| wsma_reports_know_what_youre_signing | WSMA Reports: Know what you're signing | Latest_News | Shared_Content/News/Reports/2018/wsma_reports_know_what_youre_signing | <div class="col-md-12">
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<h5>November 21, 2018</h5>
<h2>Know what you're signing</h2>
<p>
BY TIERNEY EDWARDS, JD
</p>
<p>
<em>The following Legal Matters column was featured in the November/December 2018 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em>
</p>
<p>
If you're starting your career or considering a big employment change, your new employer may offer you a recruitment agreement to sweeten the deal. But do you know what to watch out for before you sign one?
</p>
<p>
Recruitment agreements are contracts (separate from your employment agreement) physicians sign with hospitals, medical practices, or other employers to incentivize the physician to work where the employer is located—usually in a rural area where there is a physician shortage. To induce the physician into staying in a specified geographic area and joining the employer's medical staff, recruitment agreements often offer large signing bonuses, payments to cover relocation expenses, and guarantees to provide a minimum monthly salary.
</p>
<p>
While these financial incentives sound appealing, recruitment agreements often carry consequences you should consider before signing. Additionally, an advisory opinion from the Centers for Medicare &amp; Medicaid Services has stated that any subsequent changes to the terms of the recruitment agreement would likely violate the Stark Law exceptions that would normally allow employers to offer recruitment agreements. Consequently, a physician should review a recruitment agreement carefully with an experienced health care attorney to fully understand the benefits and obligations of the agreement.
</p>
<h3>Payments as a loan</h3>
<p>
On the surface, recruitment agreements appear to offer payments to augment a new physician's income, guaranteeing a certain minimum salary each month, regardless of how much the physician brings in for the employer. But these payments are actually structured as a loan or line of credit. Generally, the physician can avoid repayment by staying in the area and working for the same employer for a predetermined amount of time during which the loan is forgiven on a pro rata basis.
</p>
<p>
Every recruitment agreement contains a section frequently called the "Guarantee of Income." To illustrate how this works, let's say the recruitment agreement promises a physician a minimum salary of $20,000 per month. This means that when the physician collects less than $20,000 in a month, the other party to the agreement will make up the difference by drawing on the line of credit.
</p>
<p>
If the physician collects only $10,000, then the line of credit will provide the physician with an additional $10,000 to make sure the physician receives a total income of $20,000 for the month. This arrangement generally continues for 12 months, but some recruitment agreements contain Guarantee of Income terms that last for up to 36 months.
</p>
<p>
But these payments are essentially loans that are forgiven at a steady rate so long as the physician continues to practice in the area. One way or another, the physician will have to repay this debt, either directly or by pro rata loan forgiveness.
</p>
<p>
Recruitment agreements are written so that they comply with federal law, and as such, a physician enjoying perks such as loan forgiveness will still be required to pay applicable taxes as portions of the loan are forgiven. Such taxes will be in addition to taxes on other salary or income. This is an important consideration, and prudent physicians will consult with an attorney familiar with health law and related tax laws to fully understand how loan forgiveness might affect the taxes they're required to pay.
</p>
<h3>Consequences for early termination</h3>
<p>
Because recruitment agreements require a physician to stay in an area for a specified period, it is important for all parties to know when the agreement may be terminated, by whom, and for what reasons. The physician may be expected to immediately repay any outstanding balance on the loaned funds if he or she resigns before the loan has been completely forgiven.
</p>
<p>
The same can be true if the hospital terminates the agreement for cause, should the employed physician violate one of many stringently enforced terms of the agreement. The result may mean that a physician who desires to move away from the area must repay tens, if not hundreds, of thousands of dollars, often immediately, to cover the accrued amount of monthly salary payments.
</p>
<p>
Some recruitment agreements also penalize employed physicians for early termination of employment by requiring immediate repayment of relocation stipends and signing bonus amounts. Consider having a payment plan in place in case something unexpected forces you to move or change your practice.
</p>
<p>
Recruitment agreements are common and potentially advantageous for both rural employers and physicians thinking of jump-starting their careers in a new direction. However, these agreements can have significant financial consequences, even when fully vetted and complied with. If you are considering signing a recruitment agreement, do so only after ample consideration and careful review with an experienced health care attorney. .
