Published 6/14/2017 

OIC finalizes prior authorization rule, marking major win for physicians and patient care

In a big win for physicians and WSMA’s Healthy Doctors, Healthier Patients initiative, the Washington State Office of the Insurance Commissioner has finalized prior authorization rulemaking aimed at standardizing administrative practices, ensuring transparency and mandating certain technological requirements across health insurance plans. Most new requirements go into effect on Jan. 1, 2018. Comprehensive and nuanced in nature, the final rule includes:

  • Uniform timeframes for standard prior authorization (five calendar days maximum), expedited prior authorization (two calendar days maximum) and an extenuating circumstances provision for when the timelines are insufficient for a provider or facility to receive approval prior to the delivery of the service.
  • An online prior authorization process where critical information must be available to physicians prior to delivering a service, including clinical criteria that will be used to evaluate the request.
  • Communication requirements, including reasons for denials in clear language and the clinical criteria used to make the determination.
  • A secure online process for a participating provider or facility to complete a prior authorization request and upload documentation.

And much more. You can review the final rule at the OIC’s webpage. The WSMA will be providing member education around the new rules so that physician practices can adjust workflows to take advantage of these sweeping new requirements. A year in the making, the WSMA applauds the OIC for its commitment to removing barriers to patient care, and the Washington State Hospital Association for its collaboration around this important effort.

Published 6/14/2017

Published 6/14/2017 

Balance billing legislation remains in play during special session

With budget negotiations in Olympia stretching into a second special session, lawmakers in the House of Representatives convened to act on several bills, including House Bill 2114 to prohibit balance billing. HB 2114 was approved by the House by a vote of 61-33 and now moves to the Senate for further consideration.

Throughout this year’s legislative sessions, the WSMA has participated in negotiations on balance billing. While the WSMA is committed to finding a way to prevent patients from receiving balance bills, we believe any solution should also protect physicians from being under-reimbursed for care provided or being disadvantaged in contract negotiations with insurance carriers. To date, none of the iterations of HB 2114 has met those standards and the WSMA has been unable to support the bill.

Legislators from both sides of the aisle acknowledged HB 2114 remains a work in progress, with further changes expected. Together with our physician specialty partners, the WSMA will continue to negotiate in good faith with legislators and other stakeholders. As with any bill, for HB 2114 to be adopted it would have to pass both the House and Senate in identical form before being signed into law by the governor.

Published 6/14/2017

Published 6/14/2017 

Seats filling fast for WSMA’s fall Physician Leadership Course

Cultivating core leadership competencies can strengthen clinician resilience, improve time and stress management and help you achieve greater workflow efficiency. Develop the skills you need to thrive professionally, regardless of the type or size of your organization, by enrolling in the WSMA Physician Leadership Course, held this fall in Seattle. This unique 40-hour course is designed for maximum convenience for busy physicians, employing a hybrid distance learning model: In-person classes will be held Friday and Saturday, Sept. 8 and 9 in Seattle, followed by eight weeks of online instruction, finishing with a third in-person session on Friday, Nov. 10, also in Seattle.

Individuals or group/system teams are encouraged to apply. To apply, please submit a letter of interest along with your CV to Lynda Sue Welch at lyndasue@wsma.org or mail to Lynda Sue at 2001 6th Ave., Suite 2700, Seattle, WA 98121. The deadline to apply is June 30. Visit the course webpage for additional information. This activity has been approved for AMA PRA Category 1 Credit™.

Published 6/14/2017

Published 6/14/2017 

Bree Collaborative seeks feedback on opioid prescribing metrics

The Dr. Robert Bree Collaborative is seeking feedback on its draft opioid prescribing metrics. Physicians are encouraged to submit comments via a 10-15 minute online survey by 5 p.m. on Friday, June 23. Those interested in responding are encouraged to read the list of included and excluded opioids beforehand. The Health Care Authority uses Bree Collaborative recommendations to guide state purchasing for Medicaid, the Public Employees Benefits Board Program and other groups. For more information, visit the Bree Collaborative website or contact Ginny Weir at GWeir@qualityhealth.org or 206.204.7377.

