This Week – August 6, 2016

This Week in Washington, D.C.

  • Update from the Hill: Congress in Recess until September; Lame Duck Post-Election Schedule
  • MACRA Tidbit for the Week: CMS Overemphasizing EHR Communications?

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

Update from the Hill: Congress in Recess until September; Lame Duck Post-Election Schedule

Congress left for a seven-week recess on July 14 and will return after Labor Day, giving lawmakers limited time to act on a number of outstanding legislative priorities before the fall 2016 elections.  The Senate is scheduled to be in session for 23 days between Labor Day and the November election, and the House for only 17