Volume 115, No. 8: August 2019 Edition

AMA to CMS - So far, so Good	An Urgent Call to Contact Congress on Flawed Surprise Billing, MACRA Bills
A Renewed Call to Pass Extreme Risk Protection Orders in Pa.	Philadelphia Doctors Join "Time's Up Healthcare" to Fight Sexual Harassment, Pay Gaps in Medicine
New Outbreak of Hepatitis A in Philadelphia	Health Notification on new Requirements for Lead Screenings for Young Children
New Pa. Law on Electronic Prescribing of Controlled Substances	PAMED Has a few Questions for You on Health Care Spending Patterns

Calendar of Events

The AMA says the new CMS 1700-page proposed rule for the 2020 Medicare physician fee schedule shows that CMS is listening to physicians and is making a good-faith effort to make changes that will help both physicians and patients.

The rule covers diverse topics, including geographic payment adjustments and professional liability insurance relative values as well as new payments for managing patients with opioid disorder. The memo focuses on two key issues that have been priorities for the physician community in the AMA's advocacy with CMS - revisions to the office visit codes and payment rates, and modifications to the Merit-based Incentive Payment System (MIPS) to make the program less fragmented and more clinically relevant.

The AMA says more needs to be done in the area of CMS add-on payments for office visits and visit increases to the global surgery packages.

But the AMA concluded that "CMS has demonstrated its commitment to prioritizing patients over paperwork, partnering with the medical community in an intensive effort to improve previous policies and proposals. The AMA looks forward to further collaborations with CMS as we work toward the shared goal of providing high-value care for patients."

The AMA is urging physicians to contact their local member of Congress, to seek changes to Surprise Billing and MACRA bills that need fixes. The bills are designed to protect patients by limiting their out-of-pocket costs to amounts they would have owed if they had been treated by an in-network physician. But the bills don't hold health insurers accountable. The bills' current solution to such disputes is to set out-of-network payments at the median amount each insurer pays for in-network care. The AMA is asking you to reach out to your members of Congress this month to urge them to:

• Implement positive payment adjustments for physicians to replace the payment freeze for the next six years;
• Extend the advanced alternative payment models (APM) bonus payments for an additional six years;
• Implement additional technical improvements to MACRA.

The AMA has released an online action kit, which is available here, to give you the information you need to be an effective advocate on this issue.

In the wake of the recent mass shootings in our country, Pa. Rep. Todd Stephens (R-Montgomery) has sent a letter to Pa. House leaders to push for his bill to disarm people who are shown to be a danger to themselves and others.

Stephens is calling on "leading Republicans, including President Donald Trump, and Democrats across the country... to adopt, among other proposals, Extreme Risk Protection Orders (ERPO), a mechanism to disarm people who evidence shows are a danger to themselves or others." Stephens wrote "that studies show (ERPO laws) have saved lives in other states and are now available in 17 states and the District of Columbia."

Stephens's House bill 1075, would allow judges to hear evidence and disarm people in crisis before they commit tragic acts of violence upon innocent victims. A version of this bill was voted out of committee in the last session.

Following our Winter 2018 issue of our magazine, Philadelphia Medicine, The Philadelphia Inquirer has now reported that sexual harassment and significant pay gaps are common among Philadelphia female physicians and nurses, and that local physicians are joining the effort to end these inequities.

The paper reports that doctors, nurses, pharmacists, administrators and researchers at Philadelphia's most prominent medical schools and hospitals have joined "Time's Up Healthcare," including a number of staff members at Temple, Drexel, Einstein and Penn State.

Darilyn Moyer, MD, CEO of the Philadelphia-based American College of Physicians who has signed up, says in the August 3 Inquirer article that "There's a disproportionate power in many hospitals and universities... It's not equal among men and women, that's clear," Dr. Moyer told the paper that to help bring change to medicine in Philadelphia and around the country she joined Time's Up Healthcare. It aims to address pay inequities and sexual harassment in the medical profession.

"Time's Up Healthcare is getting the word out: we don't tolerate harassment and discrimination in any form," Dr. Moyer told the Inquirer. "The organization also offers a legal defense fund, recognizing a lot of women being harassed aren't in a financial position to file a lawsuit or hire a lawyer."

