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AMA Releases New Code for Use During the Public Health Emergency

On September 8, the American Medical Association (AMA) released a new code to report the additional practice expenses incurred during a public health emergency (PHE) that is over and above those usually included in a medical visit or service. The code accounts for the additional supplies, materials, and clinical staff time associated with evaluation, management and procedural services provided during the current PHE. 

 Code 99072 is effective immediately and reads:

Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease.

This new code is intended to capture the following practice expense activities:

  • Time over what is included in the primary service of clinical staff time (registered nurse [RN]/ licensed practical nurse [LPN]/ medical technical assistant [MTA]) to conduct a pre-visit phone call to screen the patient (symptom check), provide instructions on social distancing during the visit, check patients for symptoms upon arrival, apply and remove PPE, and perform additional cleaning of the examination/procedure/imaging rooms, equipment, and supplies
  • Three surgical masks
  • Cleaning supplies, including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers

The code should only be reported when the service is rendered in a non-facility place of service (POS) setting, such as a physician office, and in an area where the activities are required to lessen the transmission of the respiratory disease. The code should be reported only during a PHE due to a respiratory disease and only for additional items required to provide a safe in-person service. The code is to be reported once per in-person patient encounter regardless of the number of services provided at that encounter.

Currently, there are no relative value units (RVU) assigned to the code. The AMA has sent a request to the Centers for Medicare and Medicaid Services (CMS) to immediately implement the code and to assign practice expense RVUs based on input provided by the AMA. Practices can choose to assign a charge and submit the code to third-party payers however individual payer policies will dictate how the claim will be processed.

A special edition CPT Assistant article addressing this code and an additional COVID related laboratory code can be accessed here

AAPM Past President Steven Stanos, DO Discusses COVID-19’s Impact on the Opioid Epidemic with AMA

This morning AAPM Past President Steven Stanos, DO participated in an AMA COVID-19 UPDATE podcast to discuss how the pandemic has impacted the nation’s opioid epidemic. Dr. Stanos also serves as AAPM’s representative on the AMA Opioid Task Force.

Dr. Stanos describes a three-prong approach that his hospital system, Swedish Pain Services, has implemented in order to respond to the pandemic: risk mitigation for patients, increased access for virtual visits, and taking care of staff and hospital team members.

Panelists discussed ways to increase access and eliminate treatment barriers for patients suffering from pain as well as those with opioid use disorder. View the full video.

AMA Seeks Clarification, State Action to Protect Patients with Chronic Pain

The AMA joined the Indiana State Medical Association in seeking clarification from the state medical licensing board whether existing patients with chronic pain can be evaluated via telephone-only communication to satisfy state-specific controlled substances prescribing rules.

The new flexibility “may have been satisfied by Executive Orders (EO) 20-12 and 20-13, but we seek clarification – along with the Indiana State Medical Association – as to whether those EOs specifically supersede 844 Indiana Administrative Code 5-6-6,” wrote AMA Executive Vice President and CEO James L. Madara, MD, in a letter to the Indiana Medical Licensing Board (MLB). 

Dr. Madara also encouraged the Indiana MLB to “adopt, in full, guidance provided by the U.S. Drug Enforcement Administration (DEA) to help ensure patients with pain receive the medications they need while simultaneously helping support public health measures to protect patient safety, reduce unnecessary travel and potential exposure to the COVID-19 virus.” This includes urging the MLB to allow for “multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance, subject to specific conditions being met.”

If you have specific examples of states/institutions taking action to help patients with chronic pain, please consider it sharing it with the AMA. Information can be sent to [email protected].

Report from the November 2019 AMA Interim Meeting

The following report was submitted by Robert Wailes, MD, AAPM AMA Delegate

The Interim Meeting of the American Medical Association (AMA) House of Delegates (HOD) convened November 16, 2019 in San Diego. I represented the membership and interests of the American Academy of Pain Medicine at this meeting in my capacity as AAPM’s AMA Delegate along with our Alternate Delegate, Donna M. Bloodworth, MD.

Before discussing the November meeting, we would like to suggest all eligible members of the American Academy of Pain Medicine become members of the AMA and designate AAPM as your specialty organization. The role of physicians includes looking at the bigger picture regarding healthcare. It is all our responsibility to support the advancement of healthcare utilizing the resources of “organized medicine” through our specialty, state and national organizations. The AMA is by far the strongest voice of all physicians on a national basis. It is very important that we maintain our specialty representation within the AMA. There is a specific requirement that a certain percentage of our membership also be members of the AMA in order for us to maintain our AAPM delegation.

The Interim Meeting dealt with many challenging issues and new policies were created. Numerous issues were relevant to our specialty. There were resolutions and reports related to the opioid issues, addiction medicine, cannabis, prior authorizations among others. Please see below for more details and a link to the major topics covered at the AMA.

