October 2017 - Medical Association of the State of Alabama

Archive for October, 2017

Metro Areas Increasingly Dominated by Single Insurance Companies

Posted by admin on October 27, 2017

In an analysis of competition in health insurance markets across the U.S., a study conducted by the American Medical Association found that in 169 of 389 metropolitan areas (43 percent), a single health insurer had at least a 50 percent share of the market. This represents an eight percent increase in such markets over just two years. The finding comes from the newly released 2017 edition of the AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets, which examines market concentration in 2016.

High market concentration tends to lower competition among commercial health insurers. These markets become ripe for the exercise of health insurer market power, which harms patients by raising premiums above competitive levels.

The AMA study presents the most comprehensive data on the degree of competition in health insurance markets across the country, and is intended to help researchers, policymakers and regulators identify markets where consolidation among health insurers may cause anti-competitive harm to patients and the physicians who care for them.

“After years of largely unchallenged consolidation in the health insurance industry, a few recent attempts to consolidate have received closer scrutiny than in the past, including the proposed mergers of Anthem and Cigna, as well as Aetna and Humana,” said AMA President David O. Barbe, M.D. “Previous versions of the AMA study played a key role in efforts to block the proposed mega-mergers by helping federal and state antitrust regulators identify markets where those mergers would cause anti-competitive harm.”

The 2017 edition of AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets offers the largest and most complete picture of competition in health insurance markets for 389 metropolitan areas, as well as all 50 states and the District of Columbia. The study is based on 2016 data on commercial enrollment in fully and self-insured health maintenance organization (HMO), preferred provider organization (PPO), point-of-service (POS), public health exchange and consumer-driven health plans (CDHP).

In addition to assessing competition in the commercial health insurance market at large, the study also separately examines competition for the main plan types, including HMO, PPO, POS, and the exchanges.

The prospect of future consolidation in the health insurance industry should be viewed in the context of the lack of competition that already exists in most health insurance markets. According to the AMA’s latest study:

A significant absence of health insurer competition was found in 69 percent of metropolitan areas. These markets are rated “highly concentrated” based on federal guidelines used to assess the degree of competition in a market.
In 43 percent (169) of metropolitan areas, a single health insurer had at least a 50 percent share of the commercial health insurance market, compared to 40 percent (156) in 2014.
Anthem has a bigger geographic footprint than any other health insurance company in the United States. Anthem was the largest health insurer by market share in 82 of 389 metropolitan areas examined by the AMA. Health Care Service Corp. was second with a market share lead in 42 metropolitan areas, followed by UnitedHealth Group with a market share lead in 26 metropolitan areas.
The 10 states with the least competitive commercial health insurance markets were: 1. Alabama, 2. Delaware, 3. Hawaii, 4. South Carolina, 5. Louisiana, 6. Michigan, 7. Kentucky, 8. Vermont, 9. Alaska, and 10. Illinois.
The commercial health insurance market in 27 states became more concentrated between 2014 and 2016.
The 10 states that experienced the largest increase in market concentration between 2014 and 2016 were: 1. Kentucky, 2. Alaska, 3. South Carolina, 4. Mississippi, 5. South Dakota, 6.Oklahoma, 7. Vermont, 8. Arkansas, 9. Nevada and 10. New Mexico.

Competition in Health Insurance: A Comprehensive Study of U.S. Markets is free to AMA members. The study is also available to non-members. To order a copy, visit the online AMA Store, or call (800) 621-8335 and mention item number OP427117.

Editor’s Note: Credentialed members of the media can obtain a free copy of the AMA’s newest study on competition in the nation’s health insurance industry by contacting AMA Media & Editorial at: (312) 464-4430.

Tags: AMA, commercial, exchange, health, HMO, Insurance, market, PPO. POS, study

Posted in: Insurance

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Participate in Field Testing of Episode-Based Cost Measures by Nov. 15

Posted by admin on October 27, 2017

The Centers for Medicare & Medicaid Services is conducting a field test for eight episode-based cost measures before consideration of their potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program. During the field test, clinicians may access confidential feedback reports with information about their performance on these new measures. All stakeholders are also invited to comment on the measures and supplemental documents.

