The American Medical Association (AMA) announced that the Current Procedural Terminology (CPT) code set has been updated by the CPT Editorial Panel to include vaccine and administration codes for pediatric doses of the COVID-19 vaccine developed by Pfizer.
The provisional CPT codes will be effective for use on the condition that Pfizer’s two-dose regimen for the prevention of COVID-19 in children ages 5 to 11 receives approval or emergency use authorization from the U.S. Food and Drug Administration (FDA). The AMA is publishing the CPT code update now to ensure electronic systems across the U.S. health care system are prepared in advance for the potential FDA approval or authorization.
“The AMA supports the goal of extending COVID-19 immunization protection to a broader age range of children,” said AMA president Gerald E. Harmon, M.D. “A rigorous, transparent review process by the Federal Drug Administration and Centers for Disease Control and Prevention will examine the safety and efficacy of Pfizer’s COVID-19 vaccine for potential use in children between ages 5 and 11. An open and comprehensive evaluation of data from pediatric vaccine trials is critical to inspire necessary public confidence in COVID-19 vaccines for children under age 12.”
The development of vaccine-specific CPT codes has clinically distinguished each coronavirus vaccine and dosing schedule for better tracking, reporting and analysis that supports data-driven planning and allocation. COVID-19 vaccines from AstraZeneca, Janssen (Johnson & Johnson), Moderna, Novavax and Pfizer have previously been issued unique CPT codes.
To help ensure accurate coding and reporting of COVID-19 vaccines and immunization services, the AMA offers a vaccine code finder resourceto help identify the appropriate CPT code combination for the type and dose of COVID-19 vaccine provided to each patient.
For quick reference, the new vaccine and administration codes assigned to the pediatric doses of Pfizer’s COVID-19 vaccine are:
The American Medical Association (AMA) announces the release of the 2020 Current Procedural Terminology (CPT) code set containing identifiers and descriptors assigned to each medical, surgical, and diagnostic services available to patients. Trusted since 1966 as the health system’s common language, the CPT code set enables accurate reporting, measurement, analysis, and benchmarking of medical services and procedures across the nation’s entire health care system.
“An annual editorial process draws insight from the entire health care community to produce practical code enhancements to CPT that support advancements in technology and medical knowledge available for the care of patients,” said AMA president Patrice A. Harris, M.D., M.A. “This capacity ensures reliable codes are available for burgeoning tech-enabled services and affirms CPT as the trusted code set for efficiently sharing accurate information about medical services and procedures. That’s why we believe CPT serves both as the language of medicine today and the code to its future.”
There are 394 code changes in the 2020 CPT code set, including 248 new codes, 71 deletions, and 75 revisions. In making these updates, the CPT Editorial Panel considered broad input from physicians, medical specialty societies and the greater health care community.
Among this year’s important additions to CPT are new medical services sparked by novel digital communication tools, such as patient portals, that allow health care professionals to more efficiently connect with patients at home and exchange information. CPT has responded by adding six new codes to report online digital evaluation services, or e-visits. These codes describe patient-initiated digital communications provided by physician or other qualified health care professional (99421, 99422, 99423), or a non-physician health care professional (98970, 98971, 98972).
Other coding additions to CPT were prompted to better support home blood pressure monitoring that aligns with current clinical practice. CPT added codes (99473, 99474) to report self-measured blood pressure monitoring. The goal of these codes is to expand reporting pathways for physicians across the country who take care of a diverse set of patients that have varying degrees of access to care.
“With the advance of new technologies for e-visits and health monitoring, many patients are realizing the best access point for physician care is once again their home,” said Dr. Harris. “The new CPT codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to health care, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care.”
The American Medical Association (AMA) and Sling Health, a student-run biotechnology incubator, are expanding their joint efforts to allow the voice and experience of physicians to inspire technologies that resolve unmet needs in healthcare delivery and clinical medicine.
The two organizations have launched the Clinical Problem Database to compile insights from physicians on needed improvements to clinical efficiency and patient care. These real-world experiences are shared with Sling Health’s network of young entrepreneurs to foster cutting-edge medical technology development with attention to the clinical challenges faced by physicians.
“Physicians and entrepreneurs are passionate about transforming health care, and by engaging collaboratively they can advance innovation that makes the health system work better for everyone,” said Michael A. Tutty, Ph.D., M.H.A., group vice president of professional satisfaction and practice sustainability at the AMA. “Through our collaboration with Sling Health, the AMA is helping physicians and medical students take on a greater role in driving technology forward that responds to real clinical needs. Gaining insights from physicians will help make medical technology an asset, not a burden.”
