Tra Chella Johnson-Foy, M.D., Chair

Transcription

1 FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES 0 CONSENT CALENDAR REFERENCE COMMITTEE IV MEDICAL ECONOMICS Tra Chella Johnson-Foy, M.D., Chair The Reference Committee recommends that the following Consent Calendar be adopted. The item number listed below corresponds with the item number in the main report. RECOMMENDED FOR ADOPTION () Report D of the Board of Governors Recommendation D- () -0 Provider Insurance Credentialing Delay RECOMMENDED FOR ADOPTION AS AMENDED OR SUBSTITUTED () -0 Unfair Medicare Penalty () -0 Duplicative Credentialing for In-Network Practice Transitions () -0 Denials for Substitute Procedures That Can Be Reasonably Anticipated () -0 Prior Authorization for In-Patient and Non-Emergent Procedures () -0 Sham Reviews and Transparent Authorization Process () -0 CMS Reduction of Evaluation and Management Reimbursement () -, Opposing Blending Outpatient Reimbursement Rates RECOMMENDED FOR NOT ADOPTION (0) -0 Insurers Practicing Medicine Without a License () -0 Support for the CMS Proposal to Overhaul E/M Service Payments RECOMMENDED FOR REFERRAL TO BOARD OF GOVERNORS () Report D of the Board of Governors Recommendation D- RECOMMENDED FOR FILING OR REAFFIRMATION () Report D of the Board of Governors Recommendation D-

2 FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES 0 Report of Reference Committee No. IV Medical Economics Presented by: Tra Chella Johnson-Foy, M.D., Chair Mr. Speaker, Reference Committee IV- Medical Economics has considered each of the items referred to it and presents the following report. The Committee s recommendation on each item will be submitted separately and I respectfully suggest that each item be acted upon before going to the next. REPORT D OF THE BOARD OF GOVERNORS The informational report in the FMA Delegate Handbook contains a summary of major Board actions taken on items related to the Council on Medical Economics and Practice Innovation. () Board Recommendation D-: Resolution -0, Physician Payments to Same Day of Service Mr. Speaker, your Reference Committee recommends that Recommendation D- be adopted. The Committee did not receive testimony on this recommendation. () Board Recommendation D-: Resolution -0, Physician Right to Decline Supervision of Non-Physician Clinicians Mr. Speaker, your Reference Committee recommends that Recommendation D- be referred back to the Board for further study. The Committee heard testimony in favor of revising this recommendation. The testimony indicated that there may be additional options for assisting physicians who are affected by this issue. The Committee also received proposed language describing these potential options, which include the development of educational materials to assist physicians with navigating the contractual issues surrounding the supervision of non-physician-clinicians. Given that testimony indicated there may be additional options for the Board to consider, the consensus of the Committee was that Recommendation D- should be referred back to the Board for further study. () Board Recommendation D-: Mr. Speaker, your Reference Committee recommends that the remainder of Report D of the Board of Governors be filed for information. () RESOLUTION -0, PROVIDER INSURANCE CREDENTIALING DELAY, American College of Obstetricians and Gynecologists District XII Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted.

3 Reference Committee IV, Page The resolution reads as follows: RESOLVED, The Florida Medical Association will survey its members within the next months to gain insight into issues members are having with delays in credentialing; and be it further RESOLVED, The Florida Medical Association will work on behalf of its members with the appropriate agency to address issues with specific payers, If systematic credentialing delays are noted with a payer or class of payers. To be included in the potential remedies considered is pursuit of regulations that mandate insurer response to a credentialing application within 0 days of submission. The Committee heard testimony in support of this resolution. Presenters indicated that the current credentialing process can sometimes lead to substantial delays that waste caregiver time, affect the continuity of treatment, and postpone patient care. The Committee was also informed that a particular organization, CAQH, may be able to provide the capabilities to help fulfill the directives of this resolution. Note: An editorial change was made to improve the wording of the resolution. () Resolution -0, UNFAIR MEDICARE PENALTY, South Florida Caucus Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended by insertion and deletion to read as follows: RESOLVED, That the Florida Delegation to the AMA submit a resolution requesting the AMA to petition lobby CMS to rescind all penalties related to MIPS, including those related to the use of EHRs. the % penalty on physician practices that have not converted to certified computerized medical records. The Committee heard testimony in support of this resolution. It was acknowledged in testimony that MIPS has replaced the Meaningful Use program alluded to under this resolution. In light of this, the Committee agreed that a technical amendment would help clarify the resolution. The Committee also heard testimony from the author, who was in favor of an amendment to require the federal government to repay physicians who were previously penalized under the Meaningful Use program. However, the Committee did not believe that such an amendment would be feasible from a legislative standpoint. Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended. () RESOLUTION -0, DUPLICATIVE CREDENTIALING FOR IN-NETWORK PRACTICE TRANSITIONS, Orange County Medical Society

