Nov. 3, 2023: National Advocacy Update

Registration is open for the 2024 AMA National Advocacy Conference, Feb. 12-14 at the Grand Hyatt in Washington, D.C.  

The AMA National Advocacy Conference brings the power of organized medicine to our nation’s capital. Don’t miss your chance to: 

• Connect with industry experts, members of Congress and the Administration, and others about federal efforts to improve health care 
• Advocate on crucial health care issues affecting physicians and patients 

Featured speakers will include: 

• Donna Brazile, renowned political strategist and commentator, former interim chair of the Democratic National Committee 
• Ana Navarro, GOP strategist, political contributor to CNN and Telemundo, and co-host of ABC’s The View 
• Geoff Bennett, PBS NewsHour co-anchor   
• Brian Miller, MD, MBA, MPH, practicing hospitalist at the Johns Hopkins Hospital, assistant professor of medicine at the Johns Hopkins University School of Medicine and nonresident fellow at the American Enterprise Institute 

For more information, view the preliminary meeting agenda (PDF).  

On Oct. 30, the AMA sent a letter (PDF) to the Department of Health and Human Services (HHS) and the Treasury detailing strong concerns with recent correspondence practices are receiving concerning Provider Relief Fund (PRF) repayments. Specifically, practices are being informed that they will have any amounts owed, along with 11.5% annual interest and additional penalties, automatically recouped through reductions to their Medicare claims payments.  

The AMA expressed extreme concern about the abruptness and lack of transparency of these claw backs on Medicare payments without rulemaking or public notice, particularly after the AMA raised persistent concerns over lack of communication regarding the PRF reporting requirements and deadlines. The AMA also reiterated past concerns that PRF recoupments will disproportionately harm small, rural and safety net practices and the communities they serve. 

In the letter (PDF), the AMA reiterated once again a desire to work with the administration to find a resolution and outlined several specific recommendations to help bring practices into compliance and mitigate the financial impact on potentially thousands of practices across the country. 

On Oct. 30, President Biden signed a significant executive order (EO) on artificial intelligence (AI). The EO includes both broad statements of the administration’s priorities and direction on AI, but also includes a significant number of specific directives aimed at a number of sectors where AI is rapidly advancing. The EO takes a much stronger stance on new policy creation to ensure AI quality and safety than previous releases by the White House. Specifically, the EO calls on HHS to:  

• Establish an AI task force to develop a strategic plan that includes new policies, frameworks and potential regulatory actions on responsible deployment of AI-enabled technologies in health and human services in the areas of predictive and generative AI-enabled technologies; long-term safety and real-world performance monitoring; incorporation of equity principles in AI-enabled technologies; incorporation of safety, security and privacy standards; development of documentation to help users determine appropriate and safe uses of AI, and identification of uses of AI to promote workplaces satisfaction and reduce administrative burdens; among others.  
• Develop a strategy to determine whether AI-enabled technologies maintain appropriate levels of quality, including the development of an AI “assurance policy” aimed at evaluating important aspects of AI performance. 
• Consider actions to advance understanding and compliance with federal nondiscrimination laws, including technical assistance to providers and payors about their obligations under federal law. 

Also included is a directive to promote equitable administration of public benefits, requiring the HHS Secretary to publish a plan to assess the use of automated or algorithmic systems in administration of public benefits such as the Medicare and Medicaid programs. The plan should address impacts on access to benefits, disclosure of the use of such systems, unjust denials, processes to appeal to human reviewers, and others. Additional directives address use of AI as biosecurity threat and promote AI competitions to advance healthcare AI within the Department of Veterans Affairs. Many of the directives are in line with AMA policy and advocacy on AI.  

The AMA will continue policy development in the AI space to ensure the transparent, ethical, responsible and equitable deployment of AI in health care and will be closely watching the administration’s actions in response to the EO.   

On Oct. 30, the Office of the National Coordinator for Health Information Technology (ONC) and the CMS published a proposed regulation specifying the “appropriate disincentives” for health care providers that the HHS Office of Inspector General (OIG) has determined committed information blocking. This effort complements the regulation published earlier this year (PDF) that defines the civil monetary penalties for other regulated actors: health IT developers, health information exchanges and health information networks. 

This new regulation focuses on health care providers (PDF), specifically physicians, hospitals and Accountable Care Organizations (ACOs). For providers that OIG determines are information blockers, CMS is planning to use its payment policies to implement the disincentives.  

There are disincentive proposals for:  

• Eligible clinicians or groups functioning under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS) 
• Eligible hospitals or critical access hospitals in the Medicare Promoting Interoperability Program 
• Health care providers that are an ACO, ACO participant, or ACO provider or supplier under the Medicare Shared Savings Program 

Information blocking by health care providers includes an element of intent. The standard of intent for health care providers is based on their requisite knowledge of information blocking. The OIG will take this and other factors into account when investigating accusations of information blocking by providers. Each investigation will be evaluated on a case-by-case basis.  

The AMA continues to advocate that ONC’s information blocking regulations are overly complex and federal education and compliance guidelines are insufficient. Moreover, there is increasing evidence that ONC’s information blocking regulations lack necessary protections for patients’ sensitive health information. 

AMA will comment on the proposed regulations. The comment period closes on Jan. 2.   

The presence of xylazine—an animal tranquilizer that is not approved for human use—has been increasingly found in connection with overdose-related deaths. The combination of xylazine and fentanyl presents a particular risk. 

In a recent AMA Update episode, Rahul Gupta, MD, MPH, director of the White House Office of National Drug Control Policy, discussed the decision by the White House to designate this combination of fentanyl and xylazine as an emerging threat to the U.S.  

Dr. Gupta explained that this combination creates new challenges to overdose and substance use disorder treatment, including: 

• It is more difficult to treat individuals with addictions to multiple substances as opposed to just one. 
• Individuals may be slower to respond to naloxone when having an overdose involving xylazine. 
• Xylazine can cause severe flesh wounds.  

To address these challenges, harm reduction will be of particular importance. “This administration is the first in the entire federal government's history to include harm reduction policies as part of the federal policies,” said Dr. Gupta. This week, as the AMA has advocated, the administration took action (PDF) to encourage naloxone availability in all schools, with students and faculty trained on how to use the overdose-reversing agent. Dr. Gupta also stressed the importance of decriminalizing and making accessible fentanyl and xylazine test strips, which the AMA also strongly supports. 

• Nov. 3, 2023: Medicare Payment Reform Advocacy Update