The eight episode-based cost measures are:

Elective Outpatient Percutaneous Coronary Intervention (PCI)
Knee Arthroplasty
Revascularization for Lower Extremity Chronic Critical Limb Ischemia
Routine Cataract Removal with Intraocular Lens (IOL) Implantation
Screening/Surveillance Colonoscopy
Intracranial Hemorrhage or Cerebral Infarction
Simple Pneumonia with Hospitalization
ST-Elevation Myocardial Infarction (STEMI) with (PCI)

Participate in Field Testing through Nov. 15, 2017

The field test is a voluntary opportunity for stakeholders to comment on the measure specifications and the report template for the eight measures in their current stage of development. This feedback will be considered in refining the measures and for future measure development activities.

If you or your clinician group perform(s) or manage(s) the care for one or more of the procedures or medical conditions represented in the measures above, you might have a confidential Field Test Report on the CMS Enterprise Portal. For group practices, reports are available for the TIN of the group practice. Please refer to the “2017-10-cost-measure-field-test-access-guide.pdf” in the zip file linked below for instructions on setting up or activating your EIDM account. The supplemental documentation listed below is included in a zip file on the MACRA page under the “What’s new” section and “Episode-based cost measures” subsection. To download the zip file directly, please click here.

Field Test Mock Report
Draft Cost Measure Methodology
Draft Measure Codes List

Please provide comments through this online survey by 11:59 PM ET on Nov. 15, 2017.

You may refer to the fact sheet or FAQs document for additional information. If you have any questions, please contact QPPCostMeasureTesting@ketchum.com.

Join Upcoming National Provider Calls (NPC) to Learn More about Field Testing

Note: The same content will be covered on both calls. Please click one of the dates to register

Tags: CMS, MIPS

Posted in: CMS

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Trump: Opioid Epidemic “Worst Drug Crisis” in U.S. History

Posted by admin on October 27, 2017

President Trump called the opioid epidemic the “worst drug crisis” to strike the U.S. in its history while declaring a public health emergency – not a national emergency as promised earlier in the summer. According to the Centers for Disease Control and Prevention, more than 140 American die every day from an opioid overdose, which made President Trump’s announcement one of the most anticipated of the last few months yet not quite what health care advocates were expecting.

“Nobody has seen anything like this going on now. As Americans, we cannot allow this to continue,” Trump said at a White House ceremony. “It is time to liberate our communities from this scourge of drug addiction. … We can be the generation that ends the opioid epidemic. We can do it.”

There’s a legal distinction between a public health emergency, which the secretary of Health and Human Services can declare under the Public Health Services Act, and a presidential emergency under the Stafford Act or the National Emergencies Act. The President’s Opioid Commission recommended in July for a declaration of national emergency in order for the president to have more power to waive privacy laws and Medicaid regulations.

However, declaring a public health emergency, which can only last for 90 days and be renewed a number of times, demonstrates the complexity of an opioid crisis that continues to grow through an ever-evolving cycle of addiction, from prescription pain pills to illegal heroin to the lethality of fentanyl.

What the public health emergency won’t do is free up much federal funding. Acting Health and Human Services Secretary Eric Hargan will be given more room to loosen certain regulations that he otherwise would not be able to.

The declaration will expand access to telemedicine to better help those with an addiction in remote areas receive medications; allow for the shifting of resources within HIV/AIDS programs to help people eligible for those programs receive substance use disorder treatments; and more. It could spur a fight for funding in Congress, as Senate Democrats have introduced a bill to put $45 billion toward the epidemic. Many Republicans also back much more funding to combat the epidemic.

The opioid action is the first public health emergency with a nationwide scope since a year-long emergency to prepare for the H1N1 influenza virus in 2009 and 2010.

Tags: drug, health, opioid, pill

Posted in: Opioid

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Judge Rejects Bid to Revive ACA Subsidies

Posted by admin on October 27, 2017

A federal judge has denied several states’ attempt to compel the Trump administration to continue paying cost-sharing reduction payments. Attorney generals from 18 states and the District of Columbia had filed a motion in the U.S. District Court seeking a temporary injunction that would reinstate the payments, which the administration decided to end earlier this month.

