The Virginia Cannabis Control Authority (CCA) is pleased to share additional accredited online training courses on medical cannabis now available for healthcare practitioners. 

In response to continued interest from practitioners, the CCA has expanded its partnership with TheAnswerPage.com to offer more optional, self-paced courses that support informed, evidence-based patient care. 

New courses include: 

Cannabis Use Disorder and Cannabinoid Hyperemesis Syndrome

This course provides evidence-based guidance on cannabis use disorder and cannabinoid hyperemesis syndrome. It covers clinical presentation, diagnostic criteria, screening tools, cannabis withdrawal, treatment strategies, and management of recurrent nausea and vomiting. Key concepts are reinforced through clinically relevant case scenarios. 

Cannabis and Cannabinoids in Clinical Practice

This course offers a clear, evidence-based foundation to help clinicians counsel patients on cannabis use, evaluate therapeutic applications, and recognize potential risks. Topics include how cannabinoids work in the body, cannabinoid pharmacology, clinical effects, risks and contraindications, and cannabis-related disorders. 

These new courses are in addition to the Virginia Medical Cannabis Program course bundle. All courses offer CME/CE credits and are designed for physicians, nurses, nurse practitioners, pharmacists, and dentists. 

These trainings may be useful for all practitioners, not only those who issue medical cannabis certifications, as more patients are using cannabis products and seeking guidance from their providers. 

Practitioners who choose to enroll can use the code VACANNABIS20 for 20% off at checkout. 

You can learn more and register through the CCA website. 

MIPS Background

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 consolidated three historic quality reporting programs into MIPS. MIPS requires physicians to report on quality measures, health IT measures, and improvement activities, creating significant administrative burden. The Centers for Medicare & Medicaid Services (CMS) also calculates cost measures and a new population health category (not-statutorily required) using claims data. CMS combines all of this data and generates a score of 0-100 points. Based on how their score compares to the national benchmark, physicians will see a penalty, a neutral payment adjustment, or a bonus. MIPS adjusts Medicare physician payment for all physicians unless they’re new to Medicare, qualifying alternative payment model participants, or have a low volume of Medicare patients or payments. The program is budget neutral. Penalties of up to -9 percent fund the bonuses.

Why are reforms to MIPS necessary?

• MIPS disproportionately penalizes small and rural practices. Nearly 50 percent of solo eligible clinicians (ECs), 29 percent of small practices, and 18 percent of rural practices received a MIPS penalty in 2025 compared to fewer than 14 percent of ECs overall. Nearly 30 percent of solo ECs and 13 percent of small practices received the maximum -9 percent penalty compared to 2 percent of ECs overall.
• MIPS is burdensome and costly. MIPS compliance costs $12,800 and requires 202 hours per physician per year according to a 2021 Journal of the American Medical Association(JAMA) Health Forum study.
• MIPS does not measure quality and exacerbates health inequities. According to a 2022 JAMA study, MIPS scores are approximately as effective as chance in terms of identifying high versus low quality performance. Researchers found physicians providing high quality care but with low MIPS scores tended to have practices catering to a greater number of sicker and lower-income patients.
• There are too few clinically relevant measures for specialists. MIPS scoring rules also disincentivize reporting on certain quality measures that are tailored to specialty care.

Introducing DPPS

It has been more than 10 years since MACRA passed, and change is urgently needed to reduce the harmful effects of MIPS. Designed as an alternative to MIPS, DPPS has been endorsed by the AMA, every state medical society, and more than 100 national specialty societies. DPPS would reset Medicare’s approach to improving quality and reducing avoidable costs by supporting small, rural and safety net practices; and increasing the clinical relevance of quality and cost measures to physicians and patients.

How does DPPS support small, rural, and safety net practices by reducing steep penalties?

