This Week – August 3, 2013

This Week in Washington DC:

  1. Energy & Commerce Committee Passes SGR Reform Legislation Before August Recess
  2. FDA Provides Standard Definition for “Gluten Free” Food Products

House Energy & Commerce Committee Passes Bipartisan SGR Reform Bill
On Wednesday, July 31st, the U.S. House of Representatives Committee on Energy & Commerce unanimously passed legislation to repeal the sustainable growth rate (SGR) formula and reform Medicare provider reimbursement. The next step would be for the bill to move to the House floor for final passage. However, the House Ways & Means Committee is likely to take up this bill, or another version, prior to sending the bill to the House floor for a final vote. The Ways & Means Committee shares jurisdiction in some of the to-be-determined offsets to pay for the bill. The Congressional Budget Office estimates that repealing the SGR formula would cost $139 billion over 10 years. Under House of Representatives’ rules, any spending legislation must include offsets from other federal programs. Congress has a precedent in keeping these SGR offsets within Medicare and other federal health insurance programs.

The Senate Finance Committee also announced this week that it would take up its own SGR reform bill after the August recess.

While the draft that passed the Energy & Commerce had no offsets – perhaps the reason why it was passed unanimously – the bill provides:

  • A .5% Medicare physician reimbursement update for 2014-2018. During this time, programs such as PQRS and “Meaningful Use” will continue.
  • Physicians will have the option to participate in alternative payment models (APMs) beginning 2015.
  • Beginning 2019, physicians will receive annual updates of .5% but physicians continuing to practice in the Medicare fee for service model will be under a new Update Incentive Program (UIP). This program is described as a beefed up PQRS and will compare physician performance based on quality metrics developed by societies and other stakeholders. Physicians will self-select a “peer cohort,” or a group of providers practicing in a similar area of medicine. A provider’s reimbursement rate will be based on the individual’s UIP performance in their respective cohort. Physicians deemed “high performers” have the opportunity to receive a 1% increase in payment while “low performers” will experience a 1% reduction.
  • Providers not participating will receive a 3% reimbursement reduction as well as other reductions under current law pursuant to PQRS and Meaningful Use.

The bill also calls for certain Medicare providers to report information on their services such as procedure time and relative work values. Providers will be compensated for their efforts in doing so, however, this information and another provision in the bill bolstering CMS’ authority to review “misvalued codes” beginning 2016 allows the agency to cut total physician reimbursement spending in the Medicare program. ACG is encouraged that Congress is serious about SGR reform but has concerns with these provisions.

ACG continues to work with Congress to ensure these reforms are not additional quality reporting burdens for ACG members for the same, if not less, reimbursement and that ACG members have a seat at the table when defining “high quality of care.” ACG has met with staff and offered comments throughout this process as well as in response to the Committee’s requests for assistance:

April 20, 2013 “This Week”

February 23, 2013 “This Week”

ACG will continue to represent the GI clinician throughout this debate and will continue to keep membership updated on the latest developments.

FDA Releases Regulation Defining “Gluten Free”
On Friday, August 2nd, the U.S. Food and Drug Administration (FDA) released rules for food manufacturers choosing to market their food products as “gluten free.” The goal is to help the 3 million people in the U.S. with celiac disease effectively manage their diet and daily lifestyle. The new regulation standardizes this definition of “gluten free”: the food must contain less than 20 parts per million of gluten. This applies to manufacturers using the phrases “no gluten,” “free of gluten,” and “without gluten” as well.

For more information, please visit the following FDA websites:

ACG is also working closely with Representatives Tim Ryan (D-OH) and Nita Lowey (D-NY) in expanding the FDA’s drug labeling authority. The Gluten in Medication Disclosure Act requires drug manufacturers to include in the label those ingredients made from wheat or other allergens. This authority would be consistent with the FDA’s current authority in regulating food products and would provide the GI clinician with pertinent clinical information when prescribing medication to patients with celiac disease. ACG will continue to urge members of Congress to support the Gluten in Medication Disclosure Act (HR 2003). Please click here to read ACG’s letter of support to Reps. Ryan and Lowey.

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, go to gi.org and sign in as a member. Once you have done so, click here and then click the orange "Visit ACG GI Circle" button to be taken to the GI Circle site. If you have not yet activated your ACG GI Circle account, please email us at acgcirclefeedback@within3.com.

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

Brad Conway
bconway@gi.org
301-263-9000