This Week – April 22, 2017

This Week in Washington, D.C.

  • Congress Back From Recess Next Week: Health care back on the agenda
  • At the State and Local Level: ACG Active on State MOC Legislation
  • MACRA Tidbit for the Week: Learn More about the MIPS “Improvement Activities” Performance Category

From ACG National Affairs Committee Chair, Whitfield L. Knapple, MD, FACG

Congress Back From Recess Next Week: Health care back on the agenda

Congress returns to Washington next week, and House Republican Leadership maintains an ambitious agenda to pass the American Health Care Act (AHCA) despite an unclear path navigating its moderate and conservative factions.  During the in-district work period these past two weeks, the White House, House Leadership and Republican committee staff kept conversations going with the two disagreeing factions within their caucus – the moderate Republicans “Tuesday Group,” and the conservative Republicans “Freedom Caucus.”  A recently released summary of the amendment, offered by Tuesday Group member Rep. Tom MacArthur (R-NJ), includes:

  • Reinstating Essential Health Benefits as the federal standard
  • Maintain the following provisions of the AHCA:
    • Prohibition on denying coverage due to preexisting medical conditions
    • Prohibition on discrimination based on gender
    • Guaranteed issue of coverage to all applicants
    • Guaranteed renewability of coverage
    • Coverage of dependents on parents’ plan up to age 26
    • Community Rating Rules, except for limited waivers
  • The amendment would create an option for states to obtain Limited Waivers from certain federal standards, in the interest of lowering premium costs and expanding the number of insured persons. States could seek Limited Waivers for:
    • Essential Health Benefits
    • Community rating rules, except for the following categories, which are not waivable:
      • Gender
      • Age (except for reductions of the 5:1 age ratio previously established)
      • Health Status (unless the state has established a high risk pool or is participating in a federal high risk pool)
  • Read the full post here.


At the State and Local Level: ACG Active on State MOC Legislation

As ACG has kept you aware in recent policy alerts, the College is actively working with various state medical and GI societies in pursuing legislative efforts prohibiting onerous and unfair maintenance of certification (MOC) requirements.  The College believes in lifelong learning, by ongoing CME activities, rather than lifelong testing.  Stay tuned as ACG continues to work with more state medical and GI societies on MOC legislation.

ACG Members in Texas:

The Texas State Legislature is currently considering legislation stipulating that a physician’s initial board certification is sufficient for the purposes of licensure, employment, reimbursement, or admitting privileges at a hospital. While physicians are not required to complete MOC as a condition of licensure, many hospitals, employers, and public and private payers require MOC, thereby creating a de facto and burdensome mandate on ACG members. Please spread the awareness for this important MOC legislation going through the Texas state legislature.  ACG is working with the Texas Society for Gastrointestinal Endoscopy (TSGE) in helping to get this bill passed.  We need your help!

Please email Sen. Dawn Buckingham, MD and express your thanks for introducing SB 1148!

Please email Rep. Greg Bonnen, MD and express your thanks for introducing HB 3216!

The bills:
SB 1148: Relating to maintenance of certification by a physician or an applicant for a license to practice medicine in this state

HB 3216: Relating to maintenance of certification by a physician or an applicant for a license to practice medicine in this state

ACG Members in Tennessee and Massachusetts: read the full post here.

Learn More about the MIPS “Improvement Activities”
Performance Category

Many ACG Members have questions on the MIPS category of “Improvement Activities.”  This category is new and was established in MACRA.  MACRA defines a “clinical improvement activity” as: an activity that relevant eligible clinician organizations and other relevant stakeholders identify as improving clinical practice or care delivery, and that the Secretary determines, when effectively executed, is likely to result in improved outcomes.

The Improvement Activities performance category is 15% of the total composite MIPS score in 2019+.

ACG members select from a list of 93 Improvement Activities in certain areas of care, such as “Expanded Practice Access,” “Population Management,” “Care Coordination,” “Beneficiary Engagement,” “Patient Safety and Practice Assessment,” “Participation in an APM or Medical Home,” “Achieving Health Equity,” “Emergency Preparedness and Response,” and “Integrated Behavioral and Mental Health.”  Each activity is individually weighted to determine a score within this category.

What do you need to know for 2017? 

  • The Improvement Activities represents 15% of your MIPS score for 2019.
  • ACG members can be eligible for a bonus in 2019 if you submit 90 continuous days of 2017 data, and at a minimum, and report more than one measure in the Quality Performance category, more than one clinical Improvement Activity, or more than the required measures in the Advancing Care Information performance category.
  • ACG members can avoid a payment cut in 2019 if you report one measure in the Quality Performance Category; one clinical Improvement Activity performance category; or report the required measures in the Advancing Care Information performance category.

What are the individual “Improvement Activities”?

ACG can help.  Go to the ACG’s educational guidance on MACRA to learn more about clinical Improvement Activities.  The ACG website also hosts the full list of Improvement Activities to choose from.  CMS’ “Quality Payment Program” website also lists these activities.  CMS recently released a fact sheet on the Improvement Activities performance category.

How do I get full credit in this performance category?

Each activity is weighted to be either “medium” or “high.” To get the maximum score of 40 points for the Improvement Activity score, you may select any of these combinations: Attest that you completed up to 4 “medium-weighted” improvement activities, 1 “high-weighted” activity and 2 “medium-weighted” activities, or 2 “high-weighted” improvement activities for a minimum of 90 days.

Groups with fewer than 15 participants or those in a rural or health professional shortage area: Attest that you completed up to 2 “medium weighted” activities or 1 “high-weighted” activity for a minimum of 90 days.

CMS Webinars

ACG members are encouraged to watch the ACG-CMS webinar on MIPS.

Also, CMS will present on May 3rd a webinar focusing on Improvement Activities. This will be an overview of improvement activities, what are they, how are they developed and how are they submitted for program consideration.   You can register here.