AOA House targets private insurer, Medicare policies

On Saturday, the AOA House of Delegates approved several resolutions aimed at policies of private insurers and the Centers for Medicare and Medicaid Services.

One resolution voiced strong opposition to cost-containment measures by health insurers that require a physician to try a sequence of less expensive medications, tests or procedures on a patient before using a more costly or newer intervention the physician thinks will be more effective.

The new policy directs the AOA to oppose any practice by third-party payers that replaces physicians’ clinical judgment with a fixed protocol of potentially less-effective medications or prerequisite diagnostic procedures.

“This resolution needs to be acted upon and made into policy now, not next year,” said Florida delegate William M. Silverman, DO, speaking against an initial recommendation to refer the resolution. Many policies of third-party payers “take up too much of a physician’s time and adversely affect the quality of our patients’ health care,” he said.

Minnesota delegate Bruce B. Cunningham, DO, did not support the resolution, however. “I think we have to work in tandem with insurance companies to reduce health care costs,” he told The DO.

Flat fee for Medicare audits

The House approved a resolution directing the AOA to urge CMS to change the way its recovery audit contractors (RACs) are paid. Private companies hired by CMS to investigate Medicare fraud, RACs currently receive contingency payments based on the dollar amount of suspected fraud uncovered.

Submitted by the Texas Osteopathic Medical Association (TOMA), the resolution calls on the AOA to recommend replacing the contingency payment with flat-rate compensation.

“We think the current payment model likely causes RACs to be overzealous in their investigations,” said TOMA Executive Director Sam Tessen prior to the House meeting.

The House also passed a resolution instructing the AOA to advocate that CMS develop less-burdensome procedures for attesting to the medical necessity of diabetic supplies and other diabetic services. Currently, physicians are sometimes asked to supply pharmacies with several months’ worth of progress notes on their diabetic patients, which creates paperwork and data-management headaches and can compromise patient confidentiality, according to the Missouri Association of Osteopathic Physicians and Surgeons, which submitted the resolution.

Given the rollout of the Affordable Care Act, the Ohio Osteopathic Association brought forth a resolution that the AOA oppose any legislation that requires physicians to participate in any health insurance plan, be it private or public. Approved by the House, the resolution expands existing AOA policy.