| weekly_rounds_july_29_2022_5_things_you_may_have_missed | Weekly Rounds: July 29, 2022 - 5 Things You May Have Missed | Latest_News | Shared_Content/News/Weekly_Rounds/2022/weekly_rounds_july_29_2022_5_things_you_may_have_missed | <div class="col-md-12">
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<h5>July 29, 2022</h5>
<h2>5 Things You May Have Missed</h2>
<p>Jennifer Hanscom, CEO</p>
<p>
While for many the news cycle may appear to slow a bit in the summer months, that's rarely the case for physicians and health care. If you've been busy these past weeks, whether in your practice or (hopefully) on a much-needed vacation, here are several quick news updates to keep you abreast of the health care news cycle here in the Evergreen State.
</p>
<h3>Washington's hospitals and health systems face large financial losses</h3>
<p>
Last Thursday, the Washington State Hospital Association held a press briefing to announce the results of a statewide financial impact survey of Washington's hospitals. Hospitals representing 97% of all inpatient beds in Washington state responded to survey, which compared hospitals' financial performance of the first quarter of 2022 to the first quarter of 2021. The survey results paint a dire picture, with hospital operating revenues up 5%, operating expenses up 11% (driven by increased workforce, supply, and drug expenses), and total operating losses combined with investment losses resulting in a net loss of $929 million (a 13% net loss). All 52 urban hospitals and health systems reported negative margins, and account for 99% of losses statewide. Of the independent rural hospitals, 18 out of 34 reported negative margins. Reasons cited for these large losses include low Medicaid reimbursement, high inflation and labor shortages, employee compensation increases, temporary labor spending increases, more complex patients with costs of care higher than rates of reimbursement, especially patients on Medicaid and Medicare, and expenses related to the large and increasing number of patients ready for discharge unable to be transferred.
</p>
<p>
In response to this financial shortfall, WSHA is asking the state to act to get difficult-to-discharge patients into appropriate settings to allow hospitals to focus on critical care, and it will seek long-term solutions from the Legislature in 2023, including an increase in Medicaid rates for hospitals, funding for new facilities for patients needing long-term care, and funding to address the behavioral health crisis, including more staffing, facilities, and upstream interventions.
</p>
<h3>WSMA seeking input for 2023 legislative agenda</h3>
<p>
Speaking of Medicaid rates, the WSMA will be pursuing raising Medicaid rates to Medicare levels for all physician services in 2023 (to include services performed by PAs and ARNPs). This is just one of the priorities topping our preliminary 2023 legislative agenda. Our team has surveyed WSMA's membership and leadership on the most pressing issues facing their practices and we will be using those results to outline what we plan to pursue in the 2023 session. You can get a preview of what issues are rising to the top of our agenda at our next Advocacy Council meeting on Aug. 16 at noon via Zoom. During the session, our government affairs team will also provide insights on the fall midterm elections and how they may affect our agenda in 2023. <a href="https://us06web.zoom.us/meeting/register/tZAsf-qqrD4uGdf1lsde7ItlaqVlUGqxCIRr">Register for the WSMA Advocacy Council meeting online</a>.
</p>
<h3>Registration is now open for the WSMA Annual Meeting</h3>
<p>
The WSMA is set to have our Annual Meeting Oct. 1 and 2 at the Davenport Hotel in Spokane. In preparing for the policy debate that takes place at the House of Delegates, our staff is collecting resolutions to set our policy or direct our action. If you have an idea you'd like to get before the House of Delegates, a resolution template and other frequently asked questions can be found <a href="[@]WSMA/Events/Annual_Meeting/How_to_Write_a_Resolution/WSMA/Events/Annual_Meeting/How_to_Write_a_Resolution/How_to_Write_a_Resolution.aspx?hkey=a22cd977-aaed-4445-9ee2-6fc4716a7136&amp;_zs=B3aFd1&amp;_zl=mhKU8">on the WSMA website</a>. To have your resolution included in the delegate handbook (a compilation of resolutions and other business to be considered by delegates at the Annual Meeting) you must submit it to <a href="mailto:hod@wsma.org">hod@wsma.org</a> by Aug. 12. All resolutions must be sponsored by two WSMA delegates. If you need help identifying sponsors or have additional questions on the House of Delegates or resolution drafting, email the WSMA Policy Department at <a href="mailto:policy@wsma.org">policy@wsma.org</a>.
</p>
<p>
As soon as resolutions are finalized with a fiscal note and health equity note, they will be posted in our password-protected Virtual Reference Committees, where all members can share their thoughts and opinions. <a href="[@]WSMA/Membership/Discussion_Forums/Virtual_Reference_Committees/WSMA/Membership/Discussion_Forums/virtual_reference_committees.aspx?hkey=d674a5ae-4fb5-48d6-b969-16aab9b63647&amp;_zs=B3aFd1&amp;_zl=ohKU8">Bookmark the page to join the conversation</a>.
