Annual meeting report

Wednesday, July 01, 2015 12:22 PM

Colorado AMA Delegation leads way for new policy to seek ICD-10 grace period for physicians after implementation

by Kate Alfano, CMS Communications Coordinator

Colorado led the way on one of the most important policies passed at the the 2015 AMA Annual Meeting, which directed the AMA to seek a two-year grace period for ICD-10 to allow physicians to avoid financial disruptions following implementation. The AMA will call on the Centers for Medicare and Medicaid Services and other payers not to withhold claim payments based on coding errors, mistakes or malfunctions in the system for two years directly following implementation, which would allow for a smoother transition so physicians can continue providing quality care to their patients. This has already led to an agreement with the federal CMS (see boxed announcement at the bottom of the next page).

M. Ray Painter Jr., MD, the senior delegate of the CMS delegation, formulated the concept and the CMS AMA Delegation took it to the AMA two years ago. Although the resolution passed and has been AMA policy since that time, it did not receive much attention because of the AMA’s hard-line stance on achieving a delay of ICD-10 implementation, which they secured in 2014. Though the AMA is still firm on seeking a delay, this is not likely to happen again as vendors, health plans and practices have invested large amounts of time and funds on preparations for the code set.

The federal CMS has acknowledged that the transition to ICD-10 will have an impact on physician payment processes, estimating that “in the early stages of implementation, denial rates will rise by 100-200 percent,” according to a 2013 report from the Healthcare Financial Management Association. A 2014 AMA study on the cost of implementing ICD-10 estimated that a small practice could see payment disruptions ranging from $23,000 to $100,000 during the first year of ICD-10 implementation and estimates that a small practice could incur a 5 percent drop in revenue because of productivity loss during and after the change.
The policy also directs the AMA to seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement or moving to all-cash practices.

Painter’s concept was re-introduced and showcased by the most vocal opponent to ICD-10, Jeff Terry, MD, of Alabama. “It speaks to Dr. Painter’s ability to continue working with a wide constituency effectively and with grace,” said fellow CMS Delegate Lynn Parry, MD.

Colorado contributed to the passage of another important policy at the meeting regarding childhood immunizations. The 2014 AMA HOD asked the CMS Committee on Ethics and Judicial Affairs and the AMA Council on Science and Public Health to collaborate on a joint report, “Non-medical Exemptions to Immunization.” The reference committee heard a great deal of testimony on the report, including sharp criticism on its supposed ambiguity. It was referred back without adoption. However, Colorado and others in the Western Mountain States Coalition supported an amended resolution from the American Association of Public Health Physicians, “Vaccination Requirements to Protect All Children.” That resolution was adopted and creates AMA policy that is unequivocal about eliminating all exemptions other than medical exemptions from childhood vaccination requirements.

“Given the extensive publicity of the Disneyland measles outbreak and the persistent resistance of some parents to immunizing their children, it was important for the AMA to have clear scientific social policy on childhood immunization,” said CMS Alternate Delegate Katie Lozano, MD. “An important win for public health!”

AMA delegates also passed the CMS report on Integration of Physical and Behavioral Healthcare, which was prompted by a CMS resolution from the 2014 Annual Meeting, and they passed policies on the maintenance of certification process, prescription drug abuse and diversion, public health initiatives restricting youth access to energy drinks and electronic cigarettes, graduate medical education funding, and more.

Member groups and sections also met during the meeting, including the Young Physicians Section, Resident and Fellow Section, and the Medical Student Section. Ethan Lazarus, MD, and Carolynn Francavilla, MD, both of Colorado and representing the American Society of Bariatric Physicians, hosted the first ever Obesity Caucus at the AMA Annual Meeting. The caucus was an open forum to discuss resolutions related to obesity, allow delegates from different states and societies to talk about what their groups are doing for obesity, and brainstorm ways the AMA can help tackle the obesity epidemic. A highlight was discussing the obesity education resolution, co-authored by Colorado. In fact, most of the caucus involved discussing improving obesity education at various levels. Around 20 people attended the first Obesity Caucus, and all agreed that this should take place at each AMA meeting.

Steven Stack, MD, an emergency physician from Lexington, Ky., was inaugurated as the 170th president of the American Medical Association and physicians from around the country vied for open seats on the AMA Board of Trustees and six AMA councils. Donald Eckhoff, MD, MS, FACS, of Colorado, who sits on the governing council of the AMA Section of Medical Schools and serves as their delegate to the AMA House of Delegates, ran for a seat on the AMA Council on Medical education but was unsuccessful in his bid.

Roughly 2,000 doctors and physicians-in-training gathered for the meeting in Chicago, with delegations from all 50 states, the District of Columbia, Guam, Puerto Rico and the Virgin Islands. Colorado’s delegation included CMS’s four delegates – M. Ray Painter Jr., MD; Lee Morgan, MD; Lynn Parry, MD; and Brigitta Robinson, MD – and four alternate delegates – David Downs, MD; Jan Kief, MD; Katie Lozano, MD; and Tamaan Osbourne-Roberts, MD – as well as CMS President-elect Michael Volz, MD, staff and representatives from the medical specialty societies and AMA sections.

The 2015 AMA Interim Meeting is scheduled for Nov. 13-17 at the Atlanta Marriott Marquis in Atlanta, Ga. The 2016 AMA Annual Meeting will be held June 11-15 at the Hyatt Regency in Chicago.

AMA and Centers for Medicare and Medicaid Services reach agreement on important elements of “grace period” for Oct. 1 implementation penalties

Acting immediately upon a Colorado Medical Society-sponsored proposal reaffirmed and passed again at the AMA annual meeting in June, the AMA and Centers for Medicare and Medicaid Services jointly announced on July 6 that agreement has been reached on important elements of a “grace period” for the Oct. 1, 2015, implementation of the ICD-10 diagnosis code set.

In guidance that was transmitted that same day, federal CMS announced that:

• For a one-year period starting Oct. 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
• To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
• CMS will establish an ICD-10 ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
• CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The AMA will monitor and keep CMS apprised of any implementation issues that persist in 2016, and will urge the agency to make any needed adjustments to the grace period policy and timeline based on new information that surfaces during the implementation process. Physicians are encouraged to report to the Colorado Medical Society any problems their practice may be experiencing during the transition, to better inform our advocacy efforts on their behalf.

It is important to note that the implementation deadline for ICD-10 is still Oct. 1, 2015 and time is running out for physician practices to complete their preparation. Read more on page 32 of this magazine or find ICD-10 resources online on the AMA’s website at www.ama-assn.org/go/icd-10 or on the Colorado ICD-10 Coalition website at www.cms.org/icd-10. This announcement pertains to Medicare specifically and it is hoped that commercial plans will follow their lead.