</p>
<p>
<em>Tierney Edwards, JD, is WSMA's associate director of legal and federal affairs.</em>
</p>
</div> | 11/21/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |
| Practice_Alerts_November_21_2018 | Practice Alerts: November 21, 2018 | Latest_News | Shared_Content/News/Practice_Alerts/Practice_Alerts_November_21_2018 | <div class="col-md-12">
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<h5>
November 21, 2018
</h5>
<h2>Practice Alerts</h2>
<p>In this issue: In this issue: Resources and guidance on new state opioid prescribing rules, Medicare preventive and wellness visits, Healthier Washington pay-for-performance metrics and much more.</p>
<p>For personal assistance, contact the <a href="https://wsma.org/WSMA/Services/Physician_Practice_Helpline/WSMA/Services/Physician_Practice_Helpline/Physician_Practice_Helpline.aspx?hkey=fc908a57-5820-41dc-8a1f-e2a7b1498e3b">WSMA Physician Practice Helpline</a> by emailing Bob Perna, MBA, FACMPE, at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a> or Michelle Lott, CPC, CPMA at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
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Medicare / Medicare Advantage</a>
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Commercial Health Insurers</a>
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<a name="edu"></a>
<h3>
<span style="color: #4bacc6;">EDUCATIONAL PROGRAMS</span>
</h3>
<h3>New free webinar: Dealing with ERISA claims; WSMA advocacy with U.S. Department of Labor</h3>
<p>
ERISA, the Employee Retirement Income Security Act of 1974, affects self-insured health plans. Claims payments and denials with ERISA plans are becoming increasingly problematic for physician practices. In years past, only very large companies took on self-insured health care coverage; now, insurers are marketing third-party administrator/"administrative services only" to companies as small as 50–100 employees. As the employers bear full financial risk, these arrangements are not "insurance" products regulated by the state Office of the Insurance Commissioner, meaning the OIC cannot intervene to protect those patients. However, the U.S. Department of Labor does have oversight of ERISA arrangements.
</p>
<p>
The WSMA can assist you in two ways: first, we're collaborating with the Seattle office of the U.S. Department of Labor to offer a new webinar, ERISA and Payment of Healthcare Claims, to be held on Wednesday, Nov. 28, from noon–1 p.m. <a href="https://register.gotowebinar.com/register/4782950741761434882">Register online</a> for this free event. This presentation will provide an overview of ERISA Title I, as well as explain fully insured vs. self-insured health plans, claims procedures and participants' rights, and the role of the Department of Labor.
</p>
<p>
The WSMA can also assist your practice, should you receive a denial or other adverse action on a submitted ERISA claim, through our advocacy on behalf of WSMA members with the U.S. Department of Labor. Please join us for this important presentation.
</p>
<h3>New free webinar: Understand new state opioid prescribing rules</h3>
<p>
On Jan. 1, Washington state's <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/medical_commission_finalizes_opioid_prescribing_rules.aspx">new opioid prescribing rules</a> for physicians and physician assistants treating all phases of pain (acute, subacute, and chronic) go into effect. Plan now to attend this new free WSMA webinar on Wednesday, Dec. 19 from noon–1 p.m. designed to help you understand how to comply with the new requirements. <a href="https://register.gotowebinar.com/register/1349059379828828930">Register for this free session online</a>. For questions, contact Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a>. This activity has been approved for <em>AMA PRA Category 1 Credit™</em>.
</p>
<h3>Webinar: Medicare IPPE and AWV</h3>
<p>Noridian is hosting a free webinar on Medicare's Initial Preventive Physical Examination and Annual Wellness Visit. The session will cover the IPPE - aka "Welcome to Medicare" - and the Annual Wellness Visit, documentation requirements and frequency limitations for providing these services. The webinar will be held on Wednesday, Dec. 5 at 1 p.m. Register online at the <a href="https://med.noridianmedicare.com/web/jfb/education/training-events">Noridian Schedule of Events</a>.