4 Reference Committee IV, Page Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted. The resolution reads as follows: RESOLVED, That the FMA support legislation or administrative rules that would prohibit insurance carriers from subjecting in-network providers to re-credentialing when they transition to a new practice. The Committee heard testimony in support of this resolution. Presenters indicated that the current credentialing process can sometimes lead to substantial delays that waste caregiver time, affect the continuity of treatment, and postpone patient care. During testimony, one presenter offered a proposed amendment that would attempt to help clarify which physicians and practices would be affected by this resolution. However, the Committee found this proposed amendment to be unnecessary. The Committee therefore concluded that the resolution should be adopted as originally proposed. () RESOLUTION -0, DENIALS FOR SUBSTITUTE PROCEDURES THAT CAN BE REASONABLY ANTICIPATED, Florida Orthopaedic Society Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended by insertion and deletion to read as follows: RESOLVED, That the Florida Medical Association seek legislation to prohibit insurance carriers from denying claims for the performance of substitute surrogate procedures that can be reasonably anticipated to be a valid substitution for an authorized procedure to cure treat an underlying ailment or injury. The Committee heard considerable testimony in support of this resolution. During testimony, one presenter offered a proposed amendment to clarify the language in the resolution. The Committee decided to support technical changes to the resolution based on testimony. Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended. () RESOLUTION -0, PRIOR AUTHORIZATION FOR IN-PATIENT CARE AND NON-EMERGENT PROCEDURES, Florida Orthopaedic Society Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended by insertion and deletion to read as follows: RESOLVED, That the Florida Medical Association seek support legislation to prohibit insurance carriers from requiring prior authorization for patients who have been admitted to are being treated in the hospital;

5 Reference Committee IV, Page and be it further RESOLVED, That the Florida Medical Association seek support legislation that would prohibit insurance carriers from requiring prior authorization for treatment procedures codes that can be reasonably expected to be administered in connection with or substituted for associated with an emergency condition procedure that does not require prior authorization. The Committee heard considerable testimony in support of this resolution. The testimony included proposed language to help strengthen and clarify the language of the resolution. The Committee agreed that the language in the resolution could be improved and submitted amendments accordingly. Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended. () RESOLUTION -0, SHAM REVIEWS AND TRANSPARENT AUTHORIZATION PROCESS, Florida Orthopaedic Society Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended by insertion and deletion to read as follows: RESOLVED, That the Florida Medical Association seek support legislation to mandate that all treatment guidelines and authorization protocols implemented by insurance carriers must be ) transparent and readily available to their insured and treating physician and ) that Medical Directors making coverage determinations on the grounds of Medical Necessity must certify that they have directly reviewed the relevant medical records and received input from a physician in the same specialty as the treating physician, prior to the denial. The Committee heard considerable testimony in support of this resolution. The testimony included proposed language to strengthen and clarify the language of the resolution. The Committee agreed that the language in the resolution could be improved and submitted amendments accordingly. Recommendation : Mr. Speaker, your Reference Committee recommends that Resolution -0 be adopted as amended. (0) RESOLUTION -0, INSURERS PRACTICING MEDICINE WITHOUT A LICENSE, Hillsborough County Medical Association

6 Reference Committee IV, Page Mr. Speaker, your Reference Committee recommends that Resolution -0 not be adopted. RESOLVED, That the Florida Medical Association seek legislation to eliminate insurance companies from delaying or overriding the practicing physicians request for medical tests and procedures as there are established standards of care in place that are in the patients best interest; and be it further RESOLVED, That the Florida Medical Association request the American Medical Association seek legislation to eliminate medical management by insurance companies; and be it further RESOLVED, That there should be. any return of non-patient approved second opinion/medical management oversight. The Committee heard no testimony concerning this resolution. The consensus of the Committee was that the legislative directive proposed in this resolution is not feasible. The Committee also identified existing FMA policies that address the topic of this resolution. Therefore, the Committee concluded that the resolution should not be adopted. () RESOLUTION -0, CMS REDUCTION OF EVALUATION AND MANAGEMENT REIMBURSEMENT, American College of Physicians, Florida Chapter, RESOLUTION -, OPPOSING BLENDING OUTPATIENT REIMBURSEMENT RATES, Escambia County Medical Society, Santa Rosa County Medical Society Recommendation : Mr. Speaker, your Reference Committee recommends that the following resolution be adopted in lieu of resolutions -0 and -: RESOLVED, That the Florida Medical Association work diligently with the AMA to urge CMS to not adopt any changes to E/M payments that would adversely impact physicians, and instead enact reforms that would reduce administrative burdens without compromising access to care. Resolution -0 originally read as follows: RESOLVED, That the Florida Medical Association work diligently with the AMA and to write a letter from FMA to CMS urging CMS to rescind the proposed E/M cuts and even propose a payment system with the focus on increasing payment while decreasing documentation requirements that, if not corrected, could ultimately adversely affect our primary goal of quality care for the patient. Resolution - originally read as follows: RESOLVED, That the Florida AMA delegation submit a resolution to support federal legislation that opposes this CMS proposal (Proposed 0 CMS Medicare Physician Fee Schedule Change placed on the

7 Reference Committee IV, Page Florida Registry on //0) to change outpatient reimbursements to a blended methodology for new office visit codes (0-0) and established office visit codes (-), as it will reduce reimbursements to physicians and lead to lower quality and less thorough patient care. The Committee heard considerable testimony in support of Resolution -0 and -. Numerous physicians from multiple specialties and counties testified that CMS s current proposal to revise reimbursement for E/M codes would adversely impact access to care for medically complex patients. The Committee also heard testimony concerning the negative impact that this proposal could have on the economic viability of physician practices. The Committee concurred that CMS should not adopt changes that would be detrimental to patients or physicians. The Committee also noted that the AMA and other major medical societies are still working to develop their response to CMS regarding these proposed changes. The Committee further noted that resolution -0 and - were substantially similar in their content and intent. Therefore, the Committee recommends combining these resolutions. In doing so, the Committee aims to address the concerns expressed during testimony while offering sufficient flexibility to respond to this complex regulatory proposal. Recommendation : Mr. Speaker, your Reference Committee recommends that the proposed resolution be entitled PROPOSED CHANGES TO EVALUATION AND MANAGEMENT CODES () RESOLUTION -0, SUPPORT FOR THE CMS PROPOSAL TO OVERHAUL E/M SERVICE PAYMENTS, John Ward, M.D. Mr. Speaker, your Reference Committee recommends that Resolution -0 not be adopted. RESOLVED, That the FMA write a letter of support to CMS regarding this overhaul of the payment system; and further be it RESOLVED, That the FMA also urge the AMA to support this overhaul of the E/M payment system. The Committee heard testimony from the author in favor of this resolution. The author noted that these proposed changes would substantially reduce the administrative burden in his practice without adversely impacting access to care. However, the Committee also heard overwhelming opposition to this resolution from members speaking on behalf of multiple counties, specialties, and individual practices. Therefore, the Committee recommends that this resolution not be adopted. Mr. Speaker, in closing I wish to publicly thank the members of the Reference Committee: Dr. Vania Fernandez Dr. Ruple Galani Dr. Rudolph Moise Dr. Alfredo Parades Dr. Brence Sell

8 Reference Committee IV, Page Dr. Jason Wilson I would also like to thank Jarrod Fowler and Cindy Kynoch, FMA Staff, for their support of the Committee and the members of the FMA who attended our meeting and presented testimony. Mr. Speaker, I move that the Report of Reference Committee IV be adopted.

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