Marilyn Heine Profile picture
Physician leader. Tenacious advocate. Passionate promoter of quality care, patient safety, & patient-physician relationship. #AMAAmbassador Inaugural Steering
10 Sep
🧵HHS Announces $25.5B in #COVID19 Provider Funding

Administration announced today ⁦@HHSGov through @HRSAgov⁩ is making $25.5 billion in new funding available for physicians and other #healthcare providers affected by the #pandemic.

2/ Important:

👉 • HHS is also announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period.
3/ 👉 While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.
Read 5 tweets
8 Sep
🧵⁦@AmerMedicalAssn⁩ greatly appreciates the recent action taken by ⁦@USDOL⁩ to help protect patients with a #mentalillness.…

#MentalHealth #MentalHealthMatters #MentalHealthParity Image
2/ “The DOL action fining United Behavioral Healthcare & United Healthcare $13.6 million is indicative of the widespread violations by health insurers of state & federal #mentalhealth & #substanceusedisorder parity laws, including the Mental Health Parity & Addiction Equity Act”
3/ @AmerMedicalAssn wrote:

“We urge the @USDOL, as well as the states, to increase efforts to review plans on a regular basis to ensure they are in compliance with MHPAEA and hold them accountable if they are not.”
Read 14 tweets
4 Aug
🧵#OurAMA joined over 400 prominent physician, #healthcare and #technology stakeholder groups on a letter urging Congressional leadership to pass legislation that would permanently continue many of the current #telehealth flexibilities enacted at beginning of the #COVID19 PHE.
2/ @aafp @ACPinternists @FAHhospitals
@ConnectwCare @AmericanTelemed @CTATech @HealthIsMobile @Zoom video conferencing were among the diverse collection of cosigners pushing federal lawmakers to address the impending “#telehealth cliff.”
3/ Expanded #telehealth flexibilities have proven to be a lifeline for countless patients trying to retain access to their physician during the #pandemic.
Read 9 tweets
3 Aug
🧵UHC modifies laboratory designated diagnostic provider (DDP) program

AMA, many state medical associations, & national medical specialty societies expressed strong concerns about the DDP’s impact on physician practices & patients. In response to this advocacy, UHC made changes. Image
2/ Earlier this year, United Healthcare (UHC) announced the launch of its Designated Diagnostic Provider (DDP) program for laboratory services. To qualify as a DDP, a laboratory must meet certain quality and efficiency (i.e., cost) requirements.
3/ UHC initially presented the DDP as a strict covered/not covered benefit design, under which patients receiving services from a non-DDP laboratory would be responsible for the full cost of the test(s)—even if the lab was in network.
Read 8 tweets
21 Jul
🧵AMA to #Congress:

•Do not extend 2% #Medicare sequester as a spending offset in soon-to-be considered #infrastructure package.

•Do not divert scarce health-related offsets to meet objectives unrelated to healthcare.

Physicians already face steep Medicare fiscal challenges.
2/ AMA expresses “deepening alarm concerning the growing financial instability of the Medicare physician payment system.”

“Not only does Congress seem indifferent to the confluence of fiscal uncertainties confronting physician practices at the end of this year, but…”
3/ “…lawmakers’ pursuit of policies to extend the current Medicare sequester that, in effect, will require physicians and health systems to pay for
hard infrastructure amplifies our ongoing concerns.”
Read 21 tweets
20 Jul
🧵#OurAMA issues initial summary of “Interim Final Rule (Part 1) Implementing Certain Provisions of the #NoSurprisesAct.”

Several initial concerns:
•Way the QPA (median contracted rate) will be determined
•Provisions that ⬆️ admin burden for physicians without patient benefit Image
2/ July 1 @HHSGov @USDOL @USTreasury (Tri-Agencies), @USOPM released an IFR with comment period implementing many provisions of the #NoSurprisesAct signed into law as part of the Consolidated Appropriations Act, 2021 COVID-19 relief bill.
3/ Given statutory timeframes required under the NSA & the pending implementation of most provisions by January 1, 2022, the Departments made the decision to issue an IFR.

As a result, the requirements outlined in the IFR are final & will become effective on September 13, 2021.
Read 12 tweets
19 May
1/ @AmerMedicalAssn⁩ press release on the urgency to #fixpriorauth:

At the height of the #COVID19 #pandemic, physicians reported being bedeviled by unnecessary, bureaucratic obstacles that the health insurance industry pledged to reduce three years ago.
2/ The data highlights the urgent need for new bipartisan legislation introduced in the House, the Improving Seniors’ Timely Access to Care Act. [TY @RepDelBene @MikeKellyPA @RepBera @RepLarryBucshon for introducing this vital measure.]