</p>
<a name="practice"></a>
<h3>
<span style="color: #4bacc6;">PRACTICE OPERATIONS / CLINICAL ISSUES</span>
</h3>
<h3>Understanding and preparing for new opioid prescribing rules
</h3>
<p>New opioid prescribing rules for Washington state prescribing professions, prompted by House Bill 1427 and shaped by more than a year of stakeholder input, have been adopted. The following guidance from the WSMA can assist its members, both physicians and physician assistants (allopathic and osteopathic), in understanding, preparing for, and succeeding under these new requirements.</p>
<p>The comprehensive rules represent a significant change in how opioids are prescribed. Key provisions applicable to all prescribing physicians and PAs include: </p>
<ul>
<li>A seven-day pill limit for acute prescriptions and 14 days for acute operative pain, with an exemption to these limits when clinical judgment is documented in the medical record.</li>
<li>A specific care plan and documentation requirements for each phase of pain. </li>
<li>Mandated registration and targeted checks of the prescription drug monitoring program.
</li>
<li>Required continuing medical education on opioid prescribing.</li>
</ul>
<p>As the state's regulatory bodies adopted under their own authority, there are several differences between the rules for each profession. For allopathic physicians and physician assistants, the new prescribing rules go into effect Jan. 1; new rules for osteopathic physicians and PAs went into effect on Nov. 1. For more on the differing requirements between Washington Medical Commission and the Board of Osteopathic Medicine and Surgery rulemaking, see this <a href="https://www.doh.wa.gov/Portals/1/Documents/631073-OverviewHandout-Pharmacy.pdf?ver=2018-10-04-151450-403">Table of Differences</a> from the Department of Health.</p>
<p>How to prepare:</p>
<ul>
<li>Register to attend WSMA's free one-hour webinar, Understanding New State Opioid Prescribing Rules, on Wednesday, Dec. 19, noon–1 p.m., designed to help you understand how to comply with the new requirements. <a href="https://register.gotowebinar.com/register/1349059379828828930">Register for the webinar online</a>. This activity has been approved for <em>AMA PRA Category 1 Credit™</em>. Attendance will fulfill the new state requirement for continuing medical education on opioid prescribing.</li>
<li>Set up your account with Washington state's prescription monitoring program, <a href="http://www.wapmp.org/">Prescription Review</a>. Prescription Review uses a secure platform to allow a prescribing physician to access crucial patient information before prescribing, such as duplicate prescribing, misuse, drug interactions, and other potential concerns. Don't wait until the last minute—get started today setting up your account. The DOH website has a <a href="https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PrescriptionMonitoringProgramPMP#dnn_ctr32065_FAQs_lstFAQs_Q2_0">section with instructions for physicians, including video tutorials</a>. </li>
</ul>
<p>Also, the WSMA has joined the Washington State Hospital Association to reach out to hospital and health system leaders, encouraging them to work with their IT departments to build edits and prompts into electronic health records that assist clinicians with compliance under the rules. </p>
<p>For more information on the new rules and other WSMA efforts to assist physicians and other clinicians with safe opioid prescribing, visit the <a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx?hkey=1f82f660-18a4-4be3-bb2f-6b454b6eb7cd">WSMA's Opioid Clinical Guidance webpage</a>
</p>
<h3>The Physicians Foundation's biennial survey results released
</h3>
<p>The Physicians Foundation recently released the results of its 2018 survey of U.S. physicians, which reveal the impact of factors driving physicians to reassess their careers. The survey, administered by Merritt Hawkins, includes responses from nearly 9,000 physicians across the country. </p>
<p>The findings underscore the overall impact of excessive regulatory/insurer requirements, loss of clinical autonomy, and challenges with electronic health record design/interoperability on physician attitudes toward their medical practice environment and overall dissatisfaction—all of which have led to professional burnout.
</p>
<p><a href="https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf" target="_blank">Review the full survey report</a>. The WSMA is a signatory society of the Physicians Foundation, a nonprofit 501(c)(3) organization that seeks to empower physicians.
</p>
<h3>Free life insurance policy locator</h3>
<p>The <a href="https://eapps.naic.org/life-policy-locator/#/welcome">Life Insurance Policy Locator</a> helps connect consumers with lost life insurance policies or annuities. Available through the National Association of Insurance Commissioners, in its initial two years, the locator has matched nearly 25,000 consumers with policies totaling $368 million nationwide. Washington state consumers located policies totaling $7.3 million in the past two years.</p>
<a name="medicare"></a>
<h3>
<span style="color: #4bacc6;">MEDICARE / MEDICARE ADVANTAGE</span>
</h3>
<h3>New 2019 Opioid Safety Edits for UHC's Medicare Advantage and prescription drug plans</h3>
<p>
Beginning Jan. 1, UnitedHealthcare's Medicare Advantage and Prescription Drug Plans will be implementing several new point-of-service safety edits to help cut down on the prevalence of opioid misuse and address safety concerns around opioid prescriptions. To better understand these edits and any actions needed, review UHC's <a href="https://www.uhcprovider.com/content/dam/provider/docs/public/resources/pharmacy/MEDADV-Opioid-Readiness-QRG.pdf" target="_blank">2019 Opioid Readiness: Quick Reference Guide for UnitedHealthcare Medicare Advantage and Prescription Drug Plans</a>.
