to engage their U.S. representatives and U.S. senators on looming decisions that will determine the future of health care.
A new congressional Joint Select Committee on Deficit Reduction has been granted broad power to develop a legislative package by Nov. 23 to reduce spending by $1.2 trillion. If Congress fails to enact spending reductions by Dec. 23, across-the-board cuts will be imposed to achieve the target amount.

Medicare provider payments are on the chopping block again at a time when physician payments are already slated to be cut 30 percent on Jan. 1 under current law.

A Medicare advisory committee created by Congress is contemplating recommendations for an18 percent cut in payments to non-primary care physicians over the next three years followed by a freeze for seven years. Medicare payments to primary care physicians would be frozen for 10 years under the misguided scheme concocted by this congressional advisory group.

Over the next few years, physicians who fail to comply with electronic prescribing, electronic health records and quality reporting requirements face additional payment reductions under current law.

Some physicians have said they are tired of going hat in hand every year asking members of Congress not to cut their Medicare payments; that they don’t believe they can make a difference. This defeatism will produce a self-fulfilling prophesy. Fatigue and failure to engage in the legislative process will be fatal to your medical practice. Every physician is at risk—solo or small private practice as well as those employed by physician-directed groups, hospitals or health plans.

The AMA is working with state and national medical specialty societies in a united campaign to convince Congress to shift the focus from destructive payment cuts to reforms that will stabilize the Medicare program.

Procedural protections granted to the Joint Select Committee on Deficit Reduction also offer a unique opportunity to advance medical liability reforms that have been blocked in the U.S. Senate. As we all know, fixing a broken medical liability system will lower federal spending and benefit patients. The AMA convened a medical liability task force composed of state and national specialty society leaders to coordinate advocacy efforts on this issue, as well.

Deadlines for congressional action are just weeks away. The stakes for medicine are enormous. Your ability to deliver high-quality care and preserve patients’ access to care hangs in the balance.

Together, the AMA, state medical societies, national medical specialty societies and individual physicians across the country can secure a better outcome than what looms ahead. Join us in the campaign for a better future for physicians and patients by sending an urgent message on this critical issue NOW— click here:  http://ama.capwiz.com/ama/issues/alert/?alertid=53132696     

Peter W. Carmel, MD, AMA President

Robert M. Wah, MD, AMA Chair, Board of Trustees

James L. Madara, MD, AMA Executive Vice President, CEO