🚨🧵AMA survey indicates prior authorization (PA) wreaks havoc on patient care

Access to patient-centered care continues to suffer as health insurers

❗️Impose PA barriers on necessary care

❗️Substitute corporate policy for clinical decisions that are in patients’ best interest 2/🔥AMA survey shows that turmoil caused by excessive authorization controls leads to:

❗️Serious or life-threatening events for patients

❗️Unnecessary waste

❗️Physician burnout

Read:

Survey: 👇Includes health plan performance! tinyurl.com/yck5d5hs
tinyurl.com/wjrxwuzw

🎇🧵Over 100 medical organizations want clarity in ⁦@Change_HC⁩ #cyberattack

⁦@AmerMedicalAssn⁩ & others want ⁦@HHSGov⁩ to affirm that ⁦@UnitedHealthGrp⁩ alone bears responsibility for notifying patients of potentially stolen #PHI. healthcarefinancenews.com/news/over-100-… 2/ “We are writing to request more clarity around reporting responsibilities and assure affected providers that reporting and notification obligations will be handled by Change Healthcare.”

🚨🧵UnitedHealth Group (UHG) issued a press release 4/22 with more info about the Change Healthcare #Cyberattack and the impact of the breach on personal data.

UHG officials have agreed to address any additional questions from the ⁦@AmerMedicalAssn⁩ or the Federation. 2/ Please read the UHG press release here:

Send any questions you may have to ama.advocacy@ama-assn.org. AMA will try to get answers from UHG. tinyurl.com/2mcj4uh5

🚨🧵@AmerMedicalAssn 3/26 Update on Change Healthcare cyber outage

❗️Important Survey: How has the cyber outage affected your practice? Help inform AMA advocacy for you. Deadline 3/29 tinyurl.com/9bjca2ft
2/ On March 25, the Department of Health and Human Services (HHS) distributed these resources to assist physicians, pharmacists and hospitals, with the aftermath of the Change Healthcare #cybersecurity attacks.

👉 tinyurl.com/4pjvmpyz

🚨🧵@AmerMedicalAssn⁩ Update on Change Healthcare cyber outage:

3/19, @RepMMM @RepRobinKelly + 94 bipartisan Reps wrote @SecBecerra alerting the Admin of ongoing challenges physicians & patients continue to experience as part of the #Cyberattack.

Read tinyurl.com/3jhsssux


2/ 🔴 The letter:

🔺Highlighted the inability of physician practices to file claims and receive payment

🔺Urged @CMSgov to clarify why they issued such stringent repayment terms for advance payments on March 9

🚨🧵 AMA urged ⁦@HHSGov⁩ ⁦@USDOL⁩ & all healthcare system partners to use all regulatory flexibilities to continue supporting physicians & addressing the enormous interruption in physician practice ops caused by CHNG #cybersecurity incident.

tinyurl.com/bdhzj8ef
2/ The letter also asked the Depts to address additional concerns of physicians:

1. Create an inventory of all the health plans that are currently offering advance payments.

2. Ensure all Medicare Administrative Contractors (MACs) and health plans are accepting paper claims.

&

🎇🧵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. 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

🧵@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
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

🧵⁦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. 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.

🧵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 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.

🧵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). 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

🎇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:

https://twitter.com/marilynheinemd/status/1705350704796246439

🚨🚨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

🧵 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:

🔥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.

🧵 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

🧵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. 👏👏 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

🧵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. 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.“

🧵@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👇 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.”

👇

🎇#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

🧵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 👇 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.”

🧵⁦#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…

🧵⁦@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 👇