</p>
<h3>Medicare Advantage: Opioid prescribing in 2019</h3>
<p>
WSMA staff are researching imminent changes on opioid prescribing in the Medicare Advantage program. Under provisions of the <strong>Comprehensive Addiction and Recovery Act of 2016</strong>, effective Jan. 1, Medicare Advantage plans will be allowed to apply prescribing restrictions on opioids and benzodiazepines. For example, United Healthcare has posted on its website a 2019 Opioid Readiness: Quick Reference Guide, and will include related information in its November provider network bulletin. United Healthcare advises it also has sent a detailed notification letter to its participating providers.
</p>
<p>
WSMA staff are reviewing this matter with CMS Region 10 representatives. CMS' webpage <a href="https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html">Improving Drug Utilization Review Controls in Part D</a> provides some further background, yet that webpage currently includes an "Under Construction" reference for 2019 guidance. The WSMA will provide further details as those become available. For questions on Medicare Advantage, contact Bob Perna at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a>. For questions on Washington state prescribing rules, contact Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a>.
</p>
<h3>New Medicare card mailing; Some have received two cards!</h3>
<p>
The Centers for Medicare &amp; Medicaid Services (CMS) has advised that some Medicare patients have inadvertently received two of the new Medicare cards. In some cases, patients received two cards with the same new alpha-numeric Medicare beneficiary identifier (MBI). However, some patients received two cards with different identification numbers. Any patients who received two cards should be instructed to call 1.800.MEDICARE (1.800.633.4227).
</p>
<p>
If your Medicare patients say they did not get a card, ask them to:
</p>
<ul>
<li>Call 1.800.MEDICARE (1.800.633.4227). There might be something that needs to be corrected, such as updating their mailing address.</li>
<li>Sign into MyMedicare.gov to see if CMS mailed their card. If so, they can print an official card. They must create an account if they do not already have one.</li>
</ul>
<p>
Practices can use either the former Social Security number-based health insurance claim number or the new alpha-numeric Medicare beneficiary identifier (MBI) for all Medicare transactions through Dec. 31, 2019. Direct your Medicare patients to <a href="https://www.medicare.gov/NewCard">Medicare.gov/NewCard</a> for information about the mailings and to sign up to get email updates on the status of card mailings. Practice staff should become familiar with using the new online <a href="https://med.noridianmedicare.com/web/jfb/article-detail/-/view/10534/mbi-look-up-tool-available-on-the-noridian-medicare-portal">MBI Look-Up Tool</a> which is available on <a href="https://www.noridianmedicareportal.com/">Noridian's secure portal</a>.
</p>
<a name="qpp"></a>
<h3>
<span style="color: #4bacc6;">MEDICARE / MACRA QUALITY PAYMENT PROGRAM / MIPS</span>
</h3>
<h3>Quality Payment Program Year 1 Performance Results</h3>
<p>CMS released 2017 performance data for the Quality Payment Program. CMS announced the preliminary data earlier this year, and is now releasing additional data that show significant success and participation in both the Merit-based Incentive Payment System and Advanced Alternative Payment Model tracks. For a complete breakdown of the 2017 performance data, see the <a href="https://www.cms.gov/blog/quality-payment-program-qpp-year-1-performance-results">blog</a> and <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-QPP-Performance-Data-Infographic.pdf" target="_blank">infographic</a>.</p>
<h3>Quality Payment Program: Participation Status Tool Updated</h3>
<p>CMS updated the Quality Payment Program <a href="https://qpp.cms.gov/participation-lookup">Participation Status Tool</a> based on calculations from the second snapshot of Medicare Part B claims data to calculate the Alternative Payment Model (APM) entities threshold scores. The second snapshot is for dates of participation between Jan. 1 and June 30, 2018. The tool includes 2018 Qualifying APM Participant (QP) and Merit-based Incentive Payment System APM status.</p>
<h3>Quality Payment Program: Advanced APMs online training course</h3>
<p>
An updated web-based training course, Quality Payment Program in 2018: Advanced, is now available through CMS' <a href="https://learner.mlnlms.com/Default.aspx">Medicare Learning Network – Learning Management System website</a>. The program covers Advanced Alternative Payment Models (APMs), including how to identify an Advanced APM and a CMS Advanced APM, as well as how to participate in the QPP via an Advanced APM.