[See data here:…]
3/#OurAMA-conducted survey shows physicians are running into roadblocks because of #priorauthorization, the process of requiring health care professionals to obtain advance approval from health plans before a prescription medication or medical service is delivered to the patient.
Read 18 tweets
17 May
1/ New report from ⁦@AmerMedicalAssn⁩ provides:

•Detailed look at official US healthcare spending estimates through 2019 using data from ⁦@CMSGov
•Preliminary estimates of 2020 health spending from ⁦@Altarum…
2/ •Health spending was 17.7% of GDP in 2019 and increased by 4.6% to $3.8 trillion ($11,582 per capita).
•Spending in hospital care (6.2%) and prescription drugs (5.7%) grew faster than physician services (4.2%) in 2019.
3/ • In 2019, spending growth in #Medicare (6.7%) and out-of-pocket payments (4.6%) reached their highest rates in the last decade while private #healthinsurance (3.7%) and #Medicaid (2.9%) were on a downswing.
Read 5 tweets
10 Apr
1/ 👉 “After careful consideration and given the significant concerns set forth...⁦@AmerMedicalAssn⁩ respectfully urges the @TheJusticeDept to conduct a thorough examination of the antitrust ramifications of UHG/Optum’s proposed acquisition of CHNG.”
2/ @AmerMedicalAssn writes:

“There is substantial overlap in markets for health information technology (IT)/analytics services that the merging firms supply to health insurers, physicians, and hospitals.”
3/ “Given this overlap and the companies’ large sizes, it is likely that the merging firms have been, or absent the merger would become, substantial head-to-head competitors.”
Read 16 tweets
17 Mar
1/ @AmerMedicalAssn⁩ strongly supports HR1868 to protect physician practices:

Prevent across-the-board direct spending cuts that threaten financial viability of physician practices, especially during #COVID19 PHE & beyond. @SpeakerPelosi @GOPLeader
2/ HR1868 is vital to protect physician practices:

•Extend current moratorium on the 2% Medicare sequester cuts past the 3/31/21 deadline

•Avoid additional Medicare statutory PAYGO cut of up to 4% triggered by budgetary impact projected under American Rescue Plan Act of 2021
3/ The #COVID19 #pandemic persists and continues to have a substantial fiscal impact on physician practices.

It is critically important that physicians are able to provide frontline care to #Medicare beneficiaries.
Read 12 tweets
15 Mar
1/ Take care to not run afoul of #HIPAA. Lest you risk penalties and jeopardize the patient-physician relationship.

“Protecting information gathered in association with the care of the patient is a core value in health care.”…
2/ The Code of Medical #Ethics also states, “However, respecting patient #privacy in other forms is also fundamental, as an expression of respect for patient autonomy and a prerequisite for trust.”
3/ Physicians and hospitals may share patient information without explicit patient consent for treatment, payment, business operations.

@HHSOCR enforces #HIPAA. Voluntary compliance and corrective action without a fine is a goal, but penalties are steep for “willful neglect.”
Read 8 tweets
15 Jan
1/ @AmerMedicalAssn⁩ applauds
decision by ⁦@HHSGov⁩ to allow physicians to prescribe #buprenorphine without an X-waiver for the treatment of patients with #opioid use disorder. #OUD

However, it is important to keep in mind several considerations:…
2/ •Use of #buprenorphine by a person who has #OUD but is not in withdrawal can precipitate withdrawal. This is a significant adverse experience. It also dissuades patients from adherence to treatment.
3/ •It is unclear whether removal of the X-waiver requirement for #buprenorphine-prescribing will increase access to care in the community. Already, physicians who have an X-waiver do not see the full allowed complement of patients who have #OUD.
Read 12 tweets
9 Jan
1/ @HHSGov⁩ ⁦@SecAzar⁩ has extended the #COVID19 Public Health Emergency (PHE) declaration effective Jan. 21, 2021 for an additional 90 days.
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:
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.”
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/ @AmerMedicalAssn⁩ submitted comments to ⁦@CMSGov⁩ regarding a NPRM on provider burden reduction and #priorauthorization:

The NPRM cited #OurAMA prior authorization survey data and grassroots website
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
Read 8 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):

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
12 Oct 20
1/ Thank you @CongBoyle @RepBrianFitz @CongressmanGT @RepMeuser @RepJohnJoyce @RepDwightEvans @RepDean @RepHoulahan @RepSusanWild @GReschenthaler @MikeKellyPA @RepConorLamb for signing the Bera-Bucshon letter to help keep physician practices and emergency viable. Urgent issue.
2/ @mgs @USRepMikeDoyle @RepCartwright @RepFredKeller @RepScottPerry 
@RepSmucker should join their colleagues from PA in this strong bipartisan support. It is an issue of access to care for patients and healthcare jobs for physician practice employees.
3/ The #COVID19 #pandemic has taken a toll on physician practice revenue.  Survey data shows physician practice revenue plunged 50% March to May and remains on average 32% less than in February. Practice costs are ⬆️ due to PPE. Volume is ⬇️ due to required physical distancing.
Read 9 tweets
3 Aug 20
1/ Time is running out...

Physician practices are essential to the nation's health care system.

Before Congress adjourns, it must pass legislation to:

•Continue expansion/add flexibility for Medicare Accelerated/Advanced Payments: Better allow physicians to address the crisis
2/ •Better address Medicare/Medicaid payment policy. Account for lack of + updates to assist doctors caring for patients

•Include direct $ support to help sustain physician practices thru the pandemic. Include addit emergency relief fund grants, access to small business loans
3/ •Permanently lift geographic & site restrictions on #telehealth tech so all #Medicare beneficiaries have access to telehealth services, incl from home, regardless of where they live

•Institute broader liability protection for physicians on front-line fight against #COVID19
Read 5 tweets