July 23, 2020: National Advocacy Update

On July 22, the AMA led a coalition of 102 state and national medical societies which signed on to a letter urging the Centers for Medicare & Medicaid Services (CMS) to sunset temporary waivers involving scope of practice and licensure when the COVID-19 Public Health Emergency ends.

The letter outlines the extensive education and clinical training of physicians and urges CMS to support physician-led, team-based approaches to care that preserves the physician-patient relationship and makes clear that efforts to the contrary would be vigorously opposed.  The letter makes clear that this would be a major policy shift which medicine would strongly oppose.    

On July 14, the AMA sent a letter strongly urging the administration to withdraw Proposed Rule RIN 1125-AA94. If passed this rule would impose new barriers at every stage of the asylum process, which will be impossible to meet for the vast majority of applicants, resulting in a multitude of valid asylum seekers being returned to countries that do not value their lives, health or social equity. As such, the AMA urged the administration to prioritize supporting and protecting the health and well-being of individuals and families seeking asylum by withdrawing the proposed rule in its entirety.

On July 6, the Student and Exchange Visitor Program (SEVP) announced modifications to temporary exemptions for nonimmigrant students taking online classes due to the public health crisis for the Fall 2020 semester. Specifically, SEVP announced that nonimmigrant F-1 and M-1 students attending schools operating entirely online could not take a full online course load and enter or remain in the United States.

In response, the AMA sent a letter urging the administration to withdraw its modifications to the temporary exemptions for nonimmigrant students taking online classes due to the pandemic for the fall 2020 semester, so that medical students seeking to study in the U.S. on an F-1 visa could enter or remain in the country. Thankfully, and in part due to the advocacy efforts of the AMA, on July 14, the Trump Administration rescinded the directive that would have barred F-1 students from the United States if their colleges canceled in-person instruction during the pandemic. The AMA is grateful that the administration has reconsidered what would have been a setback for U.S. public and rural health. International medical students can now focus on their studies—rather than their immigration status—as they prepare to enter the health care field and help fight this pandemic. 

The AMA, joined by the American Hospital Association, urged CMS to delay the Jan. 1, 2021, implementation of the Appropriate Use Criteria (AUC) program by at least one year. As a result of the COVID-19 pandemic, physicians and hospitals need more time to adjust workflows, train staff and test operational changes necessary to achieve compliance with the program. Resources are strained as physicians and hospitals focus on continuing to meet patient care needs during the COVID-19 pandemic, including expanding their telehealth capacities and clearing the numerous hurdles of reopening. Also, in some cases, physician practices have temporarily closed, and hospitals and practices have reduced staff, making it even more difficult to access and update the necessary information systems and conduct training to prepare for AUC implementation.

CMS released the results for the second year of the Merit-based Incentive Payment Program (MIPS) and alternative payment models (APM), which impacts Medicare payments in 2020. 97% of 2018 MIPS-eligible clinicians earned a positive payment adjustment of up to 1.68 percent in 2020. As a result of strong AMA advocacy, 84% of small practices earned a positive payment adjustment. This is an improvement from the 2017 results when 74% of small practices received positive adjustments. 

More clinicians participated in MIPS as an APM – 41% in 2018, up from 34% in 2017. Additionally, the number of Advanced APM-qualified participants who earned a five percent incentive payment increased from 99,076 in 2017 to 183,306. 

The AMA continues to seek modifications to simplify and streamline MIPS reporting, particularly during the COVID-19 pandemic. CMS responded to AMA recommendations by allowing physicians to opt-out completely or partially from MIPS in 2020 by submitting a hardship exception application and indicating the reason is COVID-19.

The U.S. Department of Health and Human Services (HHS) released initial information about future reporting requirements for recipients of the Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund. Physicians and organizations that received $10,000 or more in aggregate from any of the distributions of the Provider Relief Fund, including the general Medicare distribution, the Medicaid/CHIP distribution and the targeted distributions, may be required to submit reports demonstrating compliance with the terms and conditions. 

Recipients may be required to submit data about how they expended the funds during the 2020 calendar year via an HHS reporting system between Oct. 1, 2020, and Feb. 15, 2021. Any funds that are unspent by the end of the year may be accounted for in a second and final report submitted no later than July 31, 2021. HHS intends to provide detailed reporting instructions and a data collection template by Aug. 17. The AMA will continue to advocate against undue burden on physician practices during the COVID-19 pandemic.   

The AMA submitted comments recently to CMS on the hospital inpatient prospective payment system (IPPS) for acute care hospitals and long-term care hospitals (LTCH) proposed rule. Its comments focused on areas that have particular impact on physicians and patients in those settings, such as inpatient quality reporting and reducing hospital readmissions. The AMA supports CMS' proposal to extend continuous 90-day reporting for the Medicare Promoting Interoperability (PI) Program Electronic Health Record (EHR) reporting periods in 2022, cautioning against an unnecessary tight timeline for EHR product design, development, testing and implementation. The AMA strongly urged CMS to plan for the inevitable disruptions and complications which are likely to result from physicians and hospitals having to rapidly adopt new EHRs during the 2022 PI reporting period. 

The AMA supported the query of PDMPs as a voluntary measure for EHR reporting in 2021, and advocated for a "less is more" approach to reduce burden of reporting and to promote interoperability, such as a simple "yes or no" attestation to a health information exchange measures in PI. 

The AMA weighed in strongly against the inclusion of the Safe Use of Opioids – Concurrent Prescribing measure in the Hospital Inpatient Quality Reporting (IQR) Program due to its ongoing concerns that this measure will not truly drive improvements in care, is not aligned with the CDC guideline, and may result in unintended negative consequences for patients, hospitals and physicians. Instead, the AMA recommended that quality measurement focus on how well patients' pain is controlled, whether functional improvement goals are met, and what therapies are being used to manage pain. 

The AMA also:

• Encouraged CMS to further streamline the hospital quality reporting programs to reduce physician burden and better understand the impact CMS policies have on readmissions and patient outcomes
• Urged CMS to evaluate each novel technology on a stand-alone basis to determine whether it meets the stated criteria for consideration instead of finding that technology using artificial intelligence cannot have a new mechanism of action where its main purpose is to replace or supplement human protocols or thought processes and where no such technology currently exists, as CMS suggests
• Supported the new definition of "displaced resident" which gives residents greater flexibility to transfer to new hospitals during the winding down phases of their current placements

• July 23, 2020: Advocacy spotlight on New AMA report shows 37% decline in opioid prescribing but an evolving and deadlier overdose epidemic
• July 23, 2020: State Advocacy Update
• July 23, 2020: Judicial Advocacy Update