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Society Advocacy Continues to Make Impact Amid Uncertainty

      Amid growing uncertainly inside the Washington, DC beltway, AMDA – the Society for Post-Acute and Long-Term Care Medicine continues to make an impact through its advocacy work. Through the first half of 2017, the Society has worked to expand its reach in coalitions and has had a direct impact on policies adopted by the American Medical Association (AMA) as well as Centers for Medicare & Medicaid Services regulations. Although health care reform continues to be unpredictable, there is almost unanimous agreement that the system will continue its shift from fee-for-service to value-based medicine. With that in mind, the Society continues to work to ensure post-acute and long-term care medicine is appropriately recognized in this movement.

      AMA Adopts Society Policies

      The June annual meeting of the AMA House of Delegates (HoD) was a particularly successful meeting for the Society. Society delegate Eric Tangalos, MD, CMD, and alternate delegate Rajeev Kumar, MD, CMD, presented three resolutions. The HoD meeting, which brings together all major physician specialty societies and state societies, considered hundreds of resolutions on a variety of topics ranging from gun violence to health care reform.
      It is the responsibility of component societies of the AMA to bring new policy issues forward. This was another meeting where the Society did just that. The Society’s three resolutions received support from other specialties. One resolution was adopted as new AMA policy, and the other two were referred to the AMA Board of Trustees (BoT) for decision.
      “It continues to be key for the Society to bring important issues to the AMA to advance our mission,” said Dr. Tangalos. “It shows how one member’s idea can influence important national policy,” said Dr. Kumar, the original author of two of the resolutions — that he first drafted for the Illinois Medical Directors Association — which were adopted by the Society’s HoD this past March. “I would urge every Society member to think about and submit resolutions that could further advance our standing on a national landscape,” said Suzanne Gillespie, MD, CMD, chair of the Society HoD.
      The following were the Society’s resolution results:
      • National Pressure Ulcer Advisory Panel Recommendations for Pressure Ulcer Nomenclature Change — adopted as new AMA policy.
      The resolution asks that AMA formally oppose a change in the nomenclature from “pressure ulcer” to “pressure injury” in the ICD-10 and other diagnostic catalogs and classification systems.
      • Inclusion of Continuing Care Retirement Centers (CCRCs) and Long-Term Care Facilities in Accountable Care Organizations (ACOs) Investment Model — referred to AMA BoT for decision.
      The resolution asks that AMA advocate to CMS to enable CCRCs and long-term care facilities and physicians working in those settings to initiate ACO investment models.
      The AMA Reference Committee that heard the testimony believed this was an important topic to address and that there is potential for this resolution to increase the availability of Alternative Payment Models (APMs) available to physicians. The Reference Committee also agreed with the concerns raised by other speakers that this action would require a more thoughtful analysis, thus the recommendation for referral to the AMA BoT for its decision. The House agreed with this recommendation.
      • Removing Three-Star Minimum Requirements for Skilled Nursing Facilities to Participate in Next Gen[eration] ACOs and Bundled Payments for Care Improvement (BPCI) Programs and Care for Patients With Waiver of Three-Night Hospital Stay Requirement — referred to BoT for decision.
      The resolution asks that the AMA advocate to CMS to remove the three-star quality requirement for skilled nursing facilities to participate in Next Gen ACOs and the BPCI programs with waiver of 3-night hospital stays for patients.
      The testimony on this resolution was mixed. The Reference Committee heard concerns from several speakers about the difficulty of obtaining data from SNFs and that the star ratings could protect patient safety. Despite testimony that mentioned this would be a voluntary program for risk-bearing models only, which have to meet certain quality and cost measure benchmarks, the Reference Committee recommended a referral for decision by the AMA BoT. The House voted to accept this recommendation.

      Negative Payment Adjustments

      The Society has been working in a coalition with a number of other specialty societies to lessen the impact of penalties stemming from the application of the 2016 Physician Quality Reporting System (PQRS) and the value-based payment modifier (VM). Briefly, eligible clinicians (ECs) who billed Medicare Part B services faced up to a 4% reduction in payment based on their scores in PQRS and VM. During a meeting with Secretary of Health and Human Services Tom Price, MD, the Society explained the fallacy in applying these penalties to ECs who mainly see medically complex patients in post-acute and long-term care without the proper risk adjustment.
      In the recently issued proposed physician fee schedule, CMS proposes to significantly reduce these penalties. Specifically, the rule proposes to reduce the automatic downward payment adjustment from -4% to -2% for groups of 10 or more clinicians, and from 2% to 1% for physician and non-physician solo practitioners and groups of two to nine clinicians. In addition, the rule proposes to hold harmless all physician groups and solo practitioners who met the minimum quality reporting requirements from downward payment adjustments for performance under quality-tiering for the last year of the program. Likewise, CMS proposed to “zero” out the cost category again for the 2018 performance period, which will impact ECs’ compensation in 2020.
      CMS also accepted the Society’s proposals for added Improvement Activities (IAs) quality measures in the 2018 Merit-Based Incentive Payment System (MIPS). The Quality Payment Program (QPP) proposed rule included proposals to add the following IAs:
      • Participation in the Partnership to Improve Dementia Care (reduction of unnecessary antipsychotic medication use)
      • Physician participation in the Nursing Home QAPI
      • Advance Care Planning
      • Centers for Disease Control and Prevention Course on Antibiotic Stewardship
      • CDC Course on Opioid Prescribing
      • Continuing Medical Education Activities such as the Society’s Annual Conference
      The Society also continues to work with other physician specialty societies and other groups that are developing innovative alternative payment models In all, these proposals mean that ECs in PA/LTC will have a better chance to achieve positive outcomes in future years of value-based quality reporting programs, and that CMS recognizes the importance of the work the Society’s members do and the patients we serve.

      Other Updates

      The Society has a renewed sense of urgency to provide clear information on how PA/LTC-based clinicians can succeed in the value-based environment. With that in mind, the Society has partnered with physician practices to form the Society Practice Management Section. The Section has already hosted and will host webinars on topics related to clinical practice in the age of value-based medicine, and will have a number of programs at the 2018 Society Annual Conference from March 22–25 in Grapevine, TX. Likewise, the new Society Member Forum allows Society members to discuss best practices in reporting for MIPS and participating in Alternative Payment Models. There are a number of already ongoing discussions related to these topics. Members are encouraged to participate by visiting www.paltc.org/forum.
      Alex Bardakh is director of public policy and advocacy for AMDA – the Society for Post-Acute and Long-Term Care Medicine.

      call for posters

      Posters are an excellent way to bring focus to an issue or spotlight an innovative program or initiative at the Society’s Annual Conference. The feedback poster presenters get from their work can be empowering — just ask Maria Mendoza de la Garza, MD, whose poster, “From Pots to Pods: Accidental Ingestions,” won an honorable mention at this year’s conference. “It was gratifying that so many people were interested in the topic,” she said. “One of the judges even suggested I write a guideline for caregivers on this topic.”
      A successful poster takes time, but the research and work involved helps enhance your expertise regarding a topic and helps bring attention to the work you are doing.
      The best posters are clear and concise, and balance text with appropriate tables and graphics. Handouts with key points also are useful. Having others view your completed poster and seeking their feedback before submission can help identify areas that need clarification or questions viewers may have.
      The deadline for poster submissions for the 2018 Annual Conference, scheduled for March 22–25 in Grapevine, TX, is Oct. 26. Go to https://amda2018.abstractcentral.com/ for more information.