1/ @AmerMedicalAssn⁩ submitted comments to ⁦@CMSGov⁩ regarding a NPRM on provider burden reduction and #priorauthorization: tinyurl.com/y5ebobkf

The NPRM cited #OurAMA prior authorization survey data and grassroots website FixPriorAuth.org
2/ The rule proposes policies to help make the prior authorization process more efficient and transparent.

The NPRM would require #Medicaid, CHIP, and federally facilitated health exchange plans to:

•Support technology that would convey #priorauthorization requirements
3/ The NPRM would also require impacted payers to:

•Automate the exchange of supporting clinical data from physicians’ #EHR workflow

•Publicly report data on #priorauthorization programs and comply with processing timeframes
4/ @AmerMedicalAssn:

•Commended @CMSGov for addressing #priorauth burdens
•Urged these requirements be extended to Medicare Advantage plans to benefit more patients
•Encouraged CMS to allow for adequate testing of technology it proposes before requiring its use in regulation
5/ While the NPRM focuses on #priorauthorization, it also includes a proposal to require impacted payers to request an attestation on #privacy policies from third-party #apps facilitating patient access to claims and certain clinical information.
6/ Such attestations would require third-party #app developers to indicate their adherence to industry-developed best practices around #privacy and #data sharing.
7/ @AmerMedicalAssn advocated for @CMSGov and @ONC_HealthIT to include such attestations in their patient access and #interoperability regulations, which were finalized in 2020:

8/ Neither agency did so in the latter final rules, but this new NPRM builds on CMS’ prior final rule & proposes a #privacy attestation policy.

AMA commented in support of this proposal; urged ONC to adopt a similar requirement to bolster transparency & trust in emerging #tech.

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More from @MarilynHeineMD

9 Jan
1/ @HHSGov⁩ ⁦@SecAzar⁩ has extended the #COVID19 Public Health Emergency (PHE) declaration effective Jan. 21, 2021 for an additional 90 days. Image
2/ This means that all of the #telehealth and other waivers and flexibilities that have been implemented during the #PHE will remain in effect until at least April 21, 2021.
3/ As in the summary & impact table by @AmerMedicalAssn, the Consolidated Appropriations Act signed into law 12/27/20 included provisions that offset most of the 10.2% budget neutrality adjustment that was slated to take effect for Medicare-covered services provided as of 1/1/21.
Read 8 tweets
9 Jan
1/ Check out this detailed summary by AMAzing ⁦@AmerMedicalAssn⁩ advocacy staff:

•Select provisions of the Consolidated Appropriations Act, a comprehensive omnibus spending package

•AMA table of #Medicare physician impact broken down by specialty ImageImage
2/ Dec. 22, 2020, the President signed into law the Consolidated Appropriations Act, 2021 that:

•Funds the federal government through FY 2021,

•Provides a new round of #COVID19 relief and economic stimulus, and

•Imposes new restrictions on #SurpriseMedicalBilling.
3/ For an @AmerMedicalAssn summary of select provisions in the Consolidated Appropriations Act, please see here: tinyurl.com/y65utfno
Read 13 tweets
9 Jan
1/ @AmerMedicalAssn⁩ led a sign-on letter with over 100 national specialty and state medical societies submitted to ⁦@DeptVetAffairs⁩ in opposition to its recent Interim Final Rule (IFR), “Authority of VA Professionals to Practice Health Care.” Image
2/ The @DeptVetAffairs IFR permits virtually all VHA-employed non-physician practitioners (NPPs) to practice without the clinical supervision of physicians and without regard to state scope of practice law.
3/ The IFR establishes the VA’s authority to allow virtually all NPPs to practice without the clinical supervision of a physician. In doing so, the IFR preempts state license, registration, certification, supervision, or other requirements.
Read 5 tweets
9 Jan
1/ Dec. 18, ⁦@AmerMedicalAssn⁩ wrote to ⁦@HHSGov⁩ urging it to withdraw the recently issued Most Favored Nation (MFN) Model interim final rule (IFR): tinyurl.com/yajlvlb7

Issue has broad impact on patients, e.g. those who have #cancer, GI, #rheumatology disorders.
2/ This IFR would:

•Impact pricing and availability of many of the most expensive Medicare drugs nationwide

•Have serious detrimental impacts on patient access to needed medications

•Create strain and uncertainty for physician practices
3/ @AmerMedicalAssn has long supported efforts to address escalating prescription #drugprices and reduce financial burdens on patients.

However, the MFN IFR is deeply flawed.
Read 7 tweets
17 Dec 20
@JonnyJenk 1/ TY for your inquiry @JonnyJenk.

Factors drive #SMB: insurers’ narrow networks, high deductibles w/disproportionate cost-sharing for OON, physicians OON d/t take-it-or-leave-it contracts, health plans’ inaccurate provider directories. Patients are surprised by #insurancefail.
@JonnyJenk 2/ In terms of increased administrative burden that the current proposal would impose:

There will be a struggle for small practices to navigate the IDR efficiently and effectively, ensuring they have the resources to stay afloat while they challenge inefficient payments.
@JonnyJenk 3/ That is why AMA is asking to remove the 90-day cooling off period in the proposal - so that practices don’t have to hold claims for three months before they can pursue sufficient payment.
Read 6 tweets
16 Dec 20
1/ The “No Surprises Act” is deeply flawed. It should not advance in its current form. Work must continue to reach a meaningful remedy to “surprise medical bills” #SMB that keeps patients out of the middle and provides balance.

Here are several concerns w/ the current proposal:
2/ The proposal should require that the initial “interim payment” made by the insurer for out-of-network services be considered the plan’s offer for IDR, to incentivize the insurer to pay a fair initial reimbursement.

But, the proposal does not.
3/ The proposal should allow the IDR process to consider UCR and an independent charge-based database. Lest it be a form of price-fixing by insurers since the qualifying payment is indexed to the insurer-set in-network median rate (w/CPIU adjustment).

But, the proposal does not.
Read 17 tweets

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