Our delegation spearheaded a move to create a new AMA Cannabis Task Force “to evaluate and disseminate relevant scientific evidence to health care providers and the public.” This was supported by our Pain and Palliative Medicine Specialty Section Council, which one of our primary homes in the AMA House of Delegates. We are all challenged by the lack of clear evidence regarding cannabis (including CBD). In fact, there are some studies that have valid findings that may be useful. We hope this task force will be a good resource for many types of data regarding cannabis products so in turn we can provide better education for our patients.

Previously we proposed and created the AMA Pain Care Task Force. This group is still meeting to hopefully put together a report to advance policy that will support all our efforts to have better patient access to quality pain medicine services. We hope to see a report some time in the next year.

Some highlights of adopted new policies include the following excerpts from AMA coverage.

Doctors back innovative local efforts to battle opioid epidemic
While recognizing that opioid-epidemic reversal strategies that may work in one community may not be transferable elsewhere, successful local programs can still provide lessons and inform the development of treatment and prevention efforts in other communities, according to an AMA Board of Trustees report whose recommendations delegates have adopted. The report highlights strategies in Huntington, West Virginia, and Clark County, Indiana, and examines whether other communities could use them as examples for their own efforts.

AMA to boost education on methadone maintenance therapy
The AMA supports the evidence-based use of methadone in the treatment of opioid-use disorder (OUD), and model state legislation drafted by the AMA calls for all payers to make all forms of medication-assisted treatment (MAT) available without prior authorization and placed on a formulary’s lowest cost-sharing tier.

The AMA board “strongly supports additional educational efforts to, at the very least, reduce the stigma” of methadone maintenance therapy (MMT). Delegates have directed the AMA Opioid Task Force to “increase its evidence-based educational resources focused on MMT and publicize those resources to the Federation of Medicine.”

New Pathway for Addiction Medicine Board Certification
Delegates at the 2019 AMA Interim Meeting adopted policy to recognize the ABPM (American Board of Preventative Medicine) for “developing and providing pathways for all qualified physicians to obtain certification approved by the American Board of Medical Specialties in the new ABPM subspecialty of Addiction Medicine, in order to improve access to care for patients with substance use disorder.”

Stop sales of e-cigarettes that lack FDA approval
The House of Delegates has adopted policy to “urgently advocate for regulatory, legislative or legal action at the federal or state levels to ban the sale and distribution of all e-cigarette and vaping products, with the exception of those which may be approved by the FDA for tobacco-cessation purposes and made available by prescription only.”

Boost transit for improved access to care
Barriers exist for patients to access affordable public transportation. Additionally, shifting from personal car use to public transportation can lead to a six fold drop in greenhouse gas emissions, according to a resolution introduced by the Michigan delegation. Implementing a new transit system can help increase physical activity and decrease body mass index among new users, while also improving access to health care for underserved populations and geographical areas.

Make healthful food options available at all health care facilities
AMA policy has already encouraged healthy, plant-based food options in hospitals. Such diets have been shown to improve health in everyone, not just patients in hospitals. These options also have the potential to be cheaper than other alternatives, according to a resolution introduced by the AMA Medical Student Section.

Given the need for healthy, plant-based options at all medical care facilities, delegates amended existing policy to:

  • Encourage healthful food options be available, at reasonable prices and easily accessible, on the premises of health care facilities.
  • Call on all health care facilities to improve the health of patients, staff and visitors by: providing a variety of healthy food, including plant-based meals and meals that are low in saturated and trans-fat, sodium and added sugars; eliminating processed meats from menus; and providing and promoting healthy beverages.
  • Call for health care facility cafeterias and inpatient meal menus to publish nutrition information.

More training needed on health care finance 

It’s well documented that the United States spends more on health care than any other nation. Citing research indicating that educational interventions on health care finance during residency training may have a positive impact on future health care spending in the future—and in light of a lack of explicit language that encourages coverage of this topic in residency—delegates amended existing policy on the topic.

According to the amended policy, the AMA will:

  • Ask medical schools and residencies to encourage that basic content related to the structure and financing of the current health care system, including the organization of health care delivery, modes of practice, practice settings, cost effective use of diagnostic and treatment services, practice management, risk management, and utilization review or quality assurance, is included in the curriculum.
  • Ask medical schools and residencies to ensure that content related to the environment and economics of medical practice in fee-for-service, managed care and other financing systems is presented at educationally appropriate times during undergraduate and graduate medical education.
  • Encourage the Liaison Committee on Medical Education to ensure that survey teams pay close attention during the accreditation process to the degree to which “socioeconomic” subjects are covered in the medical curriculum.