Our Philadelphia Medicine report on sexual harassment found that more than half of the 149 female Philadelphia medical students who responded to a survey on the subject said they had been subjected to sexual harassment, that included explicit jokes, inappropriate language, and inappropriate touching.

For more information on Time's Up Healthcare, go to their website - timesuphealthcare.org, or contact Dr. Darilyn Moyer at the American College of Physicians, at acponline.org.

The Philadelphia Dept. of Public Health (PDPH) has issued a health alert concerning a hepatitis A outbreak in the city.

The city declared a public health emergency to respond to the continuing rapid increases in hepatitis A (HAV) virus infections among persons who use drugs and those who are homeless. Many states are experiencing similar HAV outbreaks lasting several months due to local, person-to-person transmission among at-risk groups.

PDPH says that a vaccination is the most important tool to prevent this disease and stop the outbreak. PDPH says it's important to offer the vaccine to anyone at high risk for HAV infection or serious complication at every opportunity in any care location.

Physicians are urged to report HAV cases to PDPH by calling 215-685-6740 or 215-686-4514 after business hours. You can find more information on HAV by going to: https://www.cdc.gov/mmwr/volumes/67/wr/mm6743a5.htm

PDPH wants physicians to know that lead level screenings of young children are now mandatory in Philadelphia.

City Council passed a law in May to create requirements for the testing of blood lead levels in children. The law requires a physician to test a child between nine and 21 months who has not been treated previously for lead, and test a child between 21 and 72 months whose blood lead level has not been tested once after the age of 21 months.

For more information on the new testing program, go to: https://www.phila.gov/programs/lead-and-healthy-homes-program/

The state's new law that goes into effect on October 24, mandates that all Schedule II through V controlled substances, except when dispensed or administered directly to a patient or practitioner or authorized agent, other than a pharmacist, must be prescribed electronically. The law replaces the traditional method of prescribing these substances to a patient by paper prescription.

The Pa. Dept. of Health has published an online hardship exemption form that practices and health care facilities can use to apply for an exemption. You can find it by going to: https://appengine.egov.com/apps/pa/doh/act96of2018temporaryexemptionform

The Pa. Medical Society (PAMED) is sending a survey to its physician members to try to determine the impact of health care spending connected to the consolidation of hospitals and health care network systems in Pennsylvania.

It also wants to know the impact on physicians from insurance carriers creating narrow physician networks. You can click on to the survey here: https://form.jotform.com/91634263405151

September

12 - Southeastern PA Treatment Overdose Prevention Seminar Date: Thursday, September 12 Time: 10:00 AM - 2:00 PM Place: The Philadelphia County Medical Society, 2100 Spring Garden Street, Philadelphia, PA 19130 In collaboration with the Pennsylvania Harm Reduction Coalition, Philadelphia Department of Public Health and Caron Treatment Centers, this seminar will equip treatment providers with the necessary skills and education to implement overdose prevention strategies within their addiction treatment programs. This seminar is specifically geared towards clinical directors, medical directors, and key decision makers in the treatment field. Click Here to Register and Learn More

October

5 - Give Kids Sight Day: Free Eye Care for Kids Date: Saturday, October 5 Time: 8:30 AM - 1:00 PM Place: Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107 PCCY (Public Citizens for Children and Youth) will be holding its "Give Kids Sight Day," a day of free eye checks and eye glasses for children who need them. It will be open for children 17 years and under from Philadelphia and surrounding counties, who have not had or have not passed an eye screening and/or are uninsured. Volunteers are needed for the program. Click Here to Learn More

25 - House of Delegates Date: October 25-27 Place: The Hershey Lodge, 325 University Dr., Hershey, PA 17033 Join your colleagues for a lively, informative weekend of continuing education, leadership development, advocacy, and networking at the Pennsylvania Medical Society's House of Delegates Meeting and Annual Education Conference. Click Here to Register

28 - Pennsylvania Harm Reduction Coalition Statewide Conference Date: October 28-29 Place: Sheraton Harrisburg, 4650 Lindle Rd, Harrisburg, PA 17111 Advocates, clinicians, professionals, and community leaders will be coming together for a 2-day statewide conference on October 28th and 29th in Harrisburg to discuss cutting edge research and evidence-based solutions to the opioid epidemic. Click Here to Register