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STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

Physicians who work in small, independent primary care practices — also known as SIPs — report dramatically lower levels of burnout than the national average (13.5 percent versus 54.4 percent), according to a study led by researchers at NYU School of Medicine published online July 9 in the Journal of the American Board of Family Medicine. The findings indicate that the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout.

Physician burnout is a major concern for the health care industry. It is associated with low job satisfaction, reduced productivity among physicians, and may negatively impact the quality of care. Multiple national surveys suggest that more than half of all physicians report symptoms of burnout.

Research on physician burnout has focused primarily on hospital settings or large primary care practices. The researchers say that this is the first study that examines the prevalence of burnout among physicians in small independent primary practices — practices with five or fewer physicians.

Researchers examined data collected from 235 physicians practicing in 174 SIPs in New York City. The rate of provider reported burnout was 13.5 percent, compared to the 2014 national rate of 54.4 percent. A 2013 meta-analysis of physician surveys conducted in the United States and Europe found that lower burnout rates were associated with greater perceived autonomy, a quality and safety culture at work, effective coping skills, and less work-life conflict.

“Burnout is about the practice culture and infrastructure in which primary care doctors work. So the obvious question is: what is it about the work environment that results in low burnout rates in small practices?” says Donna Shelley, MD, professor in the Departments of Population Health and Medicine at NYU Langone Health, and the study’s senior author. “It’s important to study the group that’s not showing high burnout to help us create environments that foster lower burnout rates. The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout.”

How the Study Was Conducted

Researchers analyzed data as part of the HealthyHearts NYC (HHNYC) trial, which is funded by the Agency for Healthcare Research and Quality’s (AHRQ) EvidenceNOW national initiative. AHRQ is a division of the U.S. Department of Health and Human Services. The HHNYC trial evaluates how practice coaching or facilitation helps SIPs adopt clinical guidelines for the treatment and prevention of cardiovascular disease.

Each physician answered a multiple choice question with response options indicating various levels of burnout. Options ranged from no symptoms of burnout to feeling completely burned out and questioning whether or not to continue practicing medicine. The question was validated against the Maslach Burnout Inventory, a nationally recognized measure that identifies occupational burnout. Physician respondents were categorized as burned out if they checked one of the last three options in the multiple choice question.

As part of the HHNYC trial, physician respondents were also asked a number of questions about the culture of their practices. The tool used specifically measures “adaptive reserve,” or a culture where individuals have opportunities for growth and the ability to learn from mistakes by talking and listening to each other. Physicians who described this kind of culture in their practice reported lower levels of burnout. According to Dr. Shelley, practices, where employees feel they are included in decisions and have control over their work environment, are referred to as having “high adaptive reserve.”

Dr. Shelley is careful not to minimize the challenges faced by physicians working in solo practices or SIPs. She cites that even though burnout rates are lower, many of these practices are struggling financially, and many of these physicians are on-call all of the time.

“The more we can understand what drives low rates of burnout, the more likely it is that we’ll find solutions to this problem,” says Dr. Shelley. “The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors’ needs, values, and competencies.”

Dr. Shelley lists a number of the study’s limitations. Since the findings are representative of physicians working in small practices in New York City, the study does not capture burnout rates in other cities across the country. It is also possible that the researchers underestimated the number of hours worked by physicians, since hours worked is associated with burnout. Dr. Shelley also cited the lack of data linking physician burnout to patient outcomes.

In addition to Dr. Shelley, study co-authors include Nan Jiang, PhDCarolyn Berry, PhD; and Gbenga Ogedegbe, MD, MPH, of NYU School of Medicine; Chuck Cleland, PhD, of NYU Rory Meyers College of Nursing; and Batel Blechter of Johns Hopkins University.

The research was supported by the Agency for Healthcare Research and Quality (AHRQ).

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Association Special Committee Looks at Solving Manpower Shortage

Association Special Committee Looks at Solving Manpower Shortage

MONTGOMERY – Earlier this week, the Association’s Manpower Shortage Task Force met in person for the first time to begin addressing a resolution adopted by the House of Delegates at the 2018 Annual Meeting in April. The resolution, submitted by the Pickens County Medical Society, directs the Association’s new task force to develop and restore adequate health care manpower in all geographic areas in order to provide quality local health care for all Alabama citizens.