List transgender patient’s preferred name in EHR

Delegates moved to bolster the AMA’s existing policy on promoting inclusive gender, sex and sexual orientation options on medical documentation. The current policy supports the voluntary inclusion of a patient’s biological sex, current gender identity, sexual orientation and preferred gender pronoun, and delegates modified AMA policy to also support inclusion of “preferred name and clinically relevant, sex-specific anatomy” in medical documentation.

For more information, view highlights from the 2019 AMA Interim Meeting.

The HOD is composed of approximately 640 delegates (and slightly fewer alternate delegates) who represent all physician and medical student members of our AMA. About 60 percent of the delegates represent state associations and about 40 percent represent specialty societies. Our AMA creates national medical policy through the debate of and adoption of Council reports and of resolutions brought forth by Delegations. If you have any ideas for future resolutions or any suggestions for business at the AMA please contact the AAPM office ([email protected]) or your AAPM delegate or alternate delegate directly:

Respectfully submitted,

​Bob Wailes, MD
AAPM Delegate to the AMA​

AMA Responds to Walmart’s “Refusal to Fill” Policy

The American Medical Association (AMA) continues to express its concerns over Walmart’s corporate prescription opioid restriction policy in its recent letter to Walmart’s Chief Medical and Analytics Officer. The new policy limit opioid prescriptions to seven days or 50 morphine milligram equivalents (MME) has caused harm to patients with acute, palliative, cancer-related, chronic pain and other medical conditions requiring amounts or doses greater than the corporate policy. According to the AMA, “this policy has disrupted legitimate medical practices that receive form letters telling them their prescribing rights under state law will be superseded by a Walmart-created algorithm that deems a physician unfit to prescribe.”

AAPM has echoed AMA advocacy efforts on this subject. In 2018, AAPM Past President, Steven P. Stanos, DO, traveled to Walmart headquarters with an AMA-led contingency to discuss these issues including ensuring access to comprehensive pain care; opioid prescribing guidelines; pain care and stigma; and reducing opioid misuse and diversion. Later in the year, AAPM’s AMA Delegates joined other pain and palliative medicine societies to rally the AMA House of Delegates to adopt a policy opposing the misuse of the 2016 CDC Guideline.

Further, AAPM’s advocacy efforts around the misapplication of the CDC Guideline for Prescribing Opioids for Chronic Pain has been ongoing, and included the AAPM Foundation consensus panel report that addressed the challenges of implementing the CDC Guideline. In April, the CDC issued an advisory cautioning against the misapplication of its guideline, following the publication of an editorial in The New England Journal of Medicine. The editorial referenced the AAPM Foundation consensus panel report and recognized that some policies and practices derived from the CDC Guideline are inconsistent and go beyond its recommendations, causing undo difficulty for patients and their providers. Furthermore, the editorial acknowledges the need for improved patient access and provider reimbursement for multidisciplinary pain care.

AAPM continues to advocate for the pain medicine and its members, continuing to serve as the voice for pain clinicians in national efforts to address the opioid crisis and promote the importance and adoption of patient-centered multidisciplinary care.

Report from the June 2019 AMA Annual Meeting

The following report was submitted by Robert Wailes, MD, AAPM AMA Delegate

The Annual Meeting of the American Medical Association (AMA) House of Delegates (HOD) convened from June 8-12, in Chicago, Illinois. I represented the membership and interests of the American Academy of Pain Medicine at this meeting in my capacity as AAPM’s AMA Delegate along with our Alternate Delegate, Donna M. Bloodworth, MD. Phil Saigh, our AAPM Executive Director, was there to support our efforts as well.

Before discussing the June meeting, I would like to suggest all physician members of the American Academy of Pain Medicine become members of the AMA and designate AAPM as your specialty organization. The role of physicians includes looking at the bigger picture regarding healthcare. It is all our responsibility to support the advancement of healthcare utilizing the resources of “organized medicine” through our specialty, state, and national organizations. The AMA is by far the strongest voice of all physicians on a national basis. It is very important that we maintain our specialty representation within the AMA. There is a specific requirement that a certain percentage of our membership also be members of the AMA in order for us to maintain our AAPM delegation.

The Annual Meeting dealt with many challenging issues and new policies were created. Topics as diverse as prior authorizations and physician aid in dying, as well as many others, kept the meeting very busy. We also had elections for several major positions, including President-Elect. Numerous issues were relevant to our specialty. Some highlights include the following excerpts from AMA coverage on the internet link referenced below.

The AMA House of Delegates (HOD) adopted new policy to:

Advocate for state legislatures and other policymakers, health insurance companies and pharmaceutical benefit management companies to remove barriers, including prior authorization, to nonopioid pain care.

Support amendments to opioid-restriction policies to allow for exceptions that enable physicians, when medically necessary in the physician’s judgment, to exceed statutory, regulatory or other thresholds for post-operative care and other medical procedures or conditions.