“The best medical technologies directly tackle pressing clinical needs, enabling higher quality, less expensive, and more efficient care,” said Sling Health President Stephen W. Linderman. “Working with the physicians nationally through the AMA, teams of innovative students across the country are able to create new medical technology to address problems impacting providers on the front lines of patient care. We look forward to expanding our collaboration with the AMA and enabling students everywhere to advance clinical care.”
Too often, physicians are treated as an afterthought during technology development. Overlooking physician requirements is one reason medical technology may not live up to its promise. An AMA study demonstrates that nearly half a physician’s office day is filled by clerical tasks performed on cumbersome technology. This burden has left physicians feeling they are neglecting their patients as they try to keep up with an overload of type-and-click tasks.
Recognizing the importance of physician feedback for health care entrepreneurs to improve solutions, the Clinical Problem Database will be an added feature on the AMA’s Physician Innovation Network (PIN), an online community that connects and matches physicians with digital health companies and entrepreneurs. Through the use of the PIN platform, the voice, experience and needs of physicians can be heard and incorporated into new products as they are developed.
Since PIN was launched in 2017, more than 3,000 physicians and medical students, as well as about 1,800 entrepreneurs, have participated in the online network and there are already stories of successful physician-entrepreneur connections. Physicians matched with entrepreneurs through PIN have consulted in a range of areas, such as improving operating-room workflow, assisting to eliminate the guesswork for spinal punctures, piloting emerging solutions and identifying developers to co-develop solutions for pressing needs.
The AMA says it is committed to “successfully integrating technology into healthcare and attacking the dysfunction in healthcare by removing the obstacles and burdens that interfere with patient care. The AMA continues to work on every front to help physicians engage and shape innovation.”
By Scott E. Rupp, publisher, Electronic Health Reporter.
Prior authorizations are hurting practices, the American Medical Association contends. According to the organization, prior authorization requirements have increased in the past five years, and 85 percent of physicians say the practice interferes with continuity of care. This is according to a new survey from the organization.
Prior authorization (PA) is a process requiring healthcare providers (physicians, pharmacists, medical groups and hospitals) to obtain advance approval from health plans before a prescription medication or medical service is delivered to the patient. While health plans and benefit managers say that PA programs are important to controlling costs, providers often find these programs to be burdensome and barriers to the delivery of necessary patient care.
The AMA’s report was conducted in partnership with the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association, releasing the “Consensus Statement on Improving the Prior Authorization Process.” The statement “reflects agreement between healthcare providers and health plans on key reforms needed to reduce PA hassles and enhance patient-centered care.”
According to the 1,000 physicians interviewed, more than two-thirds of these fine folks said it’s difficult for them to determine whether a prescription or service needs prior authorization.
Alternatively, fewer than 10 percent of the physicians said they contract with a health plan that allows programs that can exempt providers from the requirement. Additionally, prior authorizations are primarily obtained by phone or fax, with just a bit more than 20 percent of physicians saying they are able to complete the requests through their electronic health records — which can be most efficient when that capability is allowed.
In a statement released with the survey findings, AMA charged insurance companies with a “year of foot-dragging and opposition” to prior authorization reforms.
According to the study, the AMA is encouraging the use of programs that selectively implement PA requirements based on stratification of healthcare providers’ performance and adherence to evidence-based medicine, but the results from the study show that only 8 percent of physicians report contracting with health plans that offer programs that exempt providers from PA. Likewise, the AMA wants an overall revision of PA requirements, including the list of services subject to PA, based on data analytics and up-to-date clinical criteria. A majority (88 percent) of physicians report that the number of PAs required for prescription medications and medical services has actually increased over the last five years.
From the payer’s point of view, prior authorizations serve as a cost control that limits unnecessary care, and the practice has supporters in high places. For example, a Government Accountability Office report released in 2017 found that prior authorization in Medicare saved as much as $1.9 billion through March 2017. The Trump administration’s proposed budget also includes expanded prior authorization measures for Medicare. The fight over them doesn’t appear head for anything but an ugly stalemate.
Imagine you could safely wield your medical data the same way you can use an ATM card at any store or cash machine anywhere, anytime.
The American Medical Association (AMA) believes that one of the biggest challenges in healthcare today is securing, sharing, and using trusted health data in real time. The AMA’s integrated innovation enterprise, Health2047, created Akiri to transform how everyone does it.
