The end of SGR is not yet in sight, but AMA and Federation partners continue to push Congress
   The House Energy and Commerce Committee unveiled draft legislation on May 28, 2013, that would repeal the sustainable growth rate (SGR) formula and replace it with a new system for determining Medicare physician payments.The shorthand explanation of this proposal, provided by the Coalition of State Medical and National Specialty Societies, is as follows:

• Phase I:  Repeal the SGR and replace it with a period of payment stability (not defined), during which time the quality infrastructure ramps up (more measures developed, clinical registries implemented, peer provider cohorts defined). The Secretary has broad power to adopt/approve an array of quality measures that could be supplied by medical specialty societies, the NQF, HHS itself and others. Quality measures will be based on core competency categories (much like the way the ACGME evaluates residents) for each peer cohort (e.g., neurosurgeons, internists, anesthesiologists) as defined by the ABMS.  
• Phase II: New payment system based in part on quality performance implemented. Under physicians would be paid a "base" rate per service, which would be some percentage of the full fee-schedule rate. In addition, they would participate in various quality programs to earn additional reimbursement. Physicians would earn the quality payment based either on how they compare head-to-head against their peers or as compared to national benchmarks (all of this is still up-in-the-air). Physicians can opt out of this new fee-for-service program and get paid under other models such as accountable care organizations, medical homes, etc. 
• Phase III:  Efficiency measures added to the system (at some point in the future)

Major Holes Include:

• Length of the initial transition period
• Mechanism to update the base payment
• Process for evaluating whether or not physicians meet quality parameters
• Overall payment structure    
• Will new system replace existing PQRS, EHR, and value based payment modifier programs (both the substance and the penalties) or will this be added to the existing penalty programs?

Timeline for Action:

   Things are somewhat fluid, but the Energy and Commerce Committee (E&C) will hold a legislative hearing on this proposal on June 5, 2013 (Read more here). They would like to receive any comments on this outline by June 10, 2013.  The Ways and Means Committee has been collaborating on this proposal as well, and will add to this conversation (likely following the E&C hearing). It is hoped that some sort of action on the SGR could occur by the end of the summer, although it is far from clear whether a bill will emerge out of committee, be voted on by the House or even reach the President's desk by this time. 

   On the Senate side, the Senate Finance Committee is also soliciting feedback on the SGR replacement policy (see letter), although they have not yet made any policy outline public.

   MSDC is supporting Federation efforts in responding to the Committee reiterating key principles (private contracting, medical liability reform and defining quality by the profession not the government) and urging the Committee to ensure that any SGR replacement policy reflects these principles.

    The Prescribers' Clinical Support System for Opioid Therapies (PCSS-O) announced a number of free, evidence based clinical resources designed to help prescribers' learn about safe opioid prescribing practices. PCSS-O provides free training and education on the safe and effective prescribing of opioid medications in the treatment of pain and/or opioid addiction. Resources include: 

Clinical online modules

Webinars (Live and Archived - available at on online database). 

Peer Support Program and Listserve    
   To learn more, see this flyer. 

Pharmacies refusing to fill doctor prescriptions ... Has this happened to you?

   The AMA has received several reports from different states concerning pharmacists refusing to fill/dispense prescriptions containing opioid analgesics. The refusals are not limited to one pharmacy and  have been for a variety of reasons. 

   While some neighboring states have received physician reports of pharmacies refusing to fill prescriptions, the Medical Society of DC has not. If this has happened to you, the Medical Society and the AMA would like to know. Please fill out this  Response Form to let us know the details. Working with other state societies, we will monitor this trend to maintain the integrity of the physician-patient relationship. 

    In response to AMA advocacy, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Medicare Advantage and standalone prescription drug plans clarifying that residents can continue to use their hospitals' Drug Enforcement Administration (DEA) number on prescriptions for Medicare patients. A new regulation that took effect in January 2013 led some plans to deny coverage for prescriptions written by residents due to a misunderstanding that prescriptions needed to have an individual rather than an institutional DEA number. The DEA does allow residents to use their hospitals' DEA number, however, so the Medicare program clarified that its regulatory policy does not conflict with or supersede DEA policy.

Senator Tom Coburn, MD (R-Okla.), along with Senators John Barrasso, MD (R-Wy.), Rand Paul, MD (R-Ky.), and John Boozman (R-Ark.), introduced S. 972, the "Cutting Costly Codes Act of 2013" on May 16. Identical legislation was introduced in the House by Representative Ted Poe (R-Texas) on April 26. This
legislation would prohibit the Secretary of Health and Human Services from replacing the current International Classification of Diseases, 9th Revision (ICD-9) with the ICD-10 diagnostic code set. It would also require the Government Accountability Office to conduct a study on ways to mitigate the disruption of health care providers resulting from a replacement of ICD-9 with new coding standards required by the Health Insurance Portability and Accountability Act.
    The AMA strongly supports this legislation and is seeking solutions that mitigate the disruption to physician practices when advancing to a new diagnostic code set.

    Editor's Note: Despite this progress, the October 1, 2014 deadline to switch to ICD-10 coding is still in effect. The Centers for Medicare and Medicaid Services (CMS) has shared resources to help physicians plan for the transition.

    Practices preparing for the October 1, 2014, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade.  For example, clearinghouses cannot help you identify which ICD-10 codes to use unless they offer coding services. Because ICD-10 codes are more specific, and one ICD-9 code may have several corresponding ICD-10 codes, selecting the appropriate ICD-10 code requires medical knowledge and familiarity with the specific clinical event.
   CMS and contractor National Government Services (NGS) have updated end-to-end testing checklists to incorporate comments from providers, payers, and vendors. The checklists were developed and refined as part of an end-to-end testing project that uses ICD-10 as a business case.
    Visit the CMS ICD-10 website for the latest news and resources to help prepare for the October 1, 2014, deadline.

     Let MedSystem Solutions help you keep your business as healthy as you keep your patients.  
     Please contact MedSystem Solutions for a free practice analysis and system demonstration. They will provide lunch for you and your staff.

   As a physician in Washington, DC, you and your patients have access to a FREE Prescription Drug Card program. The Medical Society is pleased to offer the DCRx Card. Using this card, your patients can save up to 75% on prescriptions, selected eye-wear, vitamins and other products. The card is accepted in pharmacies in the District, Maryland and Virginia.
   The Medical Society of DC has cards available and any Society member who requests it may receive a supply of 250 cards. To receive a supply of cards for your patients, please email Pia Duryea at duryea@msdc.org.

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Catherine S. May, MD

Chair of the Board; At-Large

Daniel I. Perlin, MD
President

 

Laura L. Tosi, MD

President-Elect, AMA Alternate Delegate 

 

James C. Cobey, MD

Immediate Past President   

 

Joseph E. Gutierrez, MD

Treasurer; AMA Delegation Chair

 

Reginald L. Robinson, MD

Secretary; At-Large

  

Peter E. Lavine, MD

AMA Delegate

 

J. Desiree Pineda, MD

AMA Alternate Delegate

 

Julian R. Craig, MD

At-Large  

 

John W. Larsen, MD

At-Large 

 

Barry Lewis, MD, MBA

At-Large

 

Joan B. Loveland, MD

At-Large 

Carla C. Sandy, MD

At-Large

  

Stuart F. Seides, MD

At-Large

 

K. Edward Shanbacker

Executive Vice President