Judge Vince Chhabria was skeptical of the states’ argument during a hearing on the motion earlier this week, noting many states have already taken steps to diffuse the impact of CSR uncertainty. In his order denying the states’ request for a temporary injunction, Chhabria said although a federal judge did previously rule that CSR payments should end because they were not properly appropriated by Congress, in this instance, the Trump administration has the stronger legal argument. Chhabria also noted any emergency relief requested by the states would be counterproductive as state insurance regulators have been working for months to prepare for the possibility the subsidies would end.

Many states, he continued, have therefore “devised responses that give millions of lower-income people better health coverage options than they would otherwise have had.”

The Trump administration this month terminated the payments to the insurers, which help cover medical expenses for low-income Americans, as part of several moves to dismantle Obama’s signature healthcare law formally known as the Affordable Care Act. The subsidies were due to cost $7 billion this year and were estimated at $10 billion for 2018, according to congressional analysts.

Insurers have argued they do not profit from the subsidies under the Affordable Care Act, but pass them on directly to consumers to reduce deductibles, co-payments and other out-of-pocket medical expenses for low-income people. Because insurers would raise premiums on policies in the absence of the subsidies, the government would be compelled to spend more on financial assistance to low-income Americans. The Congressional Budget Office has found that a bipartisan Senate proposal to shore up Obamacare insurance marketplaces by reviving the subsidies would cut the U.S. deficit by $3.8 billion over the next decade.

Tags: ACA, cost, CSR, expense, obamacare, payment, share

Posted in: Advocacy

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CBO Analysis of Proposed CHIP Funding Bill Causes Doubt

Posted by admin on October 27, 2017

More than three weeks after the deadline to renew the Children’s Health Insurance Program, the Congressional Budget Office has released an analysis of the five-year extension bill, which would extend the bill to 2022 so they can make a few changes, including revamping federal matching rates. The CBO analysis, which also indicated the proposed legislation would increase the federal deficit by $8.2 billion by 2027, is causing Alabama and other states to fear and doubt the CHIP funding.

Nationally, CHIP provides insurance for children up to age 19 whose households make up to 312 percent of the poverty line – up to $50,688 a year for a household of two, and up to $63,710 for a household of three. Qualifying families pay premiums – ranging from $52 to $104 per child per year, depending on income – as well as co-pays. ALL Kids, administered by the Alabama Department of Public Health, covers about 83,000 children, while about 70,000 CHIP recipients fall under Alabama Medicaid.

The Medical Association was a vital in creating CHIP in Alabama more than 20 years ago as a way to provide more health insurance coverage to children of families with low and moderate incomes. Although this is a nationwide crisis, Alabama’s program has funds to continue through March, while some states may lose all their funding by December.

Studies credit CHIP with a steep decline in the number of uninsured children in the country and particularly successful in Alabama. A 2014 study credited CHIP with reducing the number of uninsured children in Alabama 18 percent between 2011 and 2014.

“The benefits package for children is very comprehensive,” said Dr. Wes Stubblefield, a Florence pediatrician and president of the Alabama Chapter of the American Academy of Pediatrics. “It’s everything recommended by the American Academy of Pediatrics that’s recommended as a standard of care for children for preventative care.”

The Medical Association will continue to monitor the progress of this proposed legislation and is eager to work with lawmakers toward a positive solution.

Tags: children, CHIP, Medicaid

Posted in: CHIP

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CDC Reports Rising Rates of Drug Overdose Deaths in Rural Areas

Posted by admin on October 20, 2017

Rates of drug overdose deaths are rising in nonmetropolitan (rural) areas, surpassing rates in metropolitan (urban) areas, according to a new report in the Morbidity and Mortality Weekly Report (MMWR) released this week by the Centers for Disease Control and Prevention (CDC).

Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. This report analyzed trends in illicit drug use and disorders from 2003-2014 and drug overdose deaths from 1999-2015 in urban and rural areas. In 1999, drug overdose death rates for urban areas were higher than in rural areas (6.4 per 100,000 population versus 4.0 per 100,000). The rates converged in 2004, and in 2006 the rural rate began trending higher than the urban rate. In 2015, the most recent year in this analysis, the rural rate of 17.0 per 100,000 remains slightly higher than the urban rate of 16.2 per 100,000.

Urban and rural areas experienced significant increases in the percentage of people reporting past-month illicit drug use. However, there were also significant declines in the percentage of people with drug use disorders among those reporting illicit drug use in the past year. The new findings also show an increase in overdose deaths between 1999 and 2015 among urban and rural residents. This increase was consistent across sex, race, and intent (unintentional, suicide, homicide, or undetermined).

“The drug overdose death rate in rural areas is higher than in urban areas,” said CDC Director Brenda Fitzgerald, M.D. “We need to understand why this is happening so that our work with states and communities can help stop illicit drug use and overdose deaths in America.”

Although the percentage of people reporting illicit drug use is less common in rural areas, the effects of use appear to be greater. The percentage of people with drug use disorders among those reporting past-year illicit drug use were similar in rural and urban areas.

Additional findings from the CDC study:

In 1999, drug overdose death rates for urban areas were higher than in rural areas (6.4 per 100,000 population versus 4.0 per 100,000). The rates converged in 2004, and by 2006 the rural rate (11.7 per 100,000) was slightly higher than the urban rate (11.5 per 100,000).
The percentage of people reporting past-month use of illicit drugs declined for youth ages 12-17 over a 10-year period but increased substantially in other age groups.
The percentage of people reporting past-month use of illicit drugs was higher for urban areas during the study period.
Among people reporting illicit drug use in the past year, drug use disorders decreased during the study period.
In 2015, approximately six times as many drug overdose deaths occurred in urban areas than in rural areas (urban: 45,059; rural: 7,345).

Most overdose deaths occurred in homes, where rescue efforts may fall to relatives who have limited knowledge of or access to life-saving treatment and overdose follow-up care. Considering where people live and where they die from overdose could improve interventions to prevent overdose. Understanding differences in illicit drug use, illicit drug use disorders, and drug overdose deaths in urban and rural areas can help public health professionals to identify, monitor, and prioritize responses.

Visit HHS’s Opioids website for more information on their 5-point strategy to combat the opioid crisis.

Visit CDC’s Opioid Overdose website for data, tools, and resources on opioid overdose prevention.

Visit CDC’s Rural Health website for more information on rural health topics.

Tags: abuse, CDC, disorder, drug, opioid, rural, urban

Posted in: Opioid

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Tentative Bipartisan Deal Reached to Restore CSR Payments

Posted by admin on October 20, 2017

Earlier this week, the U.S. Senate reached a bipartisan deal “in principle” to restore Obamacare cost-sharing reduction payments for two years in exchange for more state flexibility in the health care act. The proposed plan would also restore more than $100 million in funding for health care outreach.

The bipartisan bill gained momentum later in the week with 24 co-sponsors to the legislation. President Trump has suggested he was “open” to authorizing payments to insurers that help offset out-of-pocket health costs in the short term — but had not given up his goal of repealing the ACA.

The short-term solution would allow insurers to offer catastrophic insurance plans to consumers ages 30 and older on the exchanges, while maintaining a single-risk pool, meanwhile also making it easier for states to obtain waivers to customize health plan rules to their needs by speeding up administration approval of the waivers and allow states to copy provisions in waivers that were already approved. This could also provide a reprieve for the Affordable Care Act that would prevent 2018 premiums from increasing as much as previously predicted. However, consumers in many states will still face double-digit rate increases, and in many counties, health plans will be available from only one insurance company.

The proposed legislation would not allow states to change the essential benefits insurers are now required to offer individuals and small businesses under the ACA or let insurers discriminate against consumers with preexisting conditions for the next two years.

The Medical Association will continue to monitor the progress of this proposed legislation and is eager to work with lawmakers toward a positive solution.

