Dec. 14, 2017: National Advocacy Update

Last week both the House and Senate moved to go to conference on H.R. 1, the Tax Cuts and Jobs Act. The Conference Committee will work to reconcile the differences between the House and Senate-passed versions of the bill. The AMA sent a letter (PDF) to the conferees highlighting areas of the two bills of importance to the physician community.

Specifically, the AMA urged the committee to adopt the Senate language that would maintain the tax deductibility of high medical expenses. The Senate bill would also lower the percentage of a person's adjusted gross income that qualified medical expenses must exceed in order to claim the deduction from 10 percent to 7.5 percent for 2017 and 2018. In addition the letter urges the conferees to maintain the deduction for student-loan interest and the exemption from taxation for qualified tuition reductions. The AMA also urged the committee to not include language in the final bill that would repeal the individual responsibility provisions of the Affordable Care Act.

Late on Wednesday, Dec. 13, it was announced that the tax bill conferees had reconciled their differences and legislative language was being drafted for passage by the House and Senate. However, no official summary of the agreement was available at press time.

"This proposed $69 billion transaction—one of the largest merger deals in the history of American health care—would have long-term impact on the markets for health insurance and pharmaceutical benefit management services. These markets are already dominated by few participants with large market shares, including Aetna in health insurance and CVS in pharmaceutical benefit management. The AMA is committed to reviewing all issues triggered by this proposed merger to preserve the benefits of competition, including increased access and choice, lower prices and higher quality care for patients."

—David O. Barbe, MD, MHA, president, American Medical Association

On Dec. 12, the House Education and Workforce Committee approved H.R. 4508, the PROSPER Act. The bill streamlines the financial aid and loan repayment programs available to undergraduates, parents and graduate students and caps the loan amounts available with annual and lifetime limits.

Importantly, it would eliminate the Federal Direct Loan Program which provides an array of repayment options that meet the needs of medical students who come from diverse backgrounds and have a high student debt burden. It would also eliminate the Public Service Loan Forgiveness program which forgives the debt of medical students who make 120 monthly payments while working for government organizations or qualified non-profit entities serving communities in need.

Due to concerns about the negative impact of these provisions on the looming physician shortage and the ability of medical students to repay their loans with the new annual and lifetime caps, the AMA submitted a letter (PDF) to committee leadership. The Senate Health, Education, Labor and Pensions Committee will consider its Higher Education Reauthorization Act in March 2018. The AMA is committed to working with committee leadership in the House and Senate to address its outstanding concerns with this legislation.

Physicians, overwhelmingly, are finding themselves the target of cyberattacks that disrupt their practices and put patient safety at risk.

A staggering 83 percent of physicians told AMA researchers that their practices have experienced a cyberattack of some type. The 1,300 physicians surveyed also said not enough cybersecurity support is coming from the government that will hold them accountable for a patient information breach. These and other findings are contained in a first-of-its-kind survey from the AMA and management consulting firm Accenture. The data (infographic) provide new depth—and an often overlooked physician voice—to the discussion on how best to protect patients in a complex health care system that is increasingly connected and vulnerable to cybercriminal exploitation.

"The important role of information sharing within clinical care makes health care a uniquely attractive target for cyber criminals through computer viruses and phishing scams that, if successful, can threaten care delivery and patient safety," said AMA President David O. Barbe, MD, MHA. "New research shows that most physicians think that securely exchanging electronic data is important to improve health care. More support from the government, technology and medical sectors would help physicians with a proactive cybersecurity defense to better ensure the availability, confidentially and integrity of health care data."

A June 2017 report by the congressionally mandated Health Care Industry Cybersecurity Task Force found "health care cybersecurity is a key public health concern that needs immediate and aggressive attention," and that, "most importantly, cybersecurity attacks disrupt patient care." The 88-page document underscores the risk to medical care delivered in smaller settings, which are especially vulnerable to attacks by cybercriminals.

Read more at AMA Wire.

AMA Board of Trustees Chairman Gerald Harmon, MD, testified on Dec. 13, before the House Energy & Commerce Subcommittee on Health at a hearing entitled, "Examining the Pharmaceutical Supply Chain." Other witnesses included major associations within the drug supply chain. Dr. Harmon highlighted the importance of patients receiving the right treatments at the right time, and that the burdens physicians and patients face often hinder access.

In his testimony (PDF), he noted that the increasing cost of pharmaceuticals has led public and private payers to develop regulatory valves for patients to access necessary medications. Among these are prior authorizations, step therapies and non-standardized forms and appeals processes that physicians and patients endure to ensure that medications are received promptly. Not having timely access to pharmaceuticals can prevent patient adherence to treatment regimens and can lead to further medical complications and greater cost to the health care system. The AMA will continue to work with Congress to address physician regulatory burdens and policies that will ensure patients have access to timely medications.

The AMA commended Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, for recent comments on the opioid epidemic in which he endorsed the need to expand use of medication-assisted treatment (MAT) for opioid-use disorder, including for people being held in the criminal justice system. The commissioner also highlighted the need to overcome stigma and insurance barriers in order to make MAT more readily available to patients, and noted that public insurance plans in all states do not yet cover all of the FDA-approved medications that treat opioid use disorder.

The FDA has also announced a public hearing to be held on Jan. 30, 2018, to discuss possible interventions at the point of prescribing that would be intended to reduce prescribing of opioids. At the hearing, the FDA's Opioid Policy Steering Committee will receive stakeholder input on strategies to change prescribing patterns by requiring special documentation in order to prescribe quantities of opioid analgesics above an amount that is determined to be routinely required for particular conditions, such as dental pain or surgery. The hearing will also explore whether a nationwide prescription-history database should be developed, as well as the role that unit-of-use packaging and mechanisms for returning unused pills could play in addressing the epidemic.

• Dec. 14, 2017: Advocacy spotlight on Pick your pace for 2017 MIPS reporting 
• Dec. 14, 2017: State Advocacy Update 
• Dec. 14, 2017: Judicial Advocacy Update