Members of the task force discussed a number of issues but focused on the importance of fully funding the Board of Medical Scholarship Awards, scope of practice, physician pipeline programs, education and the possibility of GME expansion, recruitment and retention of physicians through meaningful tax credits and rural community support, and start-up business models.

Medicaid Commissioner Stephanie Azar and Dave White from the Governor’s Office joined the meeting to hear the concerns of the task force and take their report back to Gov. Kay Ivey.

“Because this was the first face-to-face meeting of the task force, we had a lot of ground to cover,” said Executive Director Mark Jackson. “Naturally there are a lot of concerns about health care shortages in rural areas, but our goal is a long-term solution. The members of the task force realize this isn’t an easy fix, which is why they were willing to express their concerns openly and honestly to the Governor’s staff.”

The task force and the resolution stand as a reminder that Alabama ranks in the last five of 50 states in health status categories, and while primary care medicine is effective in raising health status, supporting hospitals and improving the economic status of disadvantaged communities, the state’s aging population is causing an escalation in need for primary care physicians.

See also Association’s New Task Force to Address Health Care Manpower Shortage

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Association’s New Task Force to Address Health Care Manpower Shortage

Association’s New Task Force to Address Health Care Manpower Shortage

In response to a resolution passed by the House of Delegates during the 2018 Annual Meeting in Montgomery in April, the Board of Censors formed a new task force to develop and restore adequate health care manpower in all geographic areas in order to provide quality local health care for all Alabama citizens.

The resolution, submitted by the Pickens County Medical Society, stands as a reminder that Alabama ranks in the last five of 50 states in health status categories, and while primary care medicine is effective in raising health status, supporting hospitals and improving the economic status of disadvantaged communities, the state’s aging population is causing an escalation in need for primary care physicians.

The task force had its first meeting the week of July 23 and will meet again on Aug. 14. We will post details as they become available.

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President Trump Signs VA Mission Act

President Trump Signs VA Mission Act

UPDATE JUNE 6, 2018: President Trump signed the VA Mission Act designed to increase veterans’ access to timely and private health care. The new VA law aims to combine and expand existing community care programs during the next year with intentions to roll out one centralized community care program next May.

Building off the positive changes enacted by the Choice Program, which was created in 2014 after two veterans died waiting for appointments, the Mission Act broadens the circumstances for which veterans can receive non-VA health care. Presently, veterans can seek third-party medical care if they live more than 40 miles away from a VA facility or if they must wait over 30 days for an appointment. The Mission Act will also allow veterans access to non-VA health care if they are in need of a service the VA does not offer or if their doctor thinks it is in the best interest of the patient.

With access to non-VA health care becoming more accessible, some lawmakers became fearful the new law would undermine the VA. The Mission Act recognizes this potential and includes incentives and funding to ensure the Act does not drive veterans away from the VA. The order will boost funding to allow the VA to hire more health care professionals in addition to offering scholarships to medical students willing to work for the VA.

Additionally, the new measure will help pre-9/11 veterans by giving them benefits to help cover the cost of in-home caregivers. Post-9/11 veterans already have access to such benefits. These benefits offer an alternative to institutionalized health care and will help take some of the cost of local governments.

While the Mission Act passed overwhelmingly in both the House and Senate with bi-partisan support in May 2018, there is a debate on exactly how the measure will be funded after May 2019. Sen. Richard Shelby (R-Ala.), head of the Senate Appropriations Committee, is working across party lines in both the Senate Appropriations Committee and the Veteran’s Affairs Committee to help establish the best possible funding plan for the VA Mission Act.

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Let’s Talk About Physician Burnout

Let’s Talk About Physician Burnout

According to Medscape’s 2018 Annual Physician Lifestyle Report, Burnout and Depression Section, 42 percent of physicians surveyed have reported burnout symptoms in the last year. Fifteen percent of physicians admitted to experiencing either clinical or colloquial forms of depression. The National Institute of Mental Health reports 6.7 percent of all American adults suffered at least one major depressive episode in the past year.

To say that burnout and depression have reached epidemic proportions among the medical community is an understatement.

The Medscape report also revealed a higher percentage of female physicians — 48 percent — suffered from symptoms of burnout than their male counterparts — 38 percent. Age may also be a factor. According to the report, about 35 percent of young physicians feel some sort of burnout whereas about half of physicians ages 45 to 54 feel the pinch.