</p>
<p>
CMS designates this enduring material for a maximum of 0.5 <em>AMA PRA Category 1 Creditsâ„¢</em>. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires October 23, 2021. <em>AMA PRA Category 1 Credit â„¢ is a trademark of the American Medical Association</em>.
</p>
<a name="state"></a>
<h3>
<span style="color: #4bacc6;">STATE AGENCIES – MEDICAID / HEALTHIER WASHINGTON</span>
</h3>
<h3>Healthier Washington: WSMA Guide for Physician Practices</h3>
<p>
Our state's <a href="http://www.hca.wa.gov/about-hca/healthier-washington">Healthier Washington</a> initiatives comprise a "demonstration project" – not a grant – funded by the federal Centers for Medicare &amp; Medicaid Services, intended to transform care delivery, starting with the Medicaid program.
</p>
<p>
The project runs from 2017-21. The Health Care Authority will receive funding from CMS, contingent upon achieving specific targets, framed around <a href="https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation-resources">three core strategies</a>:
</p>
<ul>
<li>Improving how health care services are paid (value-based payment).</li>
<li>Ensuring that health care focuses on the whole person (care integration).</li>
<li>Build healthier communities through a collaborative approach (through nine regional Accountable Communities of Health - ACHs).</li>
</ul>
<p>
Each of the nine ACHs have selected "projects" to address the transformation of care, including two required projects: Integration of Physical and Behavioral Health, and Addressing the Opioid Use Public Health Crisis.
</p>
<p>
Physicians and their practices can consider participating in this dramatic redesign of care delivery to Medicaid patients and the incremental introduction of value-based payment methodologies, replacing traditional fee-for-service payments. However, these models of care and payment can be complex and confusing.
</p>
<p>
To assist you in this process, we have prepared the <strong>Healthier Washington: WSMA Guide for Physician Practices</strong>. The Guide describes in detail the three Initiatives, along with the various projects being undertaken regionally by the nine ACHs. The Guide also explains the value-based payment models that can be used to reimburse physicians and practices for their participation in the selected projects. These payments are separate and distinct from payments made by managed care organizations for the traditional Medicaid services.
</p>
<p>
Visit our new Healthier Washington page under our Health Insurers section to download a copy of the guide. If you have any questions about the guidance, contact Bob Perna (<a href="mailto:rjp@wsma.org">rjp@wsma.org</a>) or Michelle Lott (<a href="mailto:mml@wsma.org">mml@wsma.org</a>) at the WSMA Practice Resource Center.
</p>
<h3>HCA launches updated Healthier Washington Measures Dashboard
</h3>
<p>The Health Care Authority has released its updated Healthier Washington Measures Dashboard. The interactive dashboard allows users to explore state population and measures data, which helps support accountable communities of health (ACHs), local health jurisdictions, and communities by providing information to assess regional health needs, engage in planning for health improvement, and monitor outcomes over time.</p>
<p>The dashboard shows ACHs' project pay-for-performance (P4P) metrics in the Medicaid Transformation effort: </p>
<ul>
<li>Over 20 new measures and sub-measures.</li>
<li>Updated specifications for existing measures to align with P4P requirements.
