RheumWATCH Archives

”RheumWatch

Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.

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CMS Announces Plans to Reduce Meaningful Use Reporting Period

CMS Announces Plans to Reduce Meaningful Use Reporting Period

CMS has announced it intends to issue a new rule shortening the attestation reporting period in 2015 from 365 days to 90 days. Several members of Congress played a role in this decision by introducing legislation to reduce the reporting period, with a push from organizations including the ACR.

The ACR advocacy team has been working diligently with Congresswoman Renee Ellmers (R-NC) on legislation known as the Flex-IT Act to address this issue. The goal of this legislation was to either compel CMS to act on its own to reduce the required reporting period or pass a new law mandating this action by the agency. Along with the bill, Congresswoman Ellmers and 29 members of Congress wrote a letter to HHS Secretary Burwell advising her to take action.

The plan announced by CMS last week is one portion of an initiative undertaken by CMS to realign the Meaningful Use program to reflect program goals and to engage in rulemaking, with the intention of reducing reporting burdens on providers. The new rule is expected to be released this spring and aims to alleviate concerns regarding software implementation, information exchange readiness and other complications.

This welcome development is expected to eliminate a huge hurdle for physicians and stakeholders who had criticized the 365-day reporting period. The announcement is significant progress, and the ACR advocacy and regulatory teams will continue to monitor and track the rule-making process with CMS. Until the change is confirmed and finalized this spring, the ACR highly recommends that providers who were set to meet the full year of reporting requirements remain on that path.

The ACR will continue to be an active participant in this and related issues, and urges CMS to quickly implement these positive changes that would reduce the reporting burden on rheumatologists and other physicians. For more information on the forthcoming rule or assistance with meeting attestation requirements, contact advocacy@rheumatology.org

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Biosimilar Substitution – Trending in State Legislatures

With the majority of state legislatures convening this past month, ACR staff continues to track and advocate on policy issues that will affect you and your state. One of the most prominent issues being discussed around the country is how pending biosimilars will be substituted.

The ACR Government Affairs team is working with coalitions around the country to advocate for appropriate physician notification provisions to ensure patient safety and to preserve the physician-patient relationship.

As of Jan. 25, 10 states have introduced legislation related to access and substitution of biosimilars. It is anticipated that an additional nine states will follow. Specific language varies in each state, but most versions include provisions that the biosimilar be deemed interchangeable by the FDA, a“dispense as written” exception for the prescribing physician, as well as patient and provider notification, which have been variable state to state.

Our message to elected officials regarding notification—that for patient safety prior notification of a substitution is preferred, but where this is not possible there should be notification as immediately as possible—is best delivered by constituents that live in their districts. If you are interested in providing expert testimony in your state, please contact our State Government Affairs staff at advocacy@rheumatology.org or 404-633-3777.

CMS Provides Addendum for –X Modifiers

On Jan. 22, CMS released guidance that providers may continue to appropriately use modifier -59 as needed. CMS indicated that additional guidance and education will be forthcoming as the agency continues to introduce the -X {EPSU} modifiers in a “gradual and controlled fashion.”

Although CMS previously stated that there will be “rapid migration” to reporting -X modifiers, the article MLN Special Edition article SE1503, Continued Use of Modifier 59 after January 1, 2015 , states that CMS is planning to provide future guidance with descriptive information on the new modifiers and will identify situations in which a specific -X {EPSU} modifier will be required. It appears the agency is preparing to continue requiring providers to use the new -X modifiers as much as possible, and they specified that all MACs should be able to accept both the modifier -59 and the -X modifiers.

With the ongoing scrutiny of modifier -59 from CMS and the Office of Inspector General, providers will need to sufficiently document services and procedures that are separate and distinct from each other on the date of service. The ACR will continue to monitor guidance and training updates from CMS on the utilization of modifier-59 and the -X {EPSU} modifiers.

For questions or additional information on coding and billing, contact Melesia Tillman at mtillman@rheumatology.org or 404-633-3777 x820.

Message from the Affiliate Society Council Chair

Having served as the ASC member for New York for the last few years and participated in multiple ACR advocacy fly-ins, I have personally seen the benefits of being engaged in advocacy efforts for our organization. But we are currently facing more threats than ever, and to have any chance of future success we need engagement from all ACR members.

While the field of rheumatology has been privileged to see the arrival of highly effective therapies for crippling and life-altering rheumatic diseases as well as advances in more sophisticated imaging and lab testing, we concurrently witness the erosion of our professional autonomy, uncertain financial stabilities of our practices, excessive burdens from federal mandates, including EHR Meaningful Use 2.0 (and 3.0 and 4.0, etc.), and the looming nightmares of ICD-10 and the value-based modifier—all of which threaten the very access of our patients to these monumental innovations. And no one is insulated from these perils—whether you are a solo doc, in a small group practice, in a multispecialty group or in academia. In medical school we were taught about the multifaceted roles of the physician—as diagnostician and clinician, scientist, educator, counselor and community leader. I would argue that in the current climate of medical practice, becoming an active and vocal advocate for our patients and our profession is an additional essential ethical obligation of a physician.

I recognize we all have competing interests for our limited time in terms of practice and institutional responsibilities, family life and personal time, which can pose a significant barrier to getting more involved. Therefore, I would like to suggest taking smaller and more manageable bites out of the problem:

  1. Identify a vocal patient who might assist in local and national advocacy efforts. Give yourself the task of looking at your patient panel once monthly and try recruiting one patient to participate in the ACR advocacy fly-in this fall. It would be nice if you can join them, but that is not a necessity or a requirement. The voices of patients are powerful and help our advocacy efforts enormously.
  2. Make it a priority to visit your legislator in their local district office once yearly. When we do our fly-ins to D.C., there are times where our "asks" achieve meaningful and measurable results. But the most important outcomes are the relationships that are fostered. To be called on as a resource for Congress when big healthcare decisions are being made is priceless. Fortunately, this process can begin in our own backyards with smaller efforts and little cost (i.e., missed time from practice to go to D.C.).
  3. Give to RheumPAC. Currently only 3.8% of ACR members donate. A donation doesn't have to be big dollars. Consider giving $5 monthly. Or give $5 every time you happen to go to the ACR website. If you want to give more, that's terrific, but don't avoid giving because you feel your contribution is not meaningful or large enough.
  4. Attend your state society meetings. Robust state societies are essential to the health of our organization. Since “all politics is local” and the individual state societies offer the most nimble ways to advocate at the local level, being a member of and attending society meetings is extremely important. Being connected to your state society also affords one an opportunity to voice important practice concerns and have your state society respond to these issues promptly.

If your state currently does not have a state society, it is time to work with the ACR and ASC to help develop one. And if you dislike your own state society, then it is time to show up for meetings and make the necessary changes that would help make it the state society you want. For more information, contact ACR Staff at advocacy@rheumatology.org.

No one can be faulted for being pessimistic about the future of medical practice in the U.S. But we have to remember why we all went into medicine in the first place—for our patients. There is a tremendous amount of work to be done and many challenges ahead, but if we collaborate more effectively and all get a little more involved, I believe we can still preserve our noble profession and continue to provide the best quality care for our patients.

I am honored to be Angus Worthing's successor as ASC chair, and look forward to working with my colleagues at the ACR and member state societies to strengthen our state and national advocacy efforts.

Howard Blumstein, MD

New York State Rheumatology Society

Chair, ACR Affiliate Society Council