The report also showed that while physicians in all specialties are susceptible to feelings of burnout, some medical specialties tend to show higher rates of burnout:

  • Critical Care — 48%
  • Neurology — 48%
  • Family Medicine — 47%
  • Obstetrics/Gynecology — 46%
  • Internal Medicine — 46%

What is burnout?

The dictionary defines burnout as exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration. But for a physician, burnout is much more…with much more at stake.

Physicians are trained to endure long hours and stressful situations. However, practicing medicine in today’s highly charged political climate filled with intrusive government regulations tends to take a toll with not only the lives of the patient, but quite possibly the physicians, hanging in the balance. There are symptoms of burnout which can easily be missed or overlooked. These include excessive fatigue, insomnia, depression and anxiety. Unfortunately, prolonged exposure to these symptoms may lead one to self-medicate with alcohol or prescription medications…or worse.

Part of the problem is that few in the medical community want to talk about burnout. However, talking about burnout is not only the beginning of a solution but can also save lives.

Fighting burnout begins with a conversation.

Physicians dealing with mental, emotional and physical exhaustion become less able to provide quality care to their patients and find themselves leaving the medical profession altogether…or worse. It’s the “or worse” scenario that worries Dr. Debbie Booher Kolb of Madison.

As president of the Madison County Medical Society, Dr. Kolb wanted to make a difference in the lives of her colleagues. Together with a wellness committee she chairs, they began to formulate a plan to help physicians in their area who felt overwhelmed in their medical practice and to help everyone achieve a better work-life balance. They had no idea the vast support they would have for the Physicians Resource Network Wellness Program.

“My father is a retired radiologist,” Dr. Kolb explained. “I remember being in school and hearing about a friend of my fathers who changed careers. I was mystified by that. I didn’t know that was even an option. I’d never heard of a physician changing careers. It’s not even on your radar once you’re in the medical profession. If you do change careers, it’s to go into pharmaceuticals, medical directorships, or to be a life coach. For physicians, it’s truly a business decision once you leave the profession. It’s sad really to think you could burn out so badly that you leave the profession you loved so much completely behind you.”

But, it’s happening more and more to physicians. With the added pressures of government regulations, such as MACRA, electronic health records, ICD-10, and Medicaid funding, the practice of medicine has become even more complicated today than it was just a decade ago. Unfortunately, these pressures have caused physicians to burnout and not only voluntarily leave the profession of medicine, but also to lose their medical license for inappropriate behavior, or died by suicide.

Dr. Kolb’s mission is to help her colleagues prevent burnout by learning how to cope with its symptoms and finding a better work-life balance. Her mission began in 2014 at the annual meeting of the American Academy of Family Physicians where she first met Dr. Dike Drummond, better known as The Happy MD, and discovered his book, Stop Physician Burnout. Dr. Drummond’s website is

“This book transcends medicine, and his website is great, too. I was so impressed with his actionable advice. What he taught was good nuts-and-bolts information that made me want to bring him to Huntsville so my colleagues could hear him locally. We’ve had three physician suicides in two
and a half years in Madison County alone. It became more and more apparent that we needed to do something. This is heartbreaking and preventable. All of this coalesced to really be something that we could all get behind.”

And everyone did. Laura Moss, executive director of the Madison County Medical Association, said it wasn’t difficult to get everyone on board with the idea to make the physician wellness initiative a continually evolving priority for Madison County.

“Physician burnout is a trending topic because it’s a huge problem among those in health care. Our hope is that the more we talk about it, and the more solutions such as coaching, counseling and workshops we offer, the more intentional our physicians will become about the decisions they make regarding their own health,” Moss said. “We also hope the more it’s out in the open, the less physicians will feel alone and turn to addiction or worse — suicide. This is not something many physicians were taught about in medical school, and we want to be here to offer ways to help prevent or overcome burnout in a healthy way. MCMS is excited to be focused on taking care of the caregivers and to be giving back to our members in a meaningful way.”

As Dr. Kolb and her colleagues admit, everything begins with a discussion. Little did they know how many lives they were about to touch when they rolled out the first component of the burnout program. The first step was an evening event with Dr. Drummond, which sold out 200 seats and had a waiting list for attendees. Burnout Proof LIVE was a huge success, and it’s just the beginning.

“Burnout transcends specialties, and that’s why our physicians have been so appreciative of this program. After the event with Dr. Drummond, we had people commenting and sharing their stories on social media. That’s what we’re trying to do — effect a paradigm shift in the culture of medicine. We really want to let our colleagues know this is more common than they may realize because physicians just don’t talk about it. We want to start talking about it,” Dr. Kolb said.

