Marilyn Heine Profile picture
Physician Leader. Tenacious Advocate. Enthusiastic Mentor. Champion for physicians, patients, public health, and the patient-physician relationship.
Dec 19, 2023 13 tweets 5 min read
🎇🧵High levels of market concentration leaves millions of Americans with limited competitive options for health insurance.

Can harm patients by raising insurance premiums above competitive levels.

⁦@AmerMedicalAssn⁩ identified industry giants with biggest market shares. Image 2/ The 2023 edition of Competition in Health Insurance: A Comprehensive Study of U.S. Markets examined 381 metropolitan statistical areas (MSAs), the 50 states and D.C. and tabulated market shares for the two largest health insurance companies.

👉Report tinyurl.com/347exrrp
Nov 29, 2023 17 tweets 6 min read
🧵@AmerMedicalAssn released new principles for augmented intelligence #AI development, deployment, and use—“a critical step toward fostering a consistent governance structure for advancements in health care technology.”

👉Read Principles here: tinyurl.com/mrxdunx2
Image 2/ “Building upon current policy on AI, the principles serve as the cornerstone for AMA advocacy on AI and…”

[AMA policy on #AI in health care: ] tinyurl.com/45msttk8
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Nov 4, 2023 33 tweets 9 min read
🧵⁦CMS⁩ released final rule for the calendar year (CY) 2024 #Medicare Physician Payment Schedule.

Here is information from a memo by ⁦@AmerMedicalAssn⁩ Advocacy staff about several key provisions and ongoing AMA efforts to mitigate negative impacts on physician pay. Image 2/ The AMA will analyze the final rule and develop a detailed summary in the coming days, but wanted to raise immediate awareness of a handful of key provisions as well as ongoing AMA efforts to mitigate negative impacts on physician pay.
Oct 24, 2023 10 tweets 3 min read
🧵Medicare physician payment reform 4 key components

•Refine Medicare fee schedule budget neutrality policies
•Provide automatic annual MEI-based inflation updates
•Reduce admin burden, improve MIPS clinical relevance
•Maintain viable pathway for physicians to opt into APMs Image 2/ GOP Doctors Caucus Co-Chairs @RepGregMurphy @RepBradWenstrup @DrBurgessTX working closely w/Ways & Means Comm Chairman @RepJasonSmith & AMA have released a discussion draft of legislation seeking to reform budget neutrality policies applied to Medicare Physician Fee Schedule.
Oct 20, 2023 5 tweets 2 min read
🧵In response to advocacy from the ⁦@AmerMedicalAssn⁩ and organized medicine, physicians may now apply for an Extreme and Uncontrollable Circumstances hardship exception to avoid an up to 9️⃣% MIPS penalty due to the impact of the COVID-19 public health emergency (PHE). Image 2/ The penalty would apply in 2025 based on the 2023 performance period.

To submit your application, please see:

Applications can be submitted through Jan. 2, 2024. tinyurl.com/ycyz56hf
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Oct 6, 2023 11 tweets 3 min read
🎇Can you afford a 9% cut in #Medicare reimbursement?

❗️To help avert cut take steps👇

❗️DEADLINE 10/9

“Performance in 2022 determines…adjustment on the Medicare services they deliver in 2024. These penalties can cut Medicare payment by as much as 9%.” ama-assn.org/practice-manag… 2/ See:
Sep 22, 2023 7 tweets 3 min read
🚨🚨The ⁦@AmerMedicalAssn⁩ has heard alarming reports of physicians facing #MIPS penalties in 2024 for the first time since the program started.

⏰Take action before October 9:

👉View your info and report errors

👉You may share your info to inform AMA advocacy

🧵 Image 2/ On Aug 10, CMS made available 2022 MIPS performance feedback

This determines whether physicians will receive a positive, neutral or negative payment adjustment on Medicare services furnished in 2024. 

❗️You are strongly encouraged to view this information ASAP for 2 reasons:
Sep 14, 2023 43 tweets 16 min read
🔥Proposed Medicare cuts:

•Threaten patients' access to care

•Further jeopardize physician practice sustainability, and

•Risk penalizing physicians unfairly.

🔥CMS’s policies increase
administrative demands on physicians.

🧵 Image 2/ This week, @AmerMedicalAssn submitted a 122-page comment letter in response to the @CMSGov proposed rule for the 2024 #Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP).

To read the letter, please see here: tinyurl.com/2hc9ce6e
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Jul 29, 2023 14 tweets 3 min read
🧵Scope of practice victory in New York

As state legislative sessions come to a close, AMA Scope of Practice Partnership (SOPP) grantees are reporting positive results. NY is among them, seeing overwhelming success in the face of over a dozen scope of practice bills. 👏👏 Image 2/ Since its inception in 2007, the SOPP has awarded over $3.5 million in grants to medical societies funding initiatives to:

• Fight inappropriate scope of practice expansions,
•Promote truth in advertising and
•Protect physician-led care.

#transparency #accountability
Jul 14, 2023 15 tweets 7 min read
🧵CMS proposed rule widens chasm between Medicare physician payment and cost to keep the lights on.

❗️Patients’ access to care is at risk.

❗️Should be a wake up call to #Congress to reform the #Medicare physician payment system. Image 2/ As @AmerMedicalAssn staff analyze and develop a summary of the nearly 2,000-page rule, they flag a few key provisions and concerns.

Notably:

“Physician practices cannot continue to absorb these increasing costs while their payment rates dwindle.“ Image
Apr 20, 2023 9 tweets 3 min read
🧵@AmerMedicalAssn & Federation letter to ⁦@Cigna⁩ expresses opposition to its forthcoming policy that will require submission of office notes with all claims including evaluation & management services & modifier 25 when a minor procedure is billed.