Akiri is partnering with healthcare leaders to solve real-world business problems. Akiri is already collaborating with the life sciences industry to solve data challenges related to drug safety and clinical trials.
In addition to the life science industry, Akiri plans to collaborate with payers, physicians, and health systems to improve the quality and efficiency of care delivery.
Who are your competitors?
Akiri leverages a unique combination of technologies and optimizes them for healthcare, so at this time, Akiri does not have any direct competitors.
How your company differentiates itself from the competition and what differentiates Akiri?
Akiri Switch is unlike any other solution for managing healthcare data. It is not a health information exchange (HIE); an extract, transform, load (ETL) process; or an electronic medical record (EMR) system. Instead, Akiri Switch is an invitation-only, subscription-based, ultra-secure private network. Rather than store any health data, it transmits it through a standardized system of codes.
The American Medical Association delivered the following comment letter to ONC National Coordinator Donald Rucker, MD and CMS Administrator Seema Verma urging a 30-day extension to the comment periods for the two proposed federal rules regarding interoperability and information blocking. The letter is posted in its entirety below:
Dear Dr. Rucker and Administrator Verma:
On behalf of the physician and medical student members of the American Medical Association (AMA), I want to express my appreciation for the detail and thought put into your proposed rules, 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program and Medicare and Medicaid Programs; Patient Protection and Affordable Care Act and the Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans in the Federally-facilitated Exchanges and Health Care Providers.
The 21st Century Cures Act includes many provisions that, through prudent regulation, will advance patients’ and physicians’ access to medical information. I recognize and appreciate the desire for swift rulemaking. However, such rapid change in health care policy, technology, and business practices may lead to unintended consequences for patient privacy and physician burden. Moreover, the proposed rules are interwoven, complex in nature, and include multiple detailed requests for information. To ensure that the rules are as successful as possible in meeting your goals, it is vital that stakeholders be given adequate time to provide comprehensive, thoughtful, and detailed comments. Expediency should not take precedence over deliberation as we confront a true paradigm shift in health care. I therefore urge that the comment periods for both rules be extended by at least 30 days. I appreciate your consideration and ongoing collaboration.
Thank you for considering our request. If you have any questions or care to discuss further, please feel free to reach out to Margaret Garikes, vice president of federal affairs, at 202-789-7409 or email@example.com.
The American Medical Association (AMA) has created a new resource to help physicians extend care beyond the exam room with technologies that are “changing the way patients interact with healthcare.” The Digital Health Implementation Playbook offers a guide to the most efficient path for applying digital health solutions including key steps, best practices, and resources to accelerate and achieve digital health adoption. The AMA made this announcement in conjunction with the Digital Health Collaborative and Connected Health Conference.
Physicians are optimistic about the potential of digital health innovation to benefit medicine and expect to use more digital health tools in the near future, however, complex factors inhibit adoption. During an AMA-convened summit this year, innovators, researchers, physicians and decision makers warned that adoption and implementation of digital health solutions can be difficult and time-consuming.
“Implementing digital health technology has been a challenge for those without a clear course to success,” said AMA chair-elect Jesse M. Ehrenfeld, M.D., M.P.H. “The AMA is committed to making technology an asset, not a burden, and the Playbook provides the medical community with widespread access to a proven path for implementing digitally enabled health and care. The Playbook’s road map is based on institutional knowledge and best practices convened by the AMA from a wide array of experts in the field.”
The Playbook is designed for care teams and administrators in medical practices of all sizes and areas of specialty. The Playbook is a living document that will be updated to include new content over time. As the Playbook evolves, it will provide a helpful 12-steps process to guide the implementation of a variety of digital health solutions. The first six stepsare fundamental to the implementation of any digital health solution. The subsequent six steps focus on specific digital health solutions and the unique considerations relevant to that specific technology.
Currently, the Playbook provides resources for the implementation of remote patient monitoring (RPM) using devices, trackers and sensors to capture and record patient generated health data outside of the traditional clinical environment. RPM provides clinicians the opportunity to apply patient generated health data to improve the management of chronic disease and engage patients in their own care.
As more connected devices and wearables are validated as accurate, reliable and effective health care tools, the medical community is increasingly looking to integrate digital health and mobile health technology into medical practices to better understand and manage chronic diseases outside of the practice environment as health care shifts toward value-based reimbursements.