Tags: ACA, cost, Insurance, obamacare, premium, reduction, share

Posted in: Advocacy

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Pres. Trump’s Executive Order Creates Confusion

Posted by admin on October 13, 2017

Earlier this week, President Trump signed an executive order that could be a first step in dismantling the Affordable Care Act. About 20 health organizations have so far spoken out against the executive order arguing the action could weaken patient protections and destabilize the individual market.

President Trump’s executive order signed on Thursday, Oct. 12, does not implement any policies, but it does request federal agencies such as the Department of Health and Human Services and the Department of Labor to develop regulations to expand the use of association health plans, which allow small businesses to join forces to purchase health coverage together, as well as to expand the definition of short-term insurance, which typically offers less coverage and comes with higher out-of-pocket costs.

The order issues three primary directives to federal agencies:

Consider ways to expand access to association health plans, potentially allowing employers to purchase insurance across state lines.
Consider expanding coverage through short-term health insurance plans, which are not subject to the Affordable Care Act’s regulations such as minimum coverage requirements.
Consider changes to health reimbursement arrangements (HRAs) — employer-funded accounts that reimburse workers for healthcare expenses — to allow employers to make better use of them.

During a press conference, President Trump said expanding use of association health plans would increase competition and allow more small businesses to have the same purchasing options as larger employers. He said he also plans to eliminate the three-month limit on short-term health insurance plans.

“The Medical Association is in the process of reviewing the President’s Executive Order and is consulting with industry experts to get a full understanding of the downstream effects the order will have on patient care. There is some concern that the order could erode important patient protections, which would be a serious issue however the true impact is unclear at this point,” Executive Director Mark Jackson said.

The executive order does not make policy changes itself, any new rules will go through a notice and comment period that could take months.

In a decision that coincided with the executive order, the White House has confirmed that it will stop federal payments for cost-sharing reductions to health insurers. These payments help insurers pay out-of-pocket costs for low-income individuals purchasing coverage through the exchanges. If stopped, premiums could dramatically rise and cause insurance companies to leave the exchanges and challenge the decision in court. There’s confusion as to when the payments, which could total about $9 billion this year, would end.

Tags: exchange, health, HRA, Insurance, order, plan

Posted in: Advocacy

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Rural Americans More Likely to Die in Motor Vehicle Crashes

Posted by admin on October 12, 2017

Motor vehicle crashes are among the leading causes of death in the U.S. A recent study found the rate of death for adult drivers and passengers from motor vehicle crashes is 3 to 10 times higher among rural Americans. The simple act of buckling seat belts can prevent needless loss of life.

Researchers at the Centers for Disease Control and Prevention examined passenger vehicle occupant deaths among adults ages 18 or older. The study found lower seat belt use, higher death rates, and a higher proportion of drivers and passengers in rural areas were not buckled up at the time of the fatal crash. About 40 percent of Alabamians live in rural areas.

Seat belt use prevented an estimated 64,000 deaths in the United States during 2011-2015. The study found that “increasing rurality is consistently shown to be associated with increased crash-related death rates and lower seat belt use.” Wearing seat belts has been shown to reduce the risk of serious injury or death by about 50 percent.

Buckle up!

Lap and shoulder belts should be secured across the pelvis and rib cage. These areas are better able to withstand crash forces than other parts of the body.
Place the shoulder belt across the middle of the chest and away from the neck.
The lap belt needs to rest across the hips, not the stomach.
NEVER put the shoulder belt behind the back or under an arm.

Airbags are designed to work with seat belts, not replace them. Motor vehicle occupants who do not buckle up could be thrown into a rapidly opening frontal airbag. Such force could injure or even kill.

More information is available at http://www.alabamapublichealth.gov/injuryprevention/motor-vehicle.html.

Tags: accident, belt, rural, seat, vehicle

Posted in: Health

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Young Physicians Have New Opportunities at Annual Meeting

Posted by admin on October 6, 2017

The 2017 Annual Meeting and Business Session added a separate educational track designed specifically for Young Physicians, Resident-Fellows and Medical Students to allow this group of young medical professionals the opportunity to meet established physicians as well as network with other colleagues from across the state. And, there’s great news…we’re planning to do it again for 2018!

