Eyeworld

EW NEWS & OPINION 20 September 2014 • Require robust testing and monitoring of ICD-10 impact • Support electronic health record (EHR) interoperability standards for nationwide data exchange Understanding the regulatory burden that has been put upon physicians is in many cases indepen- dent of the Accountable Care Act. These multiple regulatory burdens are expensive and time-consuming administrative requirements. Financial incentives: The Alli- ance recommended that Congress use positive incentives rather than penalties. Last year CMS doubled the maximum penalties associated with the value-based payment modifi er (VBM) and increased the number of physicians affected by roughly 50%. The VBM penalties combined with other program penalties including the Physician Quality Reporting System (PQRS) and EHR payments increased the penalties by nearly 10%. Physicians must be given the fl exibility to improve quality that is relevant to their patients, practices, and deemed appropriate by societies such as ASCRS. Transparent adjustments to physician payments: Congress re- quires CMS to use the resource-based relative value scale (RBRVS) to de- termine fee-for-service payments for physicians, but CMS does not release its proposed RVU changes until the fi nal rule in November. Reimburse- ment adjustments become effective approximately 2 months later. This provides little time for physicians' practices to prepare for reimburse- ment changes and provides no time to comment until after RVU adjustments have been implement- ed. The Alliance urged Congress to announce adjustments and the rationale behind the adjustments earlier in order to allow practices time to analyze and comment before implementation that could affect patients' access to care. ICD-10: Specialty physicians are concerned about the transition to ICD-10. One concern is that the volume of codes is increased signifi - cantly. ICD-10 contains more than 141,000 codes, which is a 712% increase over ICD-9's nearly 20,000 codes. The Alliance urged Congress to direct CMS to conduct testing with medical practices of all sizes and closely monitor ICD-10 imple- mentation. The Alliance has also requested CMS create an administra- tive process and hardship exception process. This is important, as it will ensure physicians will be held harm- less from steep fi nancial penalties from denied claims should they face challenges with the adoption of a complex coding system. EHR interoperability: The goal is to enable better workfl ow, enhance quality of care, promote patient cen- tric treatment and outcomes, reduce medical errors, allow data transfer between EHR systems, and decrease the cost of healthcare delivery. Interoperability is dependent upon the appropriate government agency in consultation with Congress to oversee this process to achieve a nationwide data exchange. Our responsibility: Federal reporting requirements add to the physicians' work without any direct benefi t to the patient. The only way this may change is if Congress hears from people like you. For the last 2 years that I have attended the Fly-In, we have been told by members of Congress that "physicians and their representatives give up too easily." We complain more than we advo- cate. When other health-related industries see legislative change, they advocate by allocating ample resources to ensure their voices are heard. It is our job not to sit idly by, but to be part of the change through advocacy and education. Get involved, write to or meet with your local representatives to educate them on the issues, and ask for their support. Keep yourself educated on the issues and don't expect someone else to fi x the problem for you. Independent Payment Advisory Board (IPAB) Francis W. Price Jr., MD Indianapolis Early in July, I traveled to Washington, D.C. to participate in the Legislative Fly-In with the Alliance of Specialty Medicine and ASCRS. Four physician members of Congress spoke to us with a com- mon plea that physicians become more involved in what Congress is doing—either run for offi ce or help educate our legislators about healthcare. We are on the front lines of healthcare, and no one knows it better than we do. Just as we help educate our patients every day, we need to help educate our senators and congressmen—the ones who ultimately determine the way we practice medicine. If they don't understand what we do, will they make the right decisions? A key action Congress must take is to repeal the Independent Payment Advisory Board (IPAB), which was created by a provision in the Affordable Care Act (ACA) to set up a 15 member non-elected panel beginning in 2015 that would make recommendations for cuts to Medicare if spending increases by a certain amount. The IPAB's decisions would not be subject to Congressional oversight, and since the cuts must not affect benefi cia- ries, they are likely to be directed at physicians. It is analogous to the "one ring" in Lord of the Rings: the one rules them all. While in Wash- ington, my fellow physicians and I asked our members of Congress to pass H.R. 351/S. 351—bipartisan leg- islation with more than 200 House co-sponsors that would repeal IPAB. IPAB is a good example of how just a few pages of a many-hundred page bill can have a big effect on physicians and their patients. Think about if we had a new disease that physicians said was too complex to read about—inconceivable, right? So I challenge you to take a closer look at this issue and why it is such a bad deal for physicians and patients. Hopefully, you will be moti- vated to read just 12 pages of the amended Social Security Act where the ACA has set this up. Read it for yourself, don't just rely on me, lobbyists, or lawyers to tell you if it is real or not—think of it as a new, deadly disease that will affect you and your family. Go to www. healthcare.gov/where-can-i-read-the- affordable-care-act. Here are some key points about IPAB from Sec. 1899A of the Social Security Act: 1. Essentially mandates cuts in Medicare payments if spending reaches a certain level. Since payments must not affect benefi - ciaries, that leaves physician pay- ments as the likely target. How- ever, continued cuts to physician payments will result in reduced access to care for benefi ciaries. 2. "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare benefi ciary premiums … increase Medicare benefi ciary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefi ts or modify eligibility criteria." 3. Hospitals, long-term care facili- ties, and suppliers of goods are exempt from cuts until 2020. 4. Essentially physicians, and Part C and D of Medicare, will shoulder the cuts. 5. There is no judicial review of anything the Board or Secretary of the U.S. Department of Health and Human Services (HHS) does in regard to this section. 6. The Secretary of HHS has all the same powers as the Board. 7. "The Board may secure directly from any department or agency of the United States information necessary to enable it to carry out this section." The members of the Board are to have no other job, and no more than half of the members can have been providers or managers in healthcare. The Secretary of HHS and appointed bureaucrats are giv- en wide-ranging powers and will be making essential healthcare decisions that are not under the oversight of either Congress or the judicial system. They will have the power to set criminal and civil fi nes and penalties. Practicing physi- cians, or others actively engaged in healthcare, are prohibited from decision-making. Patients are given the illusion this will improve access and quality of care, when in fact, it will do the exact opposite. EW Contact information Bakewell: eyemanaz@aol.com Patterson: larryp@ecotn.com Price: francisprice@pricevisiongroup.net Syler: sylervl@mcdonaldeye.com Yeh: syeh2020@aol.com The Alliance of Specialty Medicine continued from page 18

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