How doctors can use No Surprises Act to resolve billing disputes

The AMA has assembled a toolkit to help physicians navigate the new independent-dispute resolution process under the No Surprises Act.

The new federal law, which took effect in January of this year, bars surprise billing for emergency care and some nonemergency care at in-network facilities. The law and implementing regulations have established a process to determine payment for physicians, health care organizations and others that includes the IDR process.

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Cardiovascular disease epidemiologist named JAMA’s new top editor

Kirsten Bibbins-Domingo, MD, PhD, MAS, still recalls the excitement she felt early in her career upon learning that her study had been accepted for publication in JAMA.

For the prospective cohort study about NT-proBNP testing and cardiovascular disease events, she remembers “the editor in charge of the paper at the time demanding quite a number of additional analyses and revisions, many more than the reviewers had actually asked for and—finally—saying to us, ‘It’s really important we get things right. Because when JAMA publishes something, it affects clinical practice.’”

Now Dr. Bibbins-Domingo, who has had dozens of articles published in JAMA Network journals and well over 300 altogether, will feel that special obligation on the other side of the desk in medical journalism. Starting July 1, the general internist, cardiovascular disease epidemiologist and national leader in the fields of disease prevention and health equity will become the editor-in-chief of JAMA and JAMA Network.

With each succeeding JAMA Network publication, Dr. Bibbins-Domingo has “seen firsthand how practice or policy has shifted as a result, not just because of the scientific finding, but because of its publication under the trusted name that JAMA represents,” she said during a news briefing this week. “It’s truly very special and I’m thrilled to now be part of it.”

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With BA.2 in view, no time to skimp on COVID-19 funding

When Congress passed the massive $1.5 trillion spending bill earlier this month that assured telehealth flexibilities for the bulk of 2022, the lawmakers left out nearly $16 billion in COVID-19 relief funds that had been included in an earlier version of the omnibus bill.

Now the AMA is warning that, while COVID-19 hospitalizations and deaths are trending downward and pandemic restrictions have been loosened, more congressional funding is needed to help ensure such progress is sustained.

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Doctors see inequity daily. Fellowship helps them dig deeper.

Physicians have until March 14 to apply to be part of just the second cohort of fellows for the Medical Justice in Advocacy Fellowship. The collaborative initiative is empowering physician-led advocacy to advance health equity and remove barriers to achieve optimal health for all.

Two of the 12 doctors selected from 300-plus applicants for the inaugural fellowship cohort took time to share their perspectives on what they have learned and why other doctors who want to eliminate health inequities should apply to take part in this education initiative from the AMA and the Satcher Health Leadership Institute at the Morehouse School of Medicine.

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Let EPA curb greenhouse gases to protect public health

The U.S. Supreme Court should affirm the authority of the Environmental Protection Agency to regulate the greenhouse gas emissions that cause climate change and have been proven to inflict major health problems, argues a friend-of-the-court brief filed by the AMA, the American Thoracic Society and more than 15 other leading medical organizations and dozens of U.S. public health leaders.

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Dig deep on health care issues that matter with 10 top Q&As

In a year that started with the promise of safe and effective COVID-19 vaccines and is ending with concerns about the rise of yet another SARS-CoV-2 variant that could exacerbate the pandemic of the unvaccinated, physicians’ mettle has been tested like never before.

Many of the doctors who are fighting COVID-19, promoting vaccination, advancing health equity, working to end the drug-overdose epidemic, and battling burnout have taken time from their busy schedules this year to explore how they are moving medicine forward in exclusive, in-depth Q&A-format interviews with the AMA.

Read my latest article for the AMA to explore 10 of these Q&A interviews.

How health systems rise to meet challenges in pandemic’s 2nd year

Well into its second year, the COVID-19 pandemic has continued to test U.S. health systems seeking to rebound from 2020, ensure vaccine uptake, battle physician burnout and innovate to improve care delivery.

Throughout this challenging year, the AMA has recognized the outstanding efforts of AMA Health System Program members. The program provides enterprise solutions to equip health system leadership, physicians and care teams with resources to help drive the future of medicine.

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COVID-19 vaccine requirements: Why U.S. doctors are fighting for them

With federal health officials warning that the SARS-CoV-2 Omicron variant is already spreading quickly in the U.S. and is likely to peak with a huge caseload in January, American doctors are redoubling their support for COVID-19 vaccination—and vaccine requirements—as the best way to save lives and keep patients out of the hospital.

The scientific experts at the Centers for Disease Control and Prevention say that booster doses can effectively fight the Omicron variant, which now has joined the SARS-CoV-2 Delta variant in a kind of tag team of viral attack.

That is just one huge reason why the AMA is continuing its legal efforts in support of policies that require widespread COVID-19 vaccination.

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Congress moves to tackle Medicare physician pay cliff

There appears to be a pathway emerging in Congress to address a combined 9.75% in Medicare physician payment cuts, which amount to a physician payment cliff and were set to take effect Jan. 1, 2022.

The Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) was considered by the House of Representatives. While the underlying bill is the Senate-passed Dr. Lorna Breen Health Care Provider Protection Act, the House passed its version of that bill separately under suspension of the rules.

Highlights of the physician-payment provisions include:

  • A delay in resuming the 2% Medicare sequester for three months (Jan. 1–March 31, 2022), followed by a reduction to 1% for three months (April 1–June 30, 2022).
  • A one-year increase in the Medicare physician payment schedule of 3%, which is 0.75% less than the conversion factor boost provided for 2021.
  • A one-year delay in the cuts to the clinical laboratory payment schedule.
  • A one-year delay in the Medicare radiation oncology demonstration.
  • Erasing the 4% Medicare pay-as-you-go (PAYGO) cut, and preventing any additional PAYGO cuts through 2022.

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Doctor participation in ACOs, medical homes grows amid pandemic

Physician participation in accountable care organizations (ACO) and medical homes continues to grow steadily amid the COVID-19 pandemic, according to the results of an AMA survey of about 3,500 physicians.

Nearly one-third of doctors worked in practices participating in medical homes in 2020, up from 23.7% in 2014. On the ACO front, 42.7% of physicians were in practices that participated in a commercial ACO in 2020, up from 31.7% in 2016. Meanwhile, 29.5% of physicians were in practices took part in a Medicaid ACO, up from 20.9% in 2016.

And the share of physicians in practices involved in Medicare ACOs has risen from 28.6% in 2014 to 36.7% in 2020, though it dipped from a high of 38.2% in 2018.

The findings are included in the AMA Policy Research Perspectives report, “Payment and Delivery in 2020: Fee-for-Service Revenue Remains Stable While Participation Shifts in Accountable Care Organizations During the Pandemic.”

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Top 10 stories from the November 2021 AMA Special Meeting

Nearly 700 physicians, residents and medical students gathered for the November 2021 AMA Special Meeting of the AMA House of Delegates to consider a wide array of proposals to help fulfill the AMA’s core mission of promoting medicine and improving public health. As they have done since the global pandemic was declared last year, the delegates met virtually.

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