AMDA's Position
Medical Director 501 F-Tag & Other F-Tag Revisions
F-Tags are the official government interpretations of the federal regulations. Recently major changes to the Medical Director F501 and F325 Nutritional Status F-Tags (incontinence, pressure ulcers, and unnecessary medications due out in Sept.) were enacted with substantive input from AMDA representatives. AMDA has taken a lead role in informing and education long term care physicians on these changes. AMDA has also updated its Synopsis of Federal Legislation to reflect these changes.
Medicare Prescription Part D Drug Benefit
The Medicare Part D drug benefit is the largest change to Medicare since its inception 40 years ago. AMDA has been a vocal, insistent voice for changes to the processes that makes prescribing an exercise in excessive paperwork. AMDA made several key suggestions early on that were implemented, including extending the transition period and universal forms. We continue to identify issues and problem solve with CMS.
New and Revised Nursing Facility CPT Codes
AMDA took a leading role in redefining, updating and expanding the set of codes used for billing Medicare services in nursing facilities. These were the first changes to these billing codes in ten years. As noted above, AMDA is now preparing to advocate for greater reimbursement for this code set in April of next year as well as through participation in the AMDA efforts to respond to CMS's most recent modifications to payment.
Physician Payment
AMDA established the first discrete codes for nursing facility visits in 1990 and has been advocating for appropriate payment since then. The initiation of this set of codes improved payment by 10 to 20% for thousands of attending physicians, but Medicare cuts over the life of RBRVS eroded them. Most recently, AMDA led the effort to revise the nursing facility family of codes to better reflect the current realities of nursing facility patient care and AMDA is preparing to present the case for greater reimbursement for the Nursing Facility CPT does in front of the Resource-Based Relative Value Update Committee in April 2007.
Professional Liability
Access to affordable insurance for nursing home services caused a crisis across the nation with primary care physicians who see nursing facility patients dropping their long term care practices and limiting their services to the elderly. Many dedicated long term care physicians who have been involved in nursing facility care for their entire careers are dropped from their medical coverage when they renew their policy and list nursing homes as a site of service. Medical directors of nursing facilities are the longest tenured staff at nursing facilities - averaging 10 years of service! As an active member with the Health Coalition on Liability and Access (HCLA), AMDA is on the forefront of trying to reverse these rising costs and return quality medical services to the frail elderly. AMDA will be working with HCLA this year to get the House and Senate to pass meaningful medical liability reform. AMDA also works with the nursing home industry through its association, the American Health Care Association (AHCA) to explore other solutions specific to long term care.
White House Conference on Aging (WHCoA)
The most recent White House Conference on Aging (one is held every decade) brought together experts on aging from across the nation, including a large delegation of physicians who are members of AMDA. Many of the final resolutions were adopted by the 2006 AMDA House of Delegates and brought forward to the 2006 American Medical Association (AMA) House of Delegates by AMDA delegate Craig Kliger, MD, CMD.
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