New Concurrent Educational Sessions

While encouraged to attend many of the general sessions, such as the Ellann McCrory, M.D. Leadership Lecture with Auburn University Basketball Coach Bruce Pearl and the Jerome Cochran, M.D., Lecture with James B. McClintock, Ph.D., concurrent sessions were set aside to engage these young physicians just starting their medical practice. Medical Association Partner Regions Bank offered two sessions, Banking Basics for Residents and Students and Maximizing Your Personal Wealth, while Sirote & Permutt, P.C., discussed Contract Negotiations. Zalak Patel, M.D., with the UAB School of Medicine, Montgomery Regional Medical Campus, offered a hands-on Basic Airway Management Skill Session.

Special Exhibit Hall

A second exhibit hall filled with residency programs and Alabama physician recruiters offered a wide range of in-state opportunities for these young professionals. The Medical Association would like to extend special thanks to the following exhibitors:

American Medical Association
Anatomage, Inc. (Virtual Dissection Demonstrations)
Andalusia Health
Brookwood Baptist Health Residency Program (Internal Medicine, Pathology)
Community Hospital, Inc., (General Surgery, Radiology and Transitional Year)
Medical Center Enterprise
Montgomery Family Medicine Program
Quality of Life Health Services
St. Vincent’s East Family Medicine Residency Program, Team Health
UAB Montgomery Internal Medicine Residency Program
UAB Selma Family Medicine
UAB SOM Huntsville Campus, Family Medicine Program
University of Alabama at Birmingham Vascular Surgery Integrated Residency
University of South Alabama Psychiatry

Hotel Scholarships Awarded Via Essay Contest

To help offset the cost of staying overnight for the conference, the Medical Association awarded 12 hotel scholarships for Resident-Fellow and Medical Student Section attendees who successfully submitted a one-page essay on the importance of organized medicine. Students receiving this scholarship were: Ankita Mahajan, ACOM; Adena Shahinian, ACOM; Taylor Bono, UAB; Natasha Mehra, UAB; Jessica Powell, UAB; Tushar Ramesh, UAB; Ricky Seeber, UAB; Dillon Casey, USA; Will Lightfoot, USA; Olivia Means, USA; Brianna Clark, VCOM; and Mahreen Arshad, Resident, Brookwood Baptist Hospital.

Poster Symposium a Huge Success

Stephen Layfield

The Second Annual Poster Symposium was a rousing success with 32 entries from members of the Medical Student and Resident-Fellow Sections. All medical schools and many residency programs participated in this year’s program, and the quality of the posters was outstanding.

Congratulations to those who took the time to create research projects and present them to the physicians and committee members.

Third place winner Stephen Layfield, a student at UAB, received $125 for his poster, Building and Deploying a Clinical Data Warehouse at a Student-Run Free Clinic: A One-Year Review.
Roxanne Lockhart

Second place winner Roxanne Lockhart, a student at UAB, received $200 for her poster, Effect of O-Linked ß-N-Acetyl-Glucosamine Posttraumatic Brain Injury.
First place winner Bradley Wills, M.D., an orthopaedic surgery resident at UAB, received $300 and the opportunity to present his research poster at the 2017 AMA Interim Meeting in Honolulu in November. His poster was entitled, Outcomes with Overlapping Surgery at a Large Academic Medical Center.

Special thanks to Poster Symposium Committee Ricky Seeber and Natasha Mehra from UAB, as well as Poster Symposium Judges Jorge Alsip, M.D., Paul O’Leary, M.D., and Irma DeLeon, M.D.

Elections for Board of Censors Representatives

Bradley Wills, M.D.

The sections also held elections for representatives to the 2017-2018 Medical Association’s Board of Censors:

Mark Haygood, D.O., Young Physician Section Representative
Emily Goulet, M.D., Resident-Fellow Section Representative (University of Birmingham)
Caitlyn Marshall, M.D., Resident-Fellow Section Co-Representative (University of South Alabama)
Benjamin Bush, Medical Student Section Representative (University of South Alabama)