Read the letter here👇 ImageImageImage 2/ >100 state medical associations & national medical specialties

“…request that Cigna immediately rescind its policy requiring submission of office notes with all claims including…E/M…CPT codes 99212, 99213, 99214, & 99215 & modifier 25 when a minor procedure is billed.”

👇 ImageImageImage
Mar 13, 2023 28 tweets 10 min read
🎇#FixPriorAuth

🧵”The approval process health insurers impose on medical services or drugs is generating a toll that exceeds the purported benefits, according to a physician survey released today by ⁦@AmerMedicalAssn⁩ and shared in a letter to federal health officials.” 2/ For an infographic of the survey results, please see👇

ama-assn.org/system/files/p…

For more from the @AmerMedicalAssn press release, please read on. #OurAMA
Mar 11, 2023 10 tweets 5 min read
🧵Great review of the #340B program, how it has veered away from its intent, and negative consequences for #DrugPrices. | ⁦@wasan_kumar⁩ ⁦@kevin_schulman

Some takeaways follow 👇 ImageImageImage 2/ “The 340B program was established in response to concerns among safety-net providers regarding the Medicaid Drug Rebate Program, which was enacted in 1990 and required manufacturers to offer their lowest prices to the Medicaid program.”
Oct 14, 2022 13 tweets 7 min read
🧵⁦#OurAMA finds widespread lack of competition in local markets across US where #PBMs provide services to commercial health insurers.

⁩First analysis to examine variations in market shares/competition among PBMs at state/metropolitan levels.

Read: tinyurl.com/bdf8m258 2/ AMA’s competition analysis presents national and local market insight on 5 different #PBM services performed for insurers:

•rebate negotiation
•retail network management
•claim adjudication
•formulary management
•benefit design

Read report here: ama-assn.org/system/files/p…
Sep 22, 2022 7 tweets 3 min read
🧵⁦@AmerMedicalAssn⁩ & ⁦@ahahospitals⁩ support Texas suit challenging surprise billing rule provision.

👉 Read: ama-assn.org/press-center/p…

#NoSurprisesAct 2/ Press release states:

“Hospitals and doctors strongly believe that no patient should fear receiving a surprise medical bill and that patients should be kept out of the middle of any billing disputes between providers and commercial health insurance companies.”

continued 👇
Sep 16, 2022 7 tweets 5 min read
🧵👏👏 TY ⁦@RepBera⁩ ⁦@RepLarryBucshon⁩ for introducing HR 8800, the “Supporting Medicare Providers Act of 2022.”

This would give critical support to physicians who, w/release of the proposed rule for the 2023 Medicare Physician Fee Schedule, again face payment cuts. 2/ Read: Across-the-board Medicare physician pay cuts are wrong way forward

ama-assn.org/practice-manag…
Jun 6, 2022 7 tweets 6 min read
🔥 Congress is rushing to push through a bill that recklessly expands scope of practice.

Tell #Congress vote NO on H.R. 6087.

•Threatens patients’ health & safety,
•Leads to ⬆️ health care costs
•Does little to expand access, particularly in rural & underserved areas. Image 2/ Vote NO on H.R. 6087:

@CongBoyle @RepBrianFitz @CongressmanGT @RepMeuser @RepJohnJoyce @RepDwightEvans @RepDean @RepHoulahan @RepSusanWild @GReschenthaler @MikeKellyPA @RepConorLamb @mgs @USRepMikeDoyle @RepCartwright @RepFredKeller @RepScottPerry 
@RepSmucker
May 27, 2022 6 tweets 4 min read
🔥A must-read: ⁦@oncologyCOA⁩ report on #PBMs

Some takeaways:

“…PBMs make up an oligopoly of rich, vertically integrated conglomerates that routinely prey on health care practices, providers, and their patients.” 2/ “PBMs have done this by overwhelmingly abusing their responsibility to protect Americans from this country’s drug pricing crisis, instead exploiting the opacity throughout the nation’s drug supply chain to enrich themselves.”
May 25, 2022 9 tweets 4 min read
🧵⬆️ evidence that insurer-imposed authorizations for drugs & medical services can be a hazardous & burdensome administrative obstacle to patient-centered care.

Yet “…health insurer industry continues to show apathetic or ineffectual follow-through on mutually accepted reforms” Image 2/ “Prior authorization requirements should be selectively applied to physicians based on demonstrated adherence to evidence-based guidelines and quality measures, according to the consensus statement.” But happens in only 9%. Image
Apr 28, 2022 9 tweets 5 min read
🧵 ⁦@AmerMedicalAssn⁩ Prez ⁦@GeraldHarmonMD⁩ stated:

An investigation by ⁦@OIGatHHS⁩ “into the inappropriate use of #PriorAuthorization by Medicare Advantage plans uncovered information that mirrors physician experiences.”

Read report: oig.hhs.gov/oei/reports/OE… 2/ “Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted.” #FixPriorAuth

See 2021 survey: ama-assn.org/system/files/p…
Dec 10, 2021 4 tweets 2 min read
🧵👏👏Patients & Physicians Grateful for #Congress Fending Off #Medicare Cuts

“These automatic cuts should remind members of the needed reforms. Congress can get a head start on doing the right thing when it reconvenes early next year.”

AMA statement: tinyurl.com/2wtbarfc 2/ Last evening, the Senate passed legislation to halt Medicare physician payment cuts that were scheduled to take effect on January 1. President Biden is expected to sign the bill into law.

Highlights of the physician payment provisions include the following: 👇