Published 6/14/2017

Published 6/14/2017 

Physician joins state Senate special election

American politics is a full-time sport, so it’s no surprise that even in an off-year for elections there are important campaigns to keep an eye on. Several “special elections” to fill state legislative vacancies will determine the balance of power in Olympia—including a Senate race featuring a physician candidate.

In that closely watched race, Dr. Richard Knierim, a pathologist and WSMA member, is seeking office as an Independent Democrat to represent the 48th District (Bellevue area). A newcomer to politics, Dr. Knierim works at Swedish Medical Center and was elected to the College of American Pathologists’ board of governors in 2015. Dr. Knierim will be running against Sen. Patty Kuderer, who was appointed to the seat in January after having served in the House of Representatives for a year. A trial attorney by trade, Sen. Kuderer serves as the assistant ranking Democrat on the Senate Health Care Committee. In addition to Knierim and Kuderer, Libertarian Michelle Darnell is also seeking the seat.

The marquee matchup this year will be in the state’s 45th District (Woodinville/Redmond area), where two newcomers to politics will square off in a race that may determine partisan control of the Senate. The Majority Coalition Caucus, made up of 24 Republicans and one conservative Democrat, currently holds the district seat and governs the Senate by a 25-24 majority. Democratic candidate Manka Dhingra is running against Republican Jinyoung Englund, and her campaign, if successful, would swing that chamber to the Democrats.

This year’s primary election will be held on Aug. 1 with the general election to follow on Nov. 7. As always, look to WAMPAC, the WSMA’s campaign arm, for information on campaigns and how you can get involved. For more information, contact Sean Graham at sean@wsma.org.

Published 6/14/2017

Published 6/14/2017 

Help guide WSMA advocacy by authoring a resolution

WSMA members interested in shaping association policy can do so by submitting a resolution. For information on how to write and submit a resolution, please visit the WSMA website or talk to your local county medical or state specialty society. WSMA staff can also help you develop your policy idea and help shape it into a resolution. If you have questions or need assistance, email us at hod@wsma.org or call 206.441.9762. The final deadline for submitting resolutions to the WSMA for consideration at this year’s annual meeting is Sept. 14.

Registration will be available shortly for the 2017 WSMA Annual Meeting, Oct. 14-15 at the Hilton Seattle Airport and Conference Center. The meeting is free for WSMA and MGMA Washington State members. For now, mark your calendar and keep an eye out for details.

Published 6/14/2017

Published 6/14/2017 

Patient safety initiative submissions for the 2017 William O. Robertson Award due June 30

The yearly William O. Robertson Patient Safety Award gives the WSMA a chance to recognize innovative patient safety initiatives in the ambulatory care setting. The WSMA established the award in honor of its past-president, the late William “Robbie” Robertson, MD, who was a champion for patient safety, risk management and quality improvement throughout his long and distinguished career. To have your patient safety initiative considered for the award, please submit information on your initiative online by Friday, June 30. The award winner will be announced at the 2017 WSMA Annual Meeting in October. If you have any questions, contact Jessica Martinson at jessica@wsma.org or 206.956.3628.

Published 6/14/2017

Published 6/14/2017 

Help us stay connected!

Are you:

A graduating student moving on to residency?
A resident moving into a fellowship program or your first year of practice?
A physician moving into your second year of practice?
Changing your practice/moving out of the state?

In each case, the WSMA wants to hear from you!

Please help us keep our records updated. Provide us with your new location, your residency/fellowship program, clinic/institution or your graduation dates and training completion dates. Update your profile online at wsma.org or contact us at 206.441.9762 or membership@wsma.org.

Remember, WSMA membership is free for students, residents, fellows and physicians in their first year of practice. Physicians in their second year of practice qualify for a 50 percent dues discount. Thank you for helping us keep in touch as we work together to make Washington the best place to practice medicine and receive care.