</p>
<h3>WSMA provides input on apprenticeship rulemaking to L&amp;I</h3>
<p>
The Department of Labor and Industries has initiated <a href="https://lni.wa.gov/rulemaking-activity/AO22-15/2215CR101.pdf" target="_blank" rel="noreferrer">rulemaking</a> on apprenticeships as a result of <a href="https://app.leg.wa.gov/billsummary?BillNumber=5600&amp;Year=2021&amp;Initiative=false">Senate Bill 5600</a>, which passed the Legislature in 2022 with the intent of sustaining and expanding the state's registered apprenticeship programs. The WSMA supported this legislation during session and will provide the same support throughout the rulemaking process. The WSMA submitted a <a href="https://wsma.informz.net/WSMA/data/images/Attachments/LI-Apprenticeships-WSMA-Letter.pdf" target="_blank" rel="noreferrer">comment letter</a> on June 24 requesting that L&amp;I consider an apprenticeship platform for medical assistants under the health care and behavioral health platform. Providing medical assistants an apprenticeship pathway will strengthen care teams, improve the quality of care patients receive, and help mitigate workforce issues facing our state. This rulemaking is still in the 101 phase, or Preproposal Statement of Inquiry. The WSMA will be sure to keep you apprised of updates as this rulemaking progresses.
</p>
<h3>Payers must post negotiated prices</h3>
<p>
The Centers for Medicare and Medicaid Services' <a href="https://www.beckerspayer.com/policy-updates/payers-must-post-negotiated-prices-starting-july-1-8-things-to-know.html#key-provisions">Transparency in Coverage final rule</a> took effect on July 1, requiring payers nationwide to publish the cost of nearly every health care service they've negotiated with physicians and health care professionals. The rule requires payers to disclose in-network physician and health care professional rates for covered items and services; out-of-network allowed amounts and billed charges for all covered items and services; and negotiated rates and historical net prices for covered prescription drugs administered by physicians and health care professionals. Payers not in compliance could face fines of up to $100 per day for each violation and for each individual affected by the violation. The rule provides accommodations for health plans using alternative reimbursement arrangements that cannot accurately provide a specific dollar amount until after services are rendered. If you have any questions about CMS' new rule you may contact our policy department at <a href="mailto:policy@wsma.org">policy@wsma.org</a>.
</p>
<p>
As always, thank you for all you do in caring for Washingtonians, and keeping our state healthy.
</p>
</div> | 7/29/2022 12:00:00 AM | 1/1/0001 12:00:00 AM |
| aetna_rescinds_prior_authorization_requirement_on_cataract_surgeries | Aetna Rescinds Prior Authorization Requirement on Cataract Surgeries | Latest_News | Shared_Content/News/Membership_Memo/2022/July_22/aetna_rescinds_prior_authorization_requirement_on_cataract_surgeries | <div class="col-md-12">
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<h5>July 22, 2022</h5>
<h2>Aetna Rescinds Prior Authorization Requirement on Cataract Surgeries</h2>
<p>Aetna recently <a href="https://www.aetna.com/content/dam/aetna/pdfs/olu/July-2022-olu-monthly-notice-final.pdf" target="_blank" rel="noreferrer">announced</a> that as of July 1, it will no longer require prior authorization for cataract surgery, with the exception of Florida and Georgia Medicare Advantage patients. This change follows advocacy by the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and other members of the federation of medicine that highlighted the care delays, practice administrative burdens, and patient and public safety concerns associated with this policy. For an update on other prior authorization reform efforts, including federal legislation that would streamline prior authorization in Medicare Advantage plans, see this <a href="[@]Shared_Content/News/Weekly_Rounds/2022/weekly_rounds_april_29_2022_prior_authorization_plagues_us_all">recent Weekly Rounds issue</a>&nbsp;from WSMA CEO Jennifer Hanscom.</p>