</li>
<li>A new dashboard tab, Transformation Measures, which displays baseline, improvement targets, and current measure rates for some P4P measures, by project area and ACH region.</li>
<li>New data dimensions, including two types of race/ethnicity breakouts and additional age group filters.</li>
</ul>
<p><a href="https://fortress.wa.gov/t/51/views/HealthierWashingtonDashboard/FrontPage?:isGuestRedirectFromVizportal=y&amp;:embed=y">Access the dashboard online</a>; select “Transformation Measures.†Information about ACHs' P4P metrics and improvement targets for Medicaid Transformation year 3 (2019) are available on the <a href="https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation-metrics">Medicaid Transformation metrics</a> webpage. Further details on how accountability is measured under the Medicaid Transformation effort can be found in the <a href="https://www.hca.wa.gov/assets/program/mtp-measurement-guide.pdf" target="_blank">Measurement Guide</a>.</p>
<a name="commercial"></a>
<h3>
<span style="color: #4bacc6;">COMMERCIAL HEALTH INSURERS</span>
</h3>
<h3>UnitedHealthcare: Provider education sessions</h3>
<p>UHC is convening provider education sessions, offering updates on UHC policies and products, including commercial, Medicare Advantage, and Community Plan (Medicaid). <a href="https://uhs.cvent.com/2018ProviderTownHalls">Register online</a>. Pre-registration is required as space is limited. Each session runs about two hours. Check-in is 30 minutes before the meeting start time. Remaining dates are Astoria on Dec. 3, 1:30-3:30 p.m., and Lacey/Olympia on Dec. 4, 9-11 a.m.
</p>
<h3>UHC peer comparison reports now available</h3>
<p>
Peer comparison reports, previously known as performance reports, offer an analysis of how a physician's risk-adjusted claims data compares with that of others in the same specialty for certain key measures over a period of time. A report will be provided to UnitedHealthcare network physicians when their paid claims show trends that are statistically different from expected practice patterns.
</p>
<p>
Physicians will receive a letter early this month that gives instructions on how to access their peer comparison reports online through Document Vault on Link. Physicians can access Document Vault by signing in to Link through <a href="https://www.uhcprovider.com/">UHCprovider.com</a>.
</p>
<a name="value"></a>
<h3>
<span style="color: #4bacc6;">VALUE-BASED PAYMENT</span>
</h3>
<h3>Value-based payment models: updated AMA/RAND study</h3>
<p>
Concerns over the feasibility of physician practices' adopting value-based payment models prompted the AMA to commission the RAND Corporation to update its 2014 study on payment models. The <a href="https://www.rand.org/pubs/research_reports/RR2667.html">new study</a>, released in October 2018, presented these findings:
</p>
<ul>
<li>Payment models are changing at an accelerating pace, making it difficult to adapt and keep pace.</li>
<li>While payment models are increasingly complex, practices that invested in understanding complex alternative payment models (APMs) found opportunities to earn financial rewards for their preexisting quality, without materially changing patient care. </li>
<li>Risk aversion is more prominent among physician practices, avoiding downside risk or off-loading downside risk to partner organizations when possible. </li>
</ul>
<h3>Succeeding in value-based payment</h3>
<p>
The WSMA can help our members and their practice staff succeed with value-based payment models through our three tiers of guidance and services.
</p>
<h4>Tier 1: Reference materials</h4>
<p>
For foundational knowledge on value-based payment, review AMA's online module <a href="https://www.stepsforward.org/modules/value-based-care">Preparing Your Practice for Value-Based Care</a>.
</p>
<h4>Tier 2: Educational programs</h4>
<p>
<a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#vbptakeaction">Value-Based Payment, MACRA/MIPS, Healthier Washington – Take Action Now!</a></p>
<p>
Both Medicare's MACRA Quality Payment Program and the state's Healthier Washington initiatives are built around value-based payment models. This free 45-minute OnDemand webinar, presented by the WSMA and Attune Healthcare Partners, provides an overview of the value-based payment models currently in play and focuses on specific actions to consider.
</p>
<h4>Tier 3: Practice-specific engagements</h4>
<p>
The WSMA and Attune Healthcare Partners have partnered to offer practice-specific consulting engagements to our members on value-based transformation strategies.
</p>
<p>
For more information on the new service, review our free OnDemand webinar <a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#path">Mapping Your Path to Value-Based Care</a>. The webinar addresses: The Problem with Payment Change; The Solution: A Customized Map to Value based care; How the Process Works, Advantages &amp; Results.
</p>
<p>
For more information on WSMA's value-based payment guidance, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.