Oppose health insurance company and pharmacy benefit management company utilization-management policies, including prior authorization, that restrict access to post-operative pain care, including opioid analgesics, if those policies are not based upon sound clinical evidence, data and emerging research.

Support balanced opioid-sparing policies that are not based on hard thresholds, but on patient individuality, and help ensure safe prescribing practices, minimize workflow disruption, and ensure patients have access to their medications in a timely manner, without additional, cumbersome documentation requirements.

Oppose the use of “high prescriber” lists used by national pharmacy chains, pharmacy benefit management companies or health insurance companies when those lists do not provide due process and are used to blacklist physicians from writing prescriptions for controlled substances and preventing patients from having the prescription filled at their pharmacy of choice.

A separate resolution notes there is a “pain treatment gap” because pharmacy benefit plans will not cover medications that could serve as alternatives to opioids for treatment of pain.

In adopting the resolution’s recommendation, the HOD directed the AMA to “petition the Centers for Medicare & Medicaid Services to allow reimbursement for off-label use of medications like gabapentin or lidocaine patches at the lowest co-payment tier for the indication of pain so that patients can be effectively treated for pain and decrease the number of opioid prescriptions written.”

To address this gap, delegates directed the AMA to:

Advocate for increased access and coverage of non-opioid treatment modalities including pharmaceutical pain care options, interventional pain management procedures, restorative therapies, behavioral therapies, physical and occupational therapy, and other evidence-based therapies recommended by the patient’s physician.

Advocate for nonopioid treatment modalities being placed on the lowest cost-sharing tier for the indication of pain so that patients have increased access to evidence-based pain care as recommended by the Health and Human Services Interagency Pain Care Task Force.

Encourage the manufacturers of pharmaceutical pain care options to seek U.S. Food and Drug Administration approval for additional indications related to non-opioid pain-management therapy.

The AMA was also directed to incorporate into its advocacy that clinical practice guidelines specific to cancer treatment, palliative care, and end of life care be used in lieu of the CDC’s Guideline for Prescribing Opioids for Chronic Pain as per the CDC’s clarifying recommendation.

The AMA passed a resolution supporting better integration of Prescription Drug Monitoring Programs directly with EHRs to promote rapid and easy access.

The AMA House of Delegates adopted new policy to “support the legal access to and use of naloxone in all public spaces regardless of whether the individual holds a prescription.”

Delegates also amended existing policy that asks the AMA to “support the widespread implementation of easily accessible naloxone rescue stations (public availability of naloxone through wall-mounted display/storage units that also include instructions) throughout the country following distribution and legislative edicts similar to those” for AEDs.

Noting that language associated with substance-use disorders shapes attitudes among health professional towards patients with addiction, delegates adopted new policy for the AMA to:

Use clinically accurate, non-stigmatizing terminology (substance-use disorder, substance misuse, recovery, negative/positive urine screen) in all future resolutions, reports and educational materials regarding substance use and addiction.

Discourage the use of stigmatizing terms including substance abuse, alcoholism, clean and dirty.

The AMA also will “create educational materials on the importance of appropriate use of clinically accurate, non-stigmatizing terminology and encourage use among all physicians and U.S. health care facilities.”

There was a lot of discussion and work addressing the high level of physician burnout and suicide. This will be addressed in many ways and can be reviewed on the AMA website.

There were also educational sessions including “What does the science say about opioid management?

Other House actions of specific interest to AAPM members include CEJA Report #2 regarding the “Study of Aid in Dying as End-of-life Option” and “the need to distinguish ‘Physician Assistant Suicide’ and ‘Aid in Dying’. This is a very complex issue with people on both sides of the fence promoting excellent arguments. Some states already have physician aid in dying legislation. After much debate the report from the Council on Ethics and Judicial Affairs (CEJA) was approved by the HOD. The report concluded that Physician Assisted Suicide is unethical.

For more information, review highlights from the 2019 AMA Annual Meeting.

The HOD is composed of approximately 640 delegates (and slightly fewer alternate delegates) who represent all physician and medical student members of our AMA. About 60 percent of the delegates represent state associations and about 40 percent represent specialty societies. Our AMA creates national medical policy through the debate of and adoption of Council reports and of resolutions brought forth by Delegations. If you have any ideas for future resolutions or any suggestions for business at the AMA, please contact the AAPM office ([email protected]) or your AAPM delegate or alternate delegate directly:

Respectfully submitted,

Bob Wailes, MD
AAPM Delegate to the AMA

AMA House of Delegates Annual Meeting Update

Pain medicine was represented at the recent American Medical Association House of Delegates (HOD) Annual Meeting by AAPM delegate Robert Wailes, MD, and alternate delegate Donna Bloodworth, MD. Among topics discussed, delegates advocated for patient’s drug addiction treatment records to be easily accessed for physicians.

Read more about the meeting:

Pain Medicine Journal
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