MMS Maintains Busy Administrative-Agency Advocacy Agenda

Federal Update

MMS Maintains Busy Administrative-Agency Advocacy Agenda

Amid all our advocacy with legislators in Washington, the Society's advocacy with federal administrative agencies is often overlooked. In recent months, these agencies have been engaged in rulemaking that will affect physicians, and the MMS has been very active in responding, as summarized below.

CMS: Inpatient and Outpatient Prospective Payment
The MMS's comments to the Centers for Medicare and Medicaid Services (CMS) Inpatient and Outpatient Prospective Payment rulemaking included objections to the proposed list of hospital-acquired conditions and complications deemed "reasonably preventable" - the so-called "never events" that would be ineligible for reimbursement (see Vital Signs, October 2008). The MMS also cited the CMS's failure to analyze the impact of the nonpayment policy on the quality of care or to develop appropriate risk adjustment techniques to ensure that chronically ill and high-risk patients are not jeopardized. The Society also emphasized that physician offices need to be treated differently from inpatient settings.

CMS: 2009 Physician Payment
MMS advocacy on the 2009 Physician Payment rulemaking focused on problems with the Medicare Physician Quality Reporting Initiative (PQRI). The MMS advocated for physician review of data before it is made public, an appeals process, and an analysis of the impact of the PQRI on quality of care. The Society also questioned CMS's failure to comply with all the measurements developed by the AMA's Physician Consortium for Performance Improvement.

DEA: E-Prescriptions for Controlled Substances
The MMS joined with the AMA and many national medical specialty societies in commenting on the Drug Enforcement Agency's proposed rule to allow electronic prescribing of controlled substances. The rule would require physicians to secure in-person proof of identity, maintain a separate system for electronic prescribing for controlled and noncontrolled substances, install automatic two-minute "time outs" for computers, and use third-party auditing and prescribing logs. While the MMS stated its strong support for implementation of e-prescribing, including controlled substances, the Society maintained that the proposed rule was overly burdensome. The MMS stated that "the challenge is for the DEA to find the balance between creating pragmatic security protection while enabling busy practitioners to utilize this technology for its greatest efficiency and impact."

The full text of MMS comments on Medicare rulemaking can be found at qa.massmed.org/inpatient_comments and qa.massmed.org/outpatient_comments. Comments on DEA rules are at qa.massmed.org/DEAcomments.

- Alex. Calcagno

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