The past couple of days were busy for the Pennsylvania Medical Society (PAMED) delegation to the American Medical Association (AMA). Among the many issues debated and discussed at the 2014 AMA Interim Meeting, held Nov. 8-11, were several resolutions that came from PAMED’s October House of Delegates (HOD) meeting that aimed to address physician concerns with issues including maintenance of certification (MOC), e-cigarette advertising, and barriers to reimbursement.
Here are some of the highlights:
Many PAMED members have said that while they support life-long learning and continuing medical education, MOC requirements are burdensome and lack of evidence on its effectiveness is concerning.
As directed by the PAMED House of Delegates, the Pennsylvania Delegation to the AMA was successful in strengthening AMA policy to emphasize the need for evidence-based practices that are regularly evaluated to ensure physician needs are being met and activities are relevant to clinical practice.
The MOC principles will now include that:
- MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.
- The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake, and intent to maintain or change practice.
- MOC should be used as a tool for continuous improvement.
- The MOC program should not be a mandated requirement for licensure, credentialing, payment, network participation, or employment.
- Actively practicing physicians should be well-represented on specialty boards developing MOC.
- MOC activities and measurement should be relevant to clinical practice.
- The MOC process should not be cost-prohibitive or present barriers to patient care.
At the insistence of the Pennsylvania delegation, those core principles were expanded to include a provision that the AMA work with the American Board of Medical Specialties (ABMS) to eliminate practice performance assessment modules, as currently written, from the requirements of MOC.
Many physicians are concerned that while quality improvement via both continuing medical education and ongoing personal and practice assessment is a desirable goal and a component of professionalism, that the MOC processes, as currently designed, create barriers to the practice of medicine. Physicians often feel that these barriers are administratively unfeasible, increasingly inflexible and onerous to physicians, excessively costly and time intensive, do not adequately protect physician privacy, and are not based on high-quality evidence.
Many physicians also believe that some MOC programs have the appearance of being focused too heavily on enhancing revenues, and fail to provide a meaningful, evidence-based and accurate assessment of clinical skills.
The core principles adopted by the AMA, including the Pennsylvania delegation’s amendment, will help address these concerns.
The Pennsylvania Delegation carried an important message from PA physicians who are concerned about public health. Existing AMA policy has now been amended to support extending FDA regulation to e-cigarettes by asking that the same marketing and sales restrictions applied to tobacco cigarettes, including prohibitions on television advertising, product placement in television and films, and the use of celebrity spokespeople.
Read more about public health policy adopted at the AMA meeting.
Concerned with the existing Centers for Medicare and Medicaid Services (CMS) policy that presently requires a “triggering event code” (AT code modifier) to allow for payment of the tetanus vaccine, and believing that this specific requirement creates confusion and financial hardship for many Medicare beneficiaries when tetanus shots are administered, the PAMED HOD sought AMA action through another Pennsylvania Delegation resolution.
The AMA HOD subsequently concurred and enacted a policy provision stipulating that until compliance of AMA policy H-440.875(6) is actualized to the AMA’s satisfaction regarding the tetanus vaccine, the AMA should aggressively petition CMS to include tetanus and Tdap at both the “Welcome to Medicare” and Annual Medicare Wellness visits, and other clinically appropriate encounters, as additional “triggering event codes” (using the AT or another modifier) that allows for coverage and payment of vaccines to Medicare recipients.
An additional provision was approved directing the AMA to petition CMS to include coverage and payment for any vaccines administered to Medicare patients that are recommended by the Advisory Council on Immunization Practices (ACIP), the U.S. Preventive Services Task Force (USPSTF), or based on prevailing preventive health clinical guidelines.
Barriers to Payments
The Pennsylvania Delegation also sponsored a resolution on barriers to payment for vaccines and medication administration, which was absorbed into the existing and more comprehensive AMA policy aimed at mitigating the burdens of preauthorization and utilization review. Moving forward, the AMA will be conducting a study to quantify the amount of time physicians and their staff spend on non-clinical administrative tasks, including authorizations, pre-authorizations, and denial of authorization appeals. Read more from the AMA.
Read more about other actions taken at the AMA Interim Meeting.
For more information on the AMA Interim Meeting and the work of Pennsylvania’s AMA delegation, please contact Dr. James Goodyear, chair of the Pennsylvania Delegation to the AMA, or Sharon Miller at PAMED’s Executive Office.