Health data security and patient engagement are top priorities for the nation’s hospitals, according to results of the 17th annual HealthCare’s Most Wired Survey, released today by the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME).
The 2015 Most Wired survey and benchmarking study, in partnership with CHIME and sponsored by VMware, is a leading industry barometer measuring information technology (IT) use and adoption among hospitals nationwide. The survey of more than 741 participants, representing more than 2,213 hospitals, examined how organizations are leveraging IT to improve performance for value-based healthcare in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration.
According to the survey, hospitals are taking more aggressive privacy and security measures to protect and safeguard patient data. Top growth areas in security among this year’s Most Wired organizations include privacy audit systems, provisioning systems, data loss prevention, single sign-on and identity management. The survey also found:
96 percent of Most Wired organizations use intrusion detection systems compared to 85 percent of the all respondents. Privacy audit systems (94 percent) and security incident event management (93 percent) are also widely used.
79 percent of Most Wired organizations conduct incident response exercises or tabletop tests annually, a high-level estimate of the current potential for success of a cybersecurity incident response plan, compared to 37 percent of all responding hospitals.
83 percent of Most Wired organizations report that hospital board oversight of risk management and reduction includes cybersecurity risk.
“With the rising number of patient data breaches and cybersecurity attacks threatening the healthcare industry, protecting patient health information is a top priority for hospital customers,” said Frank Nydam, senior director of healthcare at VMware. “Coupled with the incredible technology innovation taking place today, healthcare organizations need to have security as a foundational component of their mobility, cloud and networking strategy and incorporated into the very fabric of the organization.”
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
“Hope springs eternal” is a phrase from Alexander Pope’s An Essay on Man: Epistle I, written in 1733. For some reason, right now hope is in full bloom in Washington, D.C. for physician groups, such as the American Medical Association and the Medical Group Management Association, which are pushing for passage of a permanent repeal of the sustainable growth rate (SGR), also known as a “doc fix,” prior to the congressional recess that will start in mid-December.
The points that are being made by physician groups are not new. There is the spectre of a 21.2 percent reduction in Medicare physician fees effective April 1, 2015, when the current doc fix expires, and nobody wants such a drastic reimbursement rate cut to occur. Also, because of moderating healthcare costs, the most recent Congressional Budget Office estimate of the cost of holding payment rates through 2024 at current levels is “only” $131 billion, near the low end of the CBO’s historical range. And last, earlier this year, a number of permanent SGR reform bills enjoyed bipartisan and bicameral support.
In spite of all these valid points, the case for fixing the SGR this calendar year, as opposed the first quarter of 2015, does not seem compelling or possible, due to both political and fiscal realities.
Politically, as the name implies, lame-duck congressional sessions are not known for legislative productivity. Chip Kahn, CEO of the Federation of American Hospitals, commented, “I believe that the lame-duck session is going to be limited to measures that are either emergencies like Ebola or must do’s to keep the government open.” Similarly, Tom Scully, former CMS administrator under President George W. Bush, opined in Modern Healthcare that there is “1 in 10 million” chance of a permanent SGR repeal passing during the lame-duck session.
Guest post by James Hofert, Roy Bossen, Linnea Schramm and Michael Dowell, all partners with Hinshaw & Culbertson.
New federal healthcare legislation and implementing regulations, seek to exert control over multiple aspects of patient care. The Health Information Technology for Economic and Clinical Health Act (“HITECH”)[i] with staged implementation through 2016, seeks to not only promote implementation of electronic health record systems (“EHR”), but also regulate electronic communications of health information by and between the patient, physician, hospitals and other healthcare institutions so as to enhance care quality, care coordination and reduce costs.
HITECH further envisions implementation of clinical decision support algorithms for the diagnosis and treatment of disease both during admission and after discharge. The Hospital Readmission Reduction Program[ii], effective October 1, 2012, consistent with the objectives of HITECH seeks to financially penalize hospitals for higher than standardized readmission rates for heart failure, acute MI and pneumonia. The Center of Medicine and Medicaid Service (“CMS”) intends to expand application of the program to readmission for COPD, elective total hip arthroplasty and elective total knee arthroplasty in 2015[iii]. Consistent with preventative care goals so as to mitigate further health care problems as found in HITECH, CMS has refused to adjust the re-admission penalty program to account for readmissions unrelated to the patient’s initial hospitalization even though the readmission could be considered to be outside the hospital’s or physician’s control[iv].