How can physicians get help for burnout?

The program in Madison County is an excellent start for awareness and healing, according to Rob Hunt, D.Min., director of the Alabama Physician Health Program, but there’s still more work to be done.

“More programs like the one in Madison County that get people in the medical community talking about burnout is a good start. Unfortunately, there are still so many doctors who don’t understand the warning signs, especially medical students. Female residents are among the biggest burnout populations. I think the key is education. The more they can learn about what burnout is and how to avoid it early in their careers, the better it will be on our physicians and our medical system,” Dr. Hunt said.

APHP is a member benefit for physicians of the Medical Association. It is a confidential clinical resource for physicians, physician assistants, residents and medical students created in 1990 by state law to provide a program for early detection and treatment of medical professionals with problems related to possible impairment due to alcohol, drugs, psychiatric disorders or behavior. About 90 percent of physicians who enter the APHP successfully complete the program and return to their medical practices and see patients.

“Most don’t truly understand exactly what APHP can do until they become part of the program as participants. We are here to help them, and we advocate for them to help them keep their medical licenses. We try to keep or get them healthy and keep them in their medical practice and in the State of Alabama. Our opinion is that a doctor who has gone through APHP as a participant and is being monitored is a safer physician, a better physician, than those who have problems and haven’t gone through our program,” Dr. Hunt explained.

According to Dr. Hunt, most physicians may not even realize they are burning out until the situation becomes substance abuse, disruptive behavior, or other issues that stem from being burned out. It’s these overt signs that APHP can help physicians treat.

“Physicians work as much as 80 or more hours a week easily, and they’ve done that for years and years,” Dr. Hunt said. “Some take medications to cope with that stress. They may not know it, but it gets out of control, and they become addicted. What we see are more middle-aged physicians. Older physicians have learned to cope with that stress. We’ve seen many doctors retire because of EMR, ICD-10 and other government regulations. They just refused to put up with it, so they took that step and closed their practices. It was too much stress. It’s still happening with more and more government regulations that physicians have to navigate. It takes them away from the one thing they trained their entire lives for — medicine.”

Still, if more physicians can learn about what burnout is and how to avoid it early in their careers, the better it will be for our physicians and our medical system.

Could YOU have burnout?

There are specific signs of professional burnout. Ask yourself these questions:

  • Am I overly cynical or critical at work?
  • Do I have to drag myself to work or have trouble getting started once I arrive at work?
  • Am I irritable or impatient with co-workers or patients?
  • Do I lack the energy to be productive at work?
  • Does work consistently satisfy me?
  • Am I disillusioned by the practice of medicine?
  • Have my sleep habits or appetite changed?
  • Do I have headaches, backaches or other physical complaints that don’t subside with rest?
  • Do I use food, drugs or alcohol to feel better or to simply not feel at all?

If you feel you are suffering from symptoms of burnout and would like to get help, please contact the Alabama Physicians Health Program at 1-800-239-6272. APHP is a member benefit of the Medical Association. If you live in Madison County and would like more information about the Physician Wellness program, call (256) 881-7321.

Article written by Lori M. Quiller, APR, Director of Communications, and Mikala McCurry, Communications Assistant.

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NIH’s All of Us Research Program Kicks Off in Birmingham on May 6

NIH’s All of Us Research Program Kicks Off in Birmingham on May 6

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STUDY: Independent Practice Declines Due Partially to EHRs

STUDY: Independent Practice Declines Due Partially to EHRs

A new study conducted by the Trump Administration suggests electronic health records are currently failing at reducing the cost of billing for medical facilities, especially for independent practices.

“Small physicians’ groups and solo providers could not afford to purchase and maintain electronic medical records and comply with government reporting requirements,” the White House report stated. “As a result, hospital mergers are booming, leading to horizontal integration, and large hospitals are buying up physicians’ practices and outpatient service providers to form large, vertically integrated health care networks.”

A study published in the Journal of the American Medical Association shows that billing costs consumed significant chunks of revenue even at a large academic center with a fully implemented EHR system. They represented about 14.5 percent of costs of primary care visits and 13.4 percent of costs for ambulatory surgical procedures. “These findings suggest that significant investments in certified health information technology have not reduced high billing costs in the United States,” the authors state in the report.

Independent physicians have also commented on the burdens of the EHR system. Three out of four physicians believe electronic health records (EHRs) increase practice costs, outweighing any efficiency savings, and seven out of 10 think EHRs reduce their productivity, according to a Deloitte’s recent 2016 Survey of U.S. Physicians.

The results of the survey also indicate physician satisfaction with EHRs varies by practice characteristics. About 70 percent of employed physicians are more likely to think that EHRs support the exchange of clinical information and help improve clinical outcomes compared to 50 percent of independent physicians. The results also revealed 72 percent of independent physicians are more likely to think that EHRs reduce productivity compared to 57 percent of employed physicians. Additionally, 80 percent of independent physicians think that EHRs increase practice costs, compared to 63 percent of employed physicians.

The federal government has financial interests in making it easier for physicians to cope with EHR requirements, according to President Trump’s 2018 Economic Report. As part of its 2018 economic report, released Feb. 21, the White House drew a direct connection between physicians’ struggles to purchase and operate EHR systems and the increase in consolidation among hospitals.

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Alabama’s Physicians Contribute Billions to State Financial Health

Alabama’s Physicians Contribute Billions to State Financial Health

MONTGOMERY – Alabama’s more than 8,700 patient care physicians fulfill a vital role in the state’s economy by supporting 101,770 jobs and generating $16.7 billion in economic activity, according to a new report released by the Medical Association of the State of Alabama and the American Medical Association.

“Urban or rural, large group or solo practitioner, Alabama’s physicians are major economic engines,” said Medical Association President Jerry Harrison, M.D., of Haleyville. “While we are healers first, this study shows physicians help improve the health of our state as much as the health of our patients.”

The report measured the economic impact of Alabama’s physicians according to four key economic barometers:

  • Jobs: Each physician supported an average of 11.7 jobs, including his/her own, and contributed to a total of 101,770 jobs statewide.
  • Output: Each physician supported an average of $1.9 million in economic output and contributed to a total of $16.7 billion in economic output statewide.
  • Wages and Benefits: Each physician supported an average of $839,103 in total wages and benefits and contributed to a total of $7.3 billion in wages and benefits statewide.
  • Tax Revenues: Each physician supported $64,816 in local and state tax revenues and contributed to a total of $565.4 million in local and state tax revenues statewide.

The report focused on doctors of medicine (M.D.s) and doctors of osteopathy (D.O.s) who are engaged in treating patients as opposed to those who focus on research or teaching. While this new study illustrates that physicians carry tremendous responsibility as skilled healers charged with safeguarding healthy communities, it also shows their positive impact is not confined to the exam room. Physicians are strong economic drivers in their communities by the economic growth, opportunity and prosperity they generate.

The study also noted that in comparison to other industries, patient care physicians contribute as much or more to Alabama’s economy than higher education, nursing and community care facilities, legal services and home health care.

View the full report and an interactive map of the United States here:

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State Committee of Public Health Appoints New State Health Officer

State Committee of Public Health Appoints New State Health Officer

The State Committee of Public Health has appointed Dr. Scott Harris as Alabama’s 12th state health officer, effective Feb. 21.

“I feel honored and privileged that the State Committee of Public Health granted me this opportunity to address the state’s health care needs and challenges,” Dr. Harris said.

Dr. Harris brings a wide range of knowledge and extensive experience that includes more than 19 years in private practice to his position. A graduate of Harding University in Arkansas, he attended medical school at the University of Alabama at Birmingham School of Medicine and served his residency and internship at Carraway Methodist Medical Center before returning to UAB to complete a fellowship in infectious diseases. In 2017, he was awarded a master’s degree in public health from the UAB School of Public Health with a concentration in health policy.

Dr. Harris practiced infectious disease medicine at Decatur General Hospital and Parkway Medical Center. He served on the Medical Executive Committee, medicine department chairman and director of multiple committees including infection control, pharmacy and therapeutics, and the surgical care improvement project. He is past chairman and current member of the Decatur Morgan Hospital Foundation.

In 2005, he became medical director at the Decatur-Morgan Community Free Clinic. The non-profit clinic offers health care and dental care at no charge to low income, medically uninsured local residents. The clinic relies heavily on volunteers, including community members. Dr. Harris also has served on many international medical missions to Central America, South America and Africa.

In 2015, Dr. Harris joined the Alabama Department of Public Health as area health officer for seven North Alabama counties. For the past six months, he has served as acting state health officer and currently co-chairs the Alabama Opioid Overdose and Addiction Council.

The Talladega native is a fellow of the American College of Physicians, Infectious Disease Society of America, and a credentialed HIV specialist, American Academy of HIV Medicine.

The ADPH employs approximately 3,000 and has an annual budget of $694 million.

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Bipartisan Budget Act Boosts Health Programs

Bipartisan Budget Act Boosts Health Programs

In a rare show of bipartisanship for the mostly polarized 115th Congress, the Bipartisan Budget Act of 2018 is officially one for the record books. The week leading up to the final vote was far from smooth with Sen. Nancy Pelosi impressively filibustering on the floor of the U.S. Senate for eight hours to Rep. Rand Paul blocking the final vote late Thursday night/early Friday morning and forcing a six-hour government shutdown before allowing the final vote to be taken.

Now that President Trump has signed the Bipartisan Budget Act of 2018 here’s what you need to know:

Technical Amendments to MACRA. Makes several changes to the Medicare Access and CHIP Reauthorization Act (MACRA) that the medical community has been strongly advocating for, including:

  • Excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;
  • Eliminates improvement scoring for the cost performance category for the third, fourth and fifth years of MIPS;
  • Allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS;
  • Requires CMS to update on CMS’ website by Dec. 31 of each year, information on resource use measures including measures under development, the time-frame for such development, potential future resource use measure topics, a description of stakeholder engagement and the percent of expenditures under Medicare Part A and B that are covered by resource use measures.
  • Allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;
  • Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback regarding the extent to which models meet criteria and an explanation of the basis for the feedback.

Physician fee schedule update (in lieu of Misvalued Codes). Reduces the Physician Fee Schedule conversion factor for 2019 from 0.5 percent to 0.25 percent. This is more favorable language than, and is in lieu of, the language in the House bill that would extend the “misvalued codes” provision for one additional year. The AMA estimated, based on the recommendations of the AMA / Specialty Society Relative Value Scale Update Committee (RUC), that the misvalued code provision in the House bill would have reduced the statutory 0.5 percent payment update in 2019 by 0.45 percent. Rejection of the misvalued code policy is an important outcome for future budget saving exercises. On a bipartisan basis, policymakers have recognized that the misvalued code “budget dial” is tapped out and should be shelved.

IPAB. Permanently repeals the Independent Payment Advisory Board. IPAB was a 15-member government agency created in 2010 by the Affordable Care Act for achieving specified savings in Medicare without affecting coverage or quality.

Children’s Health Insurance Program (CHIP). CHIP is extended for an additional four years beyond the previous Continuing Resolution’s six-year extension, with appropriations made through 2027.

Community Health Centers. Funding for community health centers is reauthorized for two years at a level of $3.8 billion for FY 2018 and $4 billion for FY 2019.

Medicare payment cap for therapy services. Permanently repeals the outpatient therapy caps beginning on Jan. 1, 2018.

National Health Service Corps. Funding for the National Health Service Corps is extended at the FY 2015 – 2017 annual level of $310 million for two additional years.

Teaching Health Center Graduate Medical Education. Funding for Teaching Health Center Graduate Medical Education is extended for two years at an annual level of $126.5 million, more than doubling annual funding for this program.

Geographic Practice Cost Indices (GPCI) floor. Extends the work GPCI floor for two additional years through Jan. 1, 2020.

Reducing EHR Significant Hardship. Removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

Closing the Donut Hole for Seniors. Closes the Medicare Part D prescription drug “donut hole” sooner than under current law by increasing the discounted price manufacturers provide from 50 percent to 70 percent.

Emergency Medicaid Funds for Puerto Rico and the U.S. Virgin Islands. Puerto Rico’s Medicaid caps for 2018 – 2019 are increased by an additional $4.8 billion. The Virgin Islands’ caps are increased over the same time period by $142.5 million. Also, 100 percent federal cost sharing for Medicaid is provided for both territories through Sept. 30, 2019.

Prevention and Public Health Fund (PPHF). The Senate bill reduces funding for the PPHF by $1.35 billion between FY 2018 – 2027.

Other Select Budget Agreement Provisions:

Note: there is an agreement to include these funds in the Omnibus before the March 23 deadline.

  • $6 billion in funding for the opioid crisis and for mental health
  • $4 billion to rebuild and improve VA Hospitals and clinics
  • $2 billion for NIH research (above CURES Act increases)

Click here if you would like to see how Alabama’s Congressional Delegation voted.

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