This Week – April 22, 2011

This Week in Washington DC:

  1. CMS cites GIQuIC in Report to Congress on “ASC Value-Based Purchasing”
  2. Is Joining an ACO Right for You?
  3. ACG reminder: Members need to participate in Medicare eRx Incentive Program or Face Penalty

CMS Report to Congress & GIQuIC
On Monday, the Centers for Medicare and Medicaid Services (CMS) released its report to Congress entitled “Medicare Ambulatory Surgical Center Value-Based Purchasing Implementation Plan.”  CMS is mandated by the health reform law, the Patient Protection and Affordable Care Act passed in March 2010, to develop a plan by which ambulatory surgical centers (ASCs) report quality data and to implement value-based payment adjustments based on meeting thresholds in quality improvement.  This report outlined the necessary steps and possible solutions to implementing a value-based purchasing program for ASCs as envisioned by the health reform law.  The report specifically mentions ACG and ASGE’s joint venture “GIQuIC” as an example of how registries could facilitate the reporting of quality data and help define outcome measure for services such endoscopic procedures.

CMS will further outline the quality measures, reporting process, and value-based reimbursement plan for ASCs in the 2012 Medicare ASC/OPPS proposed rule, which is expected in June 2011.  CMS did note that any value-based purchasing plan will be phased-in, including the development and reporting of quality and cost data.  ACG will update membership when the proposed rule is released in June.

Please visit the GIQuIC website for more information or to participate in the registry.

To view the CMS report to Congress, please click the following link:
CMS Report to Congress

Questions to Ask When Considering an ACO
On April 8th, ACG released a detailed summary of CMS’s proposed rule on accountable care organizations (ACO) as required by the health reform law.  Members are encouraged to review the summary to learn more about the proposed ACO models, the potential for bonus payments, and liability for failing to meet Medicare beneficiary cost-targets and quality measures.

In recognizing that that the GI clinician is busy, ACG also created a concise issue-paper containing questions members should ask when contemplating whether to join or participate in an ACO.  This does not provide every detail of the ACO models and proposal.  For that, members are encouraged to review the detailed summary of the proposed rule.  However, this document is designed to lay out certain issues the GI clinician should be mindful of when deciding whether to join or participate in an ACO.

Should I join an ACO?

Summary of CMS Proposed Rule on ACOs

ACG will continue to educate members on ACOs and other delivery of care models CMS proposes in the near future.

Medicare eRx Incentive … then Penalty … Program
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a Medicare Electronic Prescribing (eRx) Incentive Program to promote electronic prescribing.  The eRx Incentive Program is similar to the Medicare physician quality reporting system (PQRS) in that it is based on Medicare Part B fee for service (FFS) covered professional services during a defined reporting period.  Providers deemed “successful” electronic prescribers in 2011 will receive a 1% incentive payment based on the provider’s total estimated Medicare Part B FFS charges in 2011.

However, providers not successfully demonstrating that they are electronic prescribers under the eRx Program will be subject to a 1% Medicare Part B payment penalty beginning 2012.  What’s more, CMS will determine that payment penalty based on what the provider does before June 2011.

Learn how to avoid this penalty

Please stay tuned for further updates.  Please also share and discuss your thoughts with fellow ACG members on the ACG GI Circle. To login and share your comments, visit  If you have not yet activated your ACG GI Circle account, please email us at

Contact Brad Conway, VP Public Policy, with any questions or for more information.

Brad Conway