</p>
</div> | 11/20/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |
| weekly_rounds_2018_11_19_difficult_news_that_must_be_delivered | Weekly Rounds: November 19, 2018 - Difficult news that must be delivered | Latest_News | Shared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_11_19_difficult_news_that_must_be_delivered | <div class="col-md-12">
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<h5>November 19, 2018</h5>
<h2>Difficult news that must be delivered</h2>
<p>
Jennifer Hanscom, Executive Director/CEO
</p>
<p>
As physicians, you're no strangers to having to dispense difficult news. It's a burden you carry with grace, compassion, and empathy. As I write today's column, that aspect of your caring profession weighs heavy on my mind. In thinking about it, I came across <a href="https://www.medicalnewstoday.com/articles/318067.php">this quote</a> on the topic, from Steven Pantilat, MD, founding director of the Palliative Care Program at the University of California-San Francisco Medical Center: "No matter how well you deliver bad news, it's still bad. You can't make it somehow OK for the patient, but it's important not to make it worse."
</p>
<p>
These thoughts have been with me as I've considered all the ways we can make sure you're aware of how opioid prescribing rulemaking from House Bill 1427, passed by the Legislature in 2017, will ultimately impact you. Despite our efforts, the rules—which, for most of you, will be effective starting in January—are complicated and will be a challenge for some practices to implement.
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<p>
Here's some background: Combatting the opioid epidemic is a top priority for the WSMA. Over the past several years, we have advanced both <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2018/multi_pronged_efforts_seek_to_make_a_difference_in_opioid_epidemic">legislative</a> and <a href="https://wsma.org/Shared_Content/News/Press_Releases/2018/Public-private_safe_prescribing_initiative_results_in_reductions_in_Medicaid_opioid_prescriptions.aspx">patient-safety strategies</a>, partnering with the Washington State Hospital Association, the governor's office, the state Department of Health, and the state Health Care Authority.
</p>
<p>
You'll recall that over the last year, we've <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/medical_commission_finalizes_opioid_prescribing_rules.aspx">regularly</a> <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180808/Last_chance_to_comment_on_rules_impacting_the_way_you_prescribe_opioids">communicated</a> our <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180228/doh_seeks_comments_on_draft_opioid_prescribing_rules_final_public_meeting_on_march_14">efforts</a> regarding the rulemaking on this bill. It's been an exceedingly rough road, as five separate medical commissions proposed varying—and sometimes conflicting—rules, over many iterations. Throughout the process, our team in Olympia has heroically had your backs, and has been unceasingly vigilant in working to protect you from undue burden and your patients from unintended consequences.
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<p>
At the same time, as a leading voice for the physician community, the WSMA has advocated for policies that reduce the amount of inappropriate prescriptions in our communities while ensuring access to medications for patients that need them.
</p>
<p>
House Bill 1427 became the primary vehicle for many interventions, including opioid prescribing rules and data sharing by the state to improve opioid prescribing practices. After a year-long process, the boards and commissions that regulate prescribers in Washington state have finalized their rules. For allopathic physicians and physician assistants, Washington Medical Commission's final rules go into effect this Jan. 1 (read the final rule <a href="https://wmc.wa.gov/sites/default/files/public/documents/Ruleswithcoverpage.pdf" target="_blank">here</a>). For osteopathic physicians and PAs, Board of Osteopathic Medicine and Surgery rules went into effect on Nov. 1 (read that final rule <a href="https://www.doh.wa.gov/Portals/1/Documents/2300/2018/WSR-18-20-087.pdf" target="_blank">here</a>).
</p>
<p>
As medical leaders, you will want to note the prescribing professions' differing requirements, given HB 1427 allowed each regulatory body to adopt new rules under its own authority. At the request of several leaders, we are working to create a rules overview slide deck that will help you prepare your care teams for these new requirements (we expect the slides to be ready in December).
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<p>
For now, together with Washington State Hospital Association and the Health Care Authority, we are recommending three key strategies for success in this new opioid prescribing environment:
</p>
<ul>
<li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#rules">Prepare for new opioid prescribing rules</a>.</li>
<li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#data">Leverage available data to understand prescribing patterns and receive alerts for patients who have experienced an overdose</a>. </li>
<li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#pmp">Integrate your electronic health record with the state's prescription monitoring program</a>. </li>
</ul>
<p>
The links above contain details on these strategies and recommendations. You will need to develop a comprehensive strategy for engaging in this work, and I know it won't be easy. I'm chagrined at being one of the messengers on this news, but I appreciate your response to the opioid epidemic.
</p>
<p>
I hope you know that we are fully committed caring for, and protecting you, just as you do for your patients. We'll keep working hard to prevent well-intentioned, yet problematic concepts for patient care.
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<p>
Thank you for all you do on behalf of Washington patients.
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</div> | 11/19/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |