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With the transfer of power now underway in Washington, DC, the American Medical Association (AMA) is working with physician organizations like the CAP to tackle issues from national health care reform to the payment for services provided to patients.

At the recent AMA 2016 Interim Meeting, physicians outlined health reform issues and regulatory relief concerns that will be prominent following the inauguration of President-elect Donald Trump and a new Congress in Washington, DC. The CAP leads the Pathology Section Council at the AMA and participated in the discussions at this historic meeting, advocating on behalf of pathologists and laboratory medicine.

The priority issues include health care reform, regulatory relief, and the implementation Medicare reimbursement reforms under the Medicare Access and CHIP Reauthorization Act (MACRA). Of note, 170 state and specialty medical societies from across the country reaffirmed existing AMA policies on health reform. Information about the AMA's policies were shared with President-elect Donald Trump’s transition team, President Barack Obama's administration, and congressional leaders.

The AMA's comprehensive policy on health reform provides a foundation for upcoming deliberations on changes to the Affordable Care Act and other programs. On physician reimbursement, AMA policy supports improvements in the implementation of MACRA to enhance prospects for successful physician participation in new Medicare payment pathways. Other policy includes a focus on healthy information technology and improving usability and interoperability. The AMA also seeks health plan reduction in the number of services that require prior authorization.

Dr. Price to Lead HHS

A member of the AMA House of Delegates and congressman from Georgia, Rep. Tom Price, MD (R-GA), is the nominee to be the next Secretary of the Department of Health and Human Services (HHS). At the helm of HHS, Dr. Price could seek changes sought by physicians to Medicare reform under MACRA and other payment policies.

"His service as a physician, state legislator and member of the US Congress provides a depth of experience to lead HHS," said Patrice Harris, MD, chair of the AMA Board of Trustees. "Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs."

Through the years, Dr. Price has supported the CAP on a number of issues. In 2012, Dr. Price was a featured speaker at the CAP Policy Meeting. Dr. Price also was a lead sponsor on House legislation to repeal outdated cytology proficiency testing requirements, and he orchestrated passage of the bill twice in the House. In addition, he supported exempting pathologists and other hospital-based physicians from penalties under Medicare's meaningful use of electronic health record program. He supported the CAP's efforts to extend the technical component (TC) grandfather.

Dr. Price currently chairs the House Budget Committee and is a former chair of the Republican Study Committee. A vocal critic of “Obamacare,” Dr. Price has voted dozens of times with his fellow Republicans to repeal the Affordable Care Act. The repeal effort will continue under the Trump administration.

AMA-led Changes to MACRA, MIPS, APMs

During the AMA Interim Meeting, its leaders highlighted several key changes to MACRA, now known as the CMS’ Quality Payment Program (QPP), and its payment pathways, the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) programs. The first performance period for MIPS begins in 2017 and will affect Medicare payments in 2019.These changes include:

  • A 2017 transition period to avoid a MACRA/QPP 4% penalty in 2019
  • Increase in the low-volume threshold so more physicians will avoid penalties
  • A 0% weight for the MIPS' resource use category
  • A reduction in reporting threshold requirements

The AMA will continue to seek changes to MACRA. At the meeting, its House of Delegates adopted a resolution to advocate for an exemption for small practices from the Merit-Based Incentive Payment System (MIPS) under MACRA.

AMA delegates noted the CMS has established low-volume exemption for physicians who see less than $30,000 in Medicare payments or fewer than 100 Medicare patients per year. Some physicians at the AMA said the thresholds should be higher in order to exclude more small practices from the QPP. The House of Delegates agreed that the AMA should continue its efforts to advocate for small practice exemptions, which is policy that the CAP supports.

For more information on MACRA and MIPS, please view the CAP's most recent webinar and download the presentation slides.

Focus on Medical Education, Student Debt

Building on the AMA's innovative Accelerating Change in Medical Education initiative to create the medical school of the future, the new policy calls for the creation of leadership programs and new curricula that emphasize experiential and active learning models that include knowledge, skills and management techniques integral to leading interprofessional team care. The policy also calls for all medical students to receive this leadership training early in their medical education.

"As our health care system continues to evolve, medical schools must do more than simply prepare young doctors to care for patients – they must prepare them to take leadership roles in their practices," said AMA board member Jesse M. Ehrenfeld, MD. "The new policies adopted today will further our mission to create the medical school of the future by ensuring future physicians are prepared to quickly adapt to the changing health care landscape and provide care to patients, populations and communities as soon as they enter practice."

The new policy also encourages medical students and residents to work alongside community health workers as part of the physician-led team to gain valuable insight about how cultural competency can improve the delivery of care for patients with chronic diseases.

The AMA further adopted policy aimed at reducing medical student loan debt. The AMA supports eliminating tax liability for employers who offer benefits to fund repayment of student loans for physicians working in underserved areas.

Medical Malpractice

The AMA adopted a recommendation supporting state medical societies' efforts to defeat proposals to replace a state medical liability system with a no-fault liability or patient compensation system, unless those proposal are consistent with AMA policy. Several states are currently considering legislation proposing no-fault liability systems.

The AMA retains flexibility to support innovative medical liability reforms that are consistent with AMA policy, such as the National Vaccine Injury Compensation Program and birth-related neurological injury compensation funds. The AMA also supports state medical societies' efforts to implement legislation similar to California's Medical Injury Compensation Reform Act, which limits non-economic damages to $250,000.

Pathologist Receives AMA's Highest Honor

Forensic neuropathologist Bennet I. Omalu, MD, MBA, MPH, FCAP, received the AMA's Distinguished Service Award for his work to discover chronic traumatic encephalopathy (CTE) in an NFL player in 2002. Dr. Omalu persevered through challenges to discredit his work and, today, CTE is widely recognized as a risk to patients with histories of brain trauma.

"Because of the service Dr. Omalu has rendered to every player and every family member in the football and other sporting communities, I am delighted to present him, on behalf of the AMA, with the Distinguished Service Award—our highest honor," said AMA President Andrew W. Gurman, MD. "His meritorious service is all the more remarkable given that Dr. Omalu was relatively junior at the time of his discovery, having only completed his pathology residency a few years prior to describing CTE."

The Value of AMA Membership

The CAP encourages its members to strengthen pathology's voice at the AMA. The number of the CAP's delegates at the AMA's House of Delegates depends on the number of CAP members who join the AMA. By joining the CAP and AMA, pathologists can make sure our perspectives are considered during debate on health care reform and other issues important to the specialty.

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Congress passed a short-term budget resolution to keep the government open for the next five months and fund sweeping legislation to increase medical research and advance the approval process for new drugs and devices.

House lawmakers voted 326-96 on December 8 for the short-term Continuing Resolution (CR) (HR 2028) to prevent a government shutdown and continue funding for federal programs and services until April 28, 2017. The bill passed the Senate on December 9 with a 63-36 vote.

The CR on was signed into law by the president on December 10.

According to the House Appropriations Committee, the CR legislation would include $872 million in funding for the 21st Century Cures Act of 2016 , which boosts critical medical research, drug approval, opioid abuse funding, and pushes better use of technology in medicine.

On December 7, the Senate passed the 21st Century Cures bill, sending it to the desk of President Obama, who is expected to sign the legislation into law on December 13. The legislation had strong bipartisan support and passed the Senate in a vote of 94-5.

The Cures bill authorizes $4.8 billion in new funding for the National Institutes of Health; of that, $1.8 billion is reserved for the "Cancer Moonshot" launched by Vice President Biden to accelerate research in that field. Another $1.6 billion is earmarked for brain diseases including Alzheimer's. Also included are $500 million in new funding for the Food and Drug Administration and $1 billion in grants to help states deal with opioid abuse.

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Editor's Note: STATLINE is featuring stories about the upcoming transition of power across the federal government over the next several months. These stories will highlight major news on President-elect Donald Trump's administration and both chambers of Congress, and the impact of these new developments on the pathology specialty.

The 115th Congress will officially take office on January 3, 2017, where Republicans will continue to control both congressional chambers. In the House, Republicans will retain their majority with 241 House seats, to 194 for the Democrats. In the Senate the Republicans will have control with 52 seats, while Democrats have 48 Senate seats.

The CAP expects several leadership changes on key congressional committees overseeing Medicare, Medicaid, and health care reform that will be pertinent to the CAP's advocacy strategy. The following House members are identified as possible committee chairs of these House committees:

  • Rep. Greg Walden (R-OR) will chair the House Energy and Commerce Committee. Rep. Frank Pallone (D-NJ) will maintain his position as the ranking member of the committee. As for the House Energy and Commerce Health Subcommittee, several Republican members, including Rep. Michael Burgess (R-TX) and Rep. Tim Murphy (R-PA), are vying for chairmanship. Congressman Gene Green (D-TX) is expected to maintain his ranking member position on Health Subcommittee.
  • As for the House Ways and Means Committee, Rep. Kevin Brady (R-TX) will remain the committee chairman and Ranking Member Sander Levin (D-MI) will be stepping aside. Rep. Richard Neal (D-MA) likely will be the new ranking member on the committee. On the House Ways and Means Committee Health Subcommittee, Rep. Pat Tiberi (R-OH) will likely remain as the chairman. Several Democratic members are lobbying for the ranking seat on the subcommittee.

The following Senate members are identified as the committee chairs of these important Senate congressional committees:

  • On the Senate Finance Committee, Sen. Orin Hatch (R-UT), will be the Chairman of the committee and Sen. Ron Wyden (D-OR), will stay as the ranking member.
  • For the Senate Health, Education, Labor and Pensions (HELP) Committee, Sen. Lamar Alexander (R-TN) will stay as the chairman. Sen. Patty Murray (D-WA), will stay on as the ranking member.

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