<p>The WSMA has worked hard to address prior authorization challenges in Washington state. You may recall that <a href="https://apps.leg.wa.gov/WAC/default.aspx?cite=284-43-2050">new rules</a> went into effect in 2018 that were intended to ease the administrative burden you face as you strive to meet the requirements of state-regulated insurers or their third-party administrators when seeking prior authorization of medical services. To help practices adjust workflows to accommodate the new requirements, the WSMA introduced the <a href="https://priorauth.wsma.org/">Prior Authorization Navigator</a>&nbsp;- a mobile-friendly "one-stop-shop" website for guidance on the new rules. There you'll find a <a href="https://priorauth.wsma.org/">one-minute bullet-point summary</a> of the new rules as well as in-depth guidance on the rules' provisions. You'll also find guidance on 2015 rules covering <a href="https://priorauth.wsma.org/prescription-drugs/">prior authorization of prescription drugs</a>.</p>
<p>If you encounter an insurer or third-party administrator out of compliance with Office of the Insurance Commissioner's prior authorization requirements, you can easily file a complaint by utilizing the WSMA's Prior Authorization Navigator's <a href="https://priorauth.wsma.org/file-a-complaint/?_zs=B3aFd1&amp;_zl=IInK8">complaint form</a>. We urge you to take advantage of this tool.</p>
</div> | 7/22/2022 12:00:00 AM | 1/1/0001 12:00:00 AM |
| medicare_proposes_2023_payment_and_quality_reporting_changes | Medicare Proposes 2023 Payment and Quality Reporting Changes | Latest_News | Shared_Content/News/Membership_Memo/2022/July_22/medicare_proposes_2023_payment_and_quality_reporting_changes | <div class="col-md-12">
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<h5>July 22, 2022</h5>
<h2>Medicare Proposes 2023 Payment and Quality Reporting Changes</h2>
<p>The Centers for Medicare and Medicaid Services recently <a href="https://go.mgma.com/dc/6IIm65rHtrowjNzJAQcAY2TBRUJgOKRhdZbxwGDBcw4aMem6nvgfFcxcgPBwVFPFREZTbKrTMzTGEUfcURfDDn5EOnKgk6e5tx_ucpKlF8QSjXKx_OMBI3DJEA0wV_pIYRhy91F-We3pCNarDP4d6a2h-0lmMML5he2PRHC2gjGJtq3lqFAAlYEABEboSD4QXMP66dkscCjNQg38AhMQXD2PrVCPlAKoMODPTDR9Cy6rVYh27ENJAQbOxwtVfKtJ4qPnW6TCwOBo9J76QjKeO7XiPs4XgV1HfXLtFeL9p_0dLR62Thf1wAVQlvdGPUdS/MTQ0LUFNSi02MzkAAAGFebYYFqWbemWcipDhyALzm6lx9stGRy0xwsUnJ5fE-JOJgtaIwdf29Fouqia1aQbOmiOG564=">released</a> its proposed 2023 Medicare physician fee schedule rule, which includes proposed changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements for 2023.</p>
<p>Key proposals include:</p>
<ul>
<li>Setting 2023 Medicare payment rates for physician services. For 2023, CMS proposes a conversion factor of $33.0775 and $20.7191 for anesthesia (a decrease of -4.42% and -3.91%, respectively, over final 2022 rates).</li>
<li>Permitting certain telehealth services to remain on the Medicare Telehealth Service list for 151 days after the expiration of the COVID-19 public health emergency, such as telephone E/M codes (99441 - 99443).</li>
<li>Extending flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time until 2024.</li>
<li>Expanding access to behavioral health by permitting marriage and family therapists, licensed professional counselors, addiction counselors, and others to furnish behavioral health services under general supervision instead of direct.</li>
<li>Maintaining the MIPS performance threshold at 75 points for the 2023 MIPS performance year/2025 payment year.</li>
<li>Adding five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness for voluntary reporting beginning in 2023.</li>
<li>Creating an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.</li>
</ul>
<p>The WSMA remains <a href="[@]Shared_Content/News/Membership_Memo/2022/June_24/full_medicare_sequester_will_be_applied_on_july_1.aspx?_zs=A3aFd1&amp;_zl=tWxQ8">committed to the sustainability</a> of the <a href="[@]Shared_Content/News/Membership_Memo/2022/June_24/wsma_endorses_ama_medicare_physician_payment_reform_principles.aspx?_zs=A3aFd1&amp;_zl=xWxQ8">Medicare program for physicians and patients</a>. While we are still analyzing the proposal, we are deeply concerned about the across-the-board payment reductions and will continue to work with the American Medical Association and Congress to prevent them.</p>
<p>Review the <a href="https://www.federalregister.gov/public-inspection/2022-14562/medicare-and-medicaid-programs-calendar-year-2023-payment-policies-under-the-physician-fee-schedule">proposed rule</a>, the <a href="https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-proposed-rule">2023 Medicare physician fee schedule fact sheet,</a> and the <a href="https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1972/2023%20Quality%20Payment%20Program%20Proposed%20Rule%20Resources.zip">2023 Quality Payment Program fact sheet</a> (zip file). The final rule is expected by Nov. 1, 2022.</p>
<p><em>Update courtesy of the Medical Group Management Association.</em></p>
</div> | 7/22/2022 12:00:00 AM | 1/1/0001 12:00:00 AM |