Published 6/14/2017

Published 6/14/2017 

Progress update on state’s Clinical Data Repository

WSMA staff continue to work with the Health Care Authority and OneHealthPort to review the ongoing development of the WA Link4Health Clinical Data Repository, the state’s planned repository for Medicaid EHR clinical data. This past Friday, the HCA provided an updated list of provider organizations that are actively testing the data submission process. We are currently reviewing those findings in collaboration with the Medical Group Management Association Washington State.

While some larger organizations are making progress with their EHR vendors, indications are that most providers and vendors still have not achieved the needed connectivity. The WSMA continues to post to our Practice Resource Center an aggregated list of each vendor’s progress, drawn from OneHealthPort’s EHR Vendor Data Tracker webpage. The most recent list was compiled as of June 5.

Working in collaboration with MGMA Washington State, we are preparing to revisit our concerns with the leadership of the HCA as we continue to research cost-effective methods for data submission to the repository. We’ll keep you apprised. For questions, contact Bob Perna, director of the WSMA Practice Resource Center, at rjp@wsma.org or 206.441.9762.

Published 6/14/2017

Published 6/14/2017 

Webinar on HEDIS measures and well-child visits

Annual well-child visits are covered for all Medicaid managed care patients, ages 3-20. To learn more about how HEDIS well-child visit rates are measured and reported, along with tips on how to improve clinic HEDIS scores, primary care physicians and staff can attend one of two webinars this month hosted by the state Department of Health and Medicaid managed care organizations.

HEDIS and Well Child Visits: How EMR Clinical Data Can Meet Value Based Goals will be offered twice on Tuesday, June 20. Register online for session one, 7–8:30 a.m. or for session two, noon–1:30 p.m. CME credit is available through AAFP. Download the webinar flyer for more information. For questions, email tcpi@doh.wa.gov (subject line: "HEDIS well child visits webinar question").

Published 6/14/2017

Published 6/14/2017 

Preparing for transition to new Medicare beneficiary cards

MACRA legislation passed in 2015 required that the Centers for Medicare & Medicaid Services remove Social Security numbers from all Medicare cards by 2019. A newly formatted beneficiary identification number will replace the current SSN-based health insurance claim number (HICN) on subsequent Medicare cards. The new “Medicare Beneficiary Identifier” will be used for Medicare transactions including billing, eligibility and claim status. (For detailed background, see CMS’ Social Security Number Removal Initiative webpage and CMS’ presentation.)

The Medicare Beneficiary Identifier, or MBI, will be 11 characters in length, comprised only of numbers and uppercase letters (no special characters). Review CMS’ MBI format specifications as a guide for preparing your internal systems.

To allow for an ample transition period, CMS wants physicians and practices to shift to the new identification numbers by April 2018. At that time, CMS will begin sending new cards to all Medicare beneficiaries. This transition period will begin no earlier than April 1, 2018 and run through Dec. 31, 2019.

Beginning in October 2018, through the remaining 15-month transition period, when a Medicare claim is submitted using a patient’s valid and active health insurance claim number, Medicare will return both the HICN and the MBI on the remittance advice. After January 2020, Medicare claims that do not contain the MBI will be rejected.

Published 6/14/2017

Published 6/14/2017 

EHR vendor eClinicalWorks fined $155M for performance issues

Through a “whistleblower” lawsuit under the federal False Claims Act, the U.S. Department of Justice reached a settlement agreement with EHR vendor eClinicalWorks, with the vendor agreeing to pay the federal government $155 million. The Department of Justice claimed that the vendor’s systems did not enable its provider clients to achieve objectives of the CMS Meaningful Use program for EHRs and that usability shortcomings put patient lives at risk. The settlement contends that eClinicalWorks paid kickbacks in exchange for promoting its product, which had flaws that could expose patients to potential safety issues.

Published 6/14/2017