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A number of factors erode access to specialty medicine, including fair physician reimbursement, penalties to physicians caring for beneficiaries who wish to pay out of pocket, and benefit packages that may limit access in attempt to constrain spending.

Fair Medicare Physician Reimbursement - The Alliance appreciates that Congress devoted a portion of the Medicare Access and CHIP Reauthorization Act (MACRA), P.L. 114-10, to streamlining existing federal quality reporting mandates, addressing obstacles that currently prevent specialists from participating meaningfully in these programs, and reducing the amount of physician payment at risk. We also appreciate that MACRA affords medical specialty societies the opportunity to work closely with federal agencies to determine how best to interpret the law. In the interim, many of our societies' members continue to struggle with satisfying the requirements of the Electronic Health Record (EHR) Meaningful Use program because the measures are not relevant to specialty medicine and the unique patient populations our providers treat. [CLICK HERE FOR MORE INFO]

Private Contracting - The current structure of Medicare restricts the ability of seniors to see the physician of their choice by limiting beneficiary access to all physicians. One way patients can overcome this hurdle is to "privately contract" for services directly with their physicians. Unfortunately, under current law, beneficiaries who wish to privately contract with their physician must pay for the service entirely out of their own pocket, despite having paid into Medicare for many years. Furthermore, if a doctor has "opted out" of Medicare, in order to contract privately with even one patient, the physician is ineligible for Medicare reimbursement for two years.

Network Adequacy - In an effort to control costs, insurance carriers limit access to specialty care by designing their networks in a way that excludes certain types of specialists or requires higher out-of-pocket costs to see specialists. In addition, the provider directories a patient may access to find an in-network provider are often outdated or inaccurate. Since seeking care outside of the network can have significant cost-sharing implications for patients, insurers should update provider directories in real-time or, at a minimum, on a monthly basis. Federal and state regulators must ensure that network designs provide continued access to a sufficient number and variety of specialists, and that patients are held harmless when they seek care outside of the network due to misinformation provided by the carrier or due to the lack of availability of a needed specialist within the network.

Workforce - The Alliance is concerned that workforce policy focuses mostly on primary care and general surgery shortages and fails to recognize specialty shortages. Evidence indicates that specialists achieve better outcomes in the treatment of the diseases they focus on than primary care providers and other specialists.

The Council on Graduate Medical Education (COGME) reported in 2007 that "In rural areas, there is a clear need for specialty care." The report goes on to say that "Though primary care would be an essential area of medical service and training, subspecialty and surgical disciplines are also sorely needed in underserved areas." [CLICK HERE FOR MORE INFO]

The Association of American Medical Colleges (AAMC) published an updated physician workforce study in 2015 demonstrating an overall shortage of between 46,000-90,000 physicians by 2025 . Specialty shortages will be particularly large, including neurosurgeons, urologists, cardiologists, gastroenterologists, plastic and reconstructive surgeons, and orthopaedic surgeons.

Specialists are an integral part of American medicine. As a nation, we pride ourselves on having the best medical care has to offer. Regardless of what insurance product people have, Americans want to know they may see their doctor of choice when needed. However, we cannot take for granted that those specialists will be there. In fact, it takes more than 12 years to produce a specialist. The Alliance of Specialty Medicine urges Congress to address the workforce shortages in many specialties that will jeopardize access to care. [CLICK HERE FOR MORE INFO]

Regulatory Burden - The Alliance is concerned about the impact of onerous regulations on the practice of medicine and the retention of specialty physicians in the Medicare program. Physicians are well versed in their clinical discipline, but struggle with regulatory compliance. The endless stream of voluminous and complex Medicare regulations pose a serious threat to the quality of patient care as physicians are required to sacrifice valuable time spent with patients in order to monitor and comply with ever-changing rules. The additional threat of penalties makes regulatory compliance even more of a priority, further eroding the physician-patient relationship. While the Alliance agrees that fraud, waste, and abuse must be eliminated in the Medicare program as much as possible, Medicare's rules and regulations must be easily accessible and understood by practicing specialists and their staff. It is equally important that new or revised regulations are straightforward for specialty physicians and their staff to implement in clinical practice and that they do not interfere with direct patient care. The Alliance continues to work with Congress and the Administration to find balance in these activities, to include ensuring a smooth implementation of ICD-10, addressing challenges with the adoption and "meaningful use" of electronic health records (EHRs), and improving transparency of Medicare's program integrity initiatives.

Implementation of ICD-10 - The Alliance of Specialty Medicine urges Congress to continue to monitor implementation of the International Classification of Diseases - 10th Revision, or ICD-10, code set.

Meaningful Use - The Alliance of Specialty Medicine supports efforts to improve the quality and overall value of healthcare so long as programs are meaningful to specialty physicians and their patients, driven by clinical expertise, carefully evaluated for feasibility and relevance, and provide physicians with flexibility to choose activities that are most appropriate for their practice. Until such policies are in place, physicians should not be held accountable for increasingly difficult and clinically irrelevant federal reporting mandates. At a minimum Stage 3 of Meaningful Use should be delayed. [CLICK HERE FOR MORE INFO]

Program Integrity - The Alliance is increasingly concerned with Medicare's various program integrity initiatives, including the Recovery Auditor Contactor (RAC) program, and supports a comprehensive review of the Centers for Medicare and Medicaid Services' (CMS) program integrity activities, as well as subsequent improvements that would address efforts to curb fraud and abuse without burdening physician practices with inappropriate audits that may unfairly limit beneficiary access to care. [CLICK HERE FOR MORE INFO]

Medical Liability Reform - Support legislation that will help achieve health system savings by reducing the incentives for defensive medicine and protect physicians from unaffordable liability premiums.

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