Posts Tagged ‘AMA’

Healthcare Reacts to AHCA: Providers ‘Cannot Support Legislation As Drafted’

March 13th, 2017 by Patricia Donovan

American Health Care ActLast week’s unveiling of G.O.P. legislation designed to repeal and replace the Affordable Care Act (ACA) triggered a flurry of concerns and criticisms from healthcare industry sectors.

The proposed American Health Care Act (AHCA) would eliminate Obamacare’s individual mandate and put in place refundable tax credits for individuals to purchase health insurance. It also proposes restructuring Medicaid and defunding Planned Parenthood. However, the bill seeks to maintain protections for individuals with pre-existing conditions and to permit children to remain on their parents’ insurance plans until they reach the age of 26.

As of last Friday, the proposed American Health Care Act (AHCA) had cleared two committees in the U.S. House of Representatives; a final House vote on the bill is expected the week of March 20.

In a letter to leaders of the House committees that will mark up the AHCA, the American Medical Association (AMA) rejected the ACA replacement bill. In the letter, AMA CEO and Executive Vice President James L. Madara, MD, stated that his organization “cannot support the AHCA as drafted because of the expected decline in health
insurance coverage and the potential harm it would cause to vulnerable patient populations.”

In particular, the AMA, the nation’s largest physicians’ group representing more than 220,000 doctors, residents, and medical students, objected to the bill’s proposed restructuring of Medicaid, claiming it “would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes.”

The AMA’s position was also outlined in a statement issued by Andrew W. Gurman, MD, AMA president.

Meanwhile, the American Hospital Association (AHA), which counts 5,000 hospitals among its members, also opposed the AHCA. In a news release, Rick Pollack, AHA president and CEO, stated that the AHA “cannot support The American Health Care Act in its current form.” The AHA stated that it would be difficult to evaluate the bill without coverage estimates by the Congressional Budget Office (CBO).

Echoing AMA apprehension over proposed Medicaid restructuring, Pollack stated that the AHA feared the bill “will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care.”

Although Pollack lauded recent Congessional efforts to address behavioral health issues, including the growing opioid abuse epidemic, he stressed that “significant progress in these areas is directly related to whether individuals have coverage. And, we have already seen clear evidence of how expanded coverage is helping to address these high-priority needs.”

Also seeking adequate Medicaid funding in the AHCA was America’s Health Insurance Plans (AHIP), a national association whose 1,300 members provide coverage for healthcare and related services to more than 200 million Americans.

In a letter to two key House committees, AHIP President and CEO Marilyn Tavenner stated that “Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts.”

However, AHIP commended the proposed legislation for its “number of positive steps to help stabilize the market and create a bridge to a reformed market during the 2018 and 2019 transition period” and “pledged to work collaboratively to shape the final legislation.”

“AHIP members are committed to reducing cost growth by using value-based care arrangements and other innovative programs to address chronic illnesses and better manage the care of the highest-need patients,” Tavenner concluded.

In a statement on Friday, Secretary of Health and Human Services Tom Price, MD, committing his agency to using its regulatory authority to create greater flexibility in the Medicaid program for states, including “a review of existing waiver procedures to provide states the impetus and freedom to innovate and test new ideas to improve access to care and health outcomes.”

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts; Industry Reacts

December 5th, 2016 by Patricia Donovan

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Healthcare industry reaction to President-elect Donald J. Trump’s choices to head the HHS and CMS was largely positive.

Calling his nominees “the dream team that will transform our healthcare system for the benefit of all Americans,” President-elect Donald J. Trump last week announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

“Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy,” said President-elect Trump in a news release. “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American.”

Prior to serving in Washington, Rep. Price worked in private practice as an orthopedic surgeon for nearly 20 years.

In the same announcement, the President-elect called Seema Verma, his nominee for CMS administrator, one of the leading experts in the country on Medicare and Medicaid. “She has decades of experience advising on Medicare and Medicaid policy and helping states navigate our complicated systems,” he said.

Seema Verma is the president, CEO and founder of SVC, Inc., a national health policy consulting company. For more than 20 years, Ms. Verma has worked extensively on a variety of policy and strategic projects involving Medicaid, insurance, and public health, working with governors’ offices, state Medicaid agencies, state health departments, state insurance departments, as well as the federal government, private companies and foundations.

