This Week – April 9, 2016
This Week in Washington, DC
- ACG on Capitol Hill Next Week: Your Voice for Clinical GI
- ACG Members Reminder: Review Your Individual “Sunshine Payment” Information
- At the State and Local Level: Important Medicaid and Commercial Payment Changes in Ohio
From National Affairs Committee Chair, Whitfield L. Knapple, MD, FACG
The ACG Board of Governors will be on Capitol Hill next week advocating for issues important to GI practices. Congress and CMS consistently need to hear more about the difficulty in maintaining a GI practice in this current environment of lower reimbursement but higher administrative burdens.
Is your practice potentially limiting Medicare patient volume due to the extraordinary burden of declining reimbursement compounding growing regulatory mandates? Contact your ACG Governor so ACG can better educate Congress on these important state and local issues impacting their constituents.
Have you signed ACG’s petition to reverse Medicare’s cuts to colonoscopy? Sign it now. Have your partners and patients sign it, too. Congress needs to hear how short-sighted policies impact their constituents.
The ACG Board of Governors is one of the most unique aspects of the College, acting as a two-way conduit between the College leadership and the membership at-large. This helps the College make certain that it is meeting the evolving needs of the membership.
“Sunshine” Payments: Review and Dispute Periods End May 15th
CMS announced the beginning of the 45 day Open Payments (“sunshine payments”) review and dispute period. This period ends May 15, 2016. CMS will publish the 2015 payment data on June 30, 2016. This includes updates to 2013 and 2014 data.
The Affordable Care Act requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals. CMS has been charged with implementing the Sunshine Act and has called it the Open Payments Program.
From ACG Governors for Ohio, Ashley L. Faulx, MD, FACG and David G. Mangels, MD, FACG
Medicaid and Commercial Payment Changes in Ohio to Implement “Episodes of Care”
The Ohio Office of Health Transformation (OHT) has started an initiative to pay for “value” for commercial and Medicaid services. What does this mean? This has a significant impact on providers and ACG membership. For GI providers in Ohio, the relevant “episodes” are: Colonoscopy; EGD; and Gastrointestinal (GI) bleeding.
This covers all Medicaid patients (fee for services as well as Medicaid managed care plans) and four commercial carriers: Aetna, Anthem, Medical Mutual of Ohio, and United Health Care.
What is an “episode” and how will this impact me?
What is ACG doing for me?
ACG does not endorse simply linking reimbursement to quality reporting. However, in the event that state and federal policymakers mandate quality reporting as a condition to payment, it is ACG’s goal to minimize practice management burdens and protect GI reimbursement as much as possible. Thus, Ohio officials agreed with ACG physician representatives that a GI providers’ gain-sharing or cuts should be conditional upon simply participating in a quality improvement registry such as GIQuIC.
These episodes groups are complex and have a high potential for an unfair process that penalizes ACG members in OH. ACG will continue to update you as we actively engage with OH regulators on your behalf.