• DPPS would eliminate the win-lose tournament model and reduce the maximum penalty from -9 percent to one-half of a physician’s annual payment update (for example, 0.25 percent under current law or the increase in the Medicare Economic Index if H.R. 2474 passes), which is similar to other Medicare programs such as the Hospital Inpatient Quality Reporting Program.
• It would reinvest penalties in quality improvement and alternative payment model readiness by assisting under-resourced practices with their value-based care transformation.
• DPPS would freeze the performance threshold at 75 points for at least three years.

How does DPPS improve the clinical relevance and accuracy of cost and quality measures for physicians

and patients?

• DPPS would incentivize CMS to fulfill its statutory obligations to share data on a quarterly basis, enabling physicians to improve performance on quality and cost measures.
• Specifically, physicians who receive fewer than three MIPS performance feedback reports during the performance period would be exempt from any MIPS penalties.
• With quarterly reports about which cost measures are being attributed to them, which patients are being assigned to them, and what costs outside of their practice they are being held accountable for, physicians can leverage this data to implement changes that would improve patient care and use resources more efficiently, saving money for the Medicare program, taxpayers, and beneficiaries.

DPPS would lower MIPS penalties and level the playing field
With insights from the 2023 MIPS Experience Data Report

I. Stabilizing Medicare Physician Payments

Under the Data-driven Performance Payment System (DPPS):

• Maximum penalties would be reduced from -9 percent of Medicare Physician Fee Schedule covered professional services to one-half of a physician’s annual update (e.g., 0.25 percent under current law or the increase in the Medicare Economic Index minus 1 percentage point as recommended by the Medicare Payment Advisory Commission), which is similar to other Medicare programs such as the Hospital Inpatient Quality Reporting Program.
• Any penalties remaining after paying out bonuses would be reinvested penalties in quality improvement and alternative payment model readiness by assisting under-resourced practices with their value-based care transformation.

The 2023 Merit-based Incentive Payment System (MIPS) Performance Period included 541,421 total eligible clinicians (ECs). Here’s how 2023 MIPS scores would translate to Medicare payment adjustments under DPPS:

• 2.26 percent (12,236) of MIPS ECs received the maximum penalty of nine percent for not participating despite being eligible for MIPS in 2023. Under DPPS, this group would earn half of their payment update.
• 12.13 percent (65,674) scored below the 2023 performance threshold of 75 points and received a negative MIPS payment adjustment. Under DPPS, this group would receive three quarters of their payment update.
• 4.75 percent (25,717) scored 75 points and earned a neutral MIPS update. Under DPPS, they would earn their full update.
• 80.86 percent (437,793) scored above 75 points and earned a MIPS bonus. Under DPPS, they would receive up to 1.25 times their update. The remainder would be distributed to the improvement fund.

II. Mitigating Disproportionate Penalties on Certain Types of Practices to Stabilize Patient Access

2023 MIPS data shows that 29 percent of small practices, nearly 50 percent of solo practitioners, and 18 percent of rural practices received a MIPS penalty. With maximum MIPS penalties of 9 percent, this could significantly jeopardize access to care for vulnerable patient communities. Here is a breakdown of how DPPS payment adjustments would look for these practices based on 2023 MIPS data:

As shown below, DPPS would also level the playing field among specialties, thereby preserving access to primary and specialty care services particularly in rural and underserved areas.

DPPS would reinvest any remainingfunds collected through penalties not paid out in bonuses for high performers to small, rural, safety net, and other types of under-resourced practices to assist with value-based care transformation efforts. Funds could be used to hire care managers, purchase Certified Electronic Health Record Technology (CEHRT), and so on.

Moving Physicians to Value-Based Care: Merit-based Incentive Payment System (MIPS) Legislative Improvements

By replacing the current tournament model of payment adjustments with a more sustainable approach tied to annual payment updates and incentivizing CMS to share data with physicians, this legislation would stop the harmful penalties on small and rural practices while equipping physicians with timely feedback to improve care and reduce avoidable costs. This legislation would also rename the program as the Medicare Physician Data-Driven Performance Payment System (DPPS). DPPS would address two major shortcomings in MIPS:

1.Address Steep Penalties that Hurt Small and Rural Practices

Problem: MIPS subjects physicians to penalties of up to nine percent unless they meet onerous program requirements. Yet it is extremely burdensome and costly to participate and do well in MIPS. Compliance with MIPS costs $12,800 per physician per year and physicians spend 53 hours per year on MIPS-related tasks. This is why small, rural, and independent practices, along with practices that care for more patients who are dually eligible for Medicare and Medicaid, are more likely to be penalized, whereas large group practices, integrated systems, and alternative payment model participants are more likely to receive bonuses. The 2023 Quality Payment Program Experience Report shows that 29% of small practices, nearly 50% of solo practitioners, and 18% of rural practices received a MIPS penalty, which could jeopardize access to care for patients.

DPPS solutions:

• Freeze the performance threshold at 75 to promote stability in MIPS. GAO will conduct a study in consultation with national medical specialty societies and make recommendations to Congress and HHS about an alternative threshold methodology.
• Eliminate the MIPS win-lose style payment adjustments and instead link physicians’ MIPS performance to a portion of their annual payment update (e.g., 0.25% under MACRA or the percentage increase in MEI).
• Reinvest penalties in bonuses for high performers, as well as investments in quality improvement and APM readiness with a targeted emphasis on assisting small, under-resourced practices.

2. Prioritize Timely and Actionable Data to Reduce Avoidable Costs and Improve Patient Outcomes

Problem: CMS has not met its statutory obligation1 to provide timely (e.g., quarterly) MIPS feedback reports and Medicare claims data to physicians. Instead, CMS issues a single feedback report after the performance period, up to 18 months after applicable services and care were provided.

DPPS solution: Hold CMS accountable for fulfilling its statutory obligations by exempting from DPPS penalties any physicians who do not receive at least three quarterly data reports during the performance period. These reports allow physicians to monitor their ongoing performance and identify gaps or variations in care that can be used to improve quality of care, care outcomes, and reduce costs.

1 §42 USC 1395w-4(q)(12) requires the Secretary to provide timely (e.g., quarterly) MIPS quality and cost feedback, as well as claims data feedback about items and services furnished to patients by other providers and suppliers, similar to data provided to Medicare Shared Savings Program accountable care organizations.

Read discussion draft here.

Film Examines Corporate Greed, Silenced Patients and the Systematic Destruction of American Medicine

BALTIMORE, MD, UNITED STATES, February 20, 2026 / EINPresswire.com / — At a time when healthcare systems nationwide are navigating workforce shortages, financial strain and evolving regulatory pressures, the documentary ” Suck It Up, Buttercup: Trust & Betrayal – Healthcare in America,” will screen in Baltimore on March 19, at 7 p.m at the historic The Senator Theatre.

Hosted by the Irreverent Health podcast team, the event is open to healthcare professionals, executives, policymakers, students, and anyone who is frustrated with the state of the healthcare.The film examines how unchecked corporate greed — driven by private equity takeovers, predatory consolidation, and profit-first reimbursement models — has gutted the U.S. healthcare system from within. Patients pay the highest price: their voices silenced, their care decisions overridden by administrators who have never set foot in an exam room, and their trust in medicine systematically eroded.

Through interviews with frontline physicians, healthcare leaders, patient advocates, and policy experts, “Suck It Up, Buttercup,” presents perspectives from inside exam rooms and executive offices, exploring how financial priorities and compliance demands intersect with clinical decision-making.

Crucially, the film amplifies patient voices — people whose care has been denied, delayed, or degraded — ensuring those most affected by corporate greed in healthcare are finally heard.

“This film pulls back the curtain on how the prioritization of profits over people has fractured trust in healthcare,” said Executive Producer Todd R. Otten, MD. “It reveals the human cost of a system where administrators and stakeholders often protect financial interests at the expense of patient care and clinician wellbeing.” “Greed is not a business strategy — it is a destruction strategy. And American patients are paying the ultimate price.”

“Suck It Up, Buttercup,” examines the increasing role of bureaucracy and financial incentives in modern medicine,” said Executive Producer MaryAnn Wilbur, MD, MPH, MHS. “It addresses the learned helplessness many clinicians describe and invites a broader discussion about leadership accountability and long-term sustainability in healthcare. What is too often missing from these conversations is the patient,“ she adds. “This film insists that the patient voice be heard — not as an afterthought, but as the entire point.”

Directed by the collaborative team of Amy Schrob, Scott Pressler, John Mottern, MaryAnn Wilbur and Todd Otten, the documentary features physicians, nurses, healthcare executives and policy voices discussing operational realities, including documentation burdens, productivity targets, consolidation and shifting governance structures.

Executive producers, Otten and Wilbur lead the producing team that includes The American Academy of Emergency Medicine along with John Hunter Mottern, Director of Photography, Producer, Scott Pressler, Creative Director, Producer, and Amy Schrob, Editor, Producer.

Featured participants include Mark Cuban; Dr. and Lady Glaucomflecken; Wendy Dean, MD; Leah Carpenter, RN; Ashley Chancellor, RN; Dike Drummond, MD; Don Berwick, MD; Mark Reiter, MD, Tammy Scott, RN; Terrence Mulligan, MD; Rebecca Wood; Camille Burnett, PhD; Linda Peeno, MD; Wendell Potter; Matthew Zachary; Taylor Paige Borque, RN; Tina Shah, MD; Steve Abelowitz, MD; and Kemia M. Sarraf, MD.

For Baltimore — home to globally recognized healthcare institutions, academic medical centers, and a robust life sciences ecosystem — the screening offers an opportunity to engage in dialogue around workforce stability, leadership responsibility, and the business decisions shaping care delivery.

The screening is open to the public and will include a post-film discussion.

Tickets and additional information are available at: https://irreverenthealth.com/suck-it-up-buttercup/

About “Suck It Up, Buttercup: Trust & Betrayal – Healthcare in America”:

The documentary explores systemic pressures within the U.S. healthcare system and their impact on patient care, clinician wellbeing, and organizational culture. The film is produced by Buttercup Productions and its executive producing team. The film makes the case that unchecked greed — through private equity, corporate medicine, consolidation, and profit-first mandates — has devastated U.S. healthcare, and that restoring it requires centering the patient voice above all else.

For more information about the film visit https://suckitupbuttercupfilm.com.

Official teaser: https://www.youtube.com/watch?v=p2g6yxyUydY

Read full press release HERE.

The American Medical Association (AMA) has delivered eight major wins for physicians and patients—wins that did not happen by chance. They happened because the AMA fought relentlessly on your behalf.

The federal government funding package passed Tuesday includes several AMA-backed provisions that will directly impact your practice and strengthen patient care:

1. Medicare telehealth coverage extended for two more years, preserving essential access for patients nationwide.
    
2. A 3.1 percent bonus reinstated for physicians in Medicare alternative payment models, helping stabilize practices participating in value-based care.
    
3. Expansion of the Medicare Diabetes Prevention Program to include virtual services through 2029, improving access for at-risk patients.
    
4. New requirements for Medicare Advantage plans to maintain accurate, regularly updated provider directories, reducing administrative burdens and patient confusion.
    
5. Extension of the Acute Hospital Care at Home waiver through 2030, supporting innovative, physician-led care models.
    
6. A five-year extension of the Dr. Lorna Breen Health Care Provider Protection Act, continuing vital efforts to reduce stigma around physician mental health.
    
7. Targeted PBM reforms that increase transparency and move us closer to lowering prescription drug costs for patients.
    
8. Reauthorized PREEMIE Reauthorization Act, expanding research on preterm birth, and the Preventing Maternal Deaths Act, increasing funding to $100 million annually through 2030 to prevent maternal mortality.

When combined, these hard-fought victories demonstrate something more powerful than legislative wins alone. They represent what is possible when physicians stand together and when lawmakers find common ground to support better care. Learn more here.