Ms. Verma has extensive experience redesigning Medicaid programs in several states. Ms. Verma is the architect of the Healthy Indiana Plan (HIP), the nation’s first consumer-directed Medicaid program, and served as the State of Indiana’s health reform lead following the ACA’s passage in 2010.

Responding to the announcement, the American Medical Association (AMA) said it supports the nomination of Dr. Tom Price, who would be the first physician to serve as HHS secretary since President George H.W. Bush appointed Louis W. Sullivan, MD, in 1989, and only the third doctor in the HHS’s 63-year history.

In a statement, Patrice A. Harris, MD, MA, AMA Board Chair, cited decades of interactions with Dr. Price as a member of the AMA House of Delegates, Georgia state senator and House of Representatives. “Over these years, there have been important policy issues on which we agreed (medical liability reform) and others on which we disagreed (passage of the Affordable Care Act). Two things that have been consistent are [Dr. Price’s] understanding of the many challenges facing patients and physicians today, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations.”

On the payor side, America’s Health Insurance Plans (AHIP), the national trade association representing the health insurance community, said in a statement that it anticipates cooperative, collaborative relationships with the new leaders of HHS and CMS.

“For many years, Dr. Price has been committed to ensuring that patients and consumers are well-served,” said Marilyn Tavenner, AHIP president and CEO. “He will bring a balanced and thoughtful perspective to his role as Secretary of HHS. We look forward to working with him to promote competition, increase choice, and lower costs for every consumer.

“Likewise, we look forward to working with Seema Verma to strengthen our nation’s healthcare system and empower Americans to improve their health and financial well-being, particularly those who depend on the valuable support and services provided through Medicare and Medicaid.”

Related Resource: MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System

MACRA MIPS

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), one of two payment paths Medicare will offer to practices beginning January 1, 2017.

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 16th, 2016 by Patricia Donovan

Physician groups digested the 962-page MACRA notice of proposed rule-making in order to distill the notice for their members.

As they digest the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations are assembling arsenals of educational tools to de-mystify MACRA.

The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

Just nine days after that bulletin, the AAFP arranged a town hall meeting for its members with two high-ranking CMS officials to discuss the law that will greatly influence how physicians are paid. Comments provided by CMS Acting Administrator Andy Slavitt via conference call are detailed here.

While the HHS window to receive feedback on the proposal remains open through June 27, 2016, the AMA has created an extensive set of online resources to support physician preparations for a post-MACRA Medicare. The resources include a guide to physician-focused payment models, key points of the Merit-based Incentive Payment System (MIPS), and five things providers can do now to prepare for the legislation, among other resources, according to a May 2016 press release.

“The core policy elements in MACRA are surfacing in other public and private insurance programs, so understanding these policies will be essential for most physician practices,” said AMA President Steven J. Stack, MD.

The AMA’s MACRA support tools were announced in conjunction with the release of its new interactive module on practicing value-based care authored by Grace Terrell, MD, an internal medicine physician and president of Cornerstone Health Care, who shares the proven steps her clinic used to focus on patients at the center of care.

The value-based care module is the latest in the AMA’s STEPS Forward™ collection of physician-developed practice improvement strategies.

Also readying its membership for MACRA is the AAFP, which last week launched a comprehensive member communication and education effort related to the proposed legislation. The AAFP’s MACRA Ready site is a one-stop shop filled with resources family physicians can use right now such as the following:

  • A timeline of important MACRA dates;
  • A list of acronyms to help digest the alphabet soup associated with MACRA’s complicated regulations;
  • A “MACRA in a Minute” 60-second overview video;
  • A deep-dive review of what value-based payment means to family physicians;
  • and much more.

In announcing the MACRA tools, AAFP President Wanda Filer, MD, MB, told family physicians that the academy’s MACRA communication plan “is designed to help simplify the transition and provide the guidance that you will need to realize the benefits of MACRA and value-based payments.”

A recent AAFP survey indicated that some 40 percent of family physicians already were involved in some kind of value-based payment system, she noted.

As she related the history of MACRA, Dr. Filer reminded members that the legislation not only repealed the sustainable growth rate (SGR) but also established an annual positive or flat-fee payment for the next 10 years as well as a two-track program (the MIPS, and Alternative Payment Models, referred to as APMs) for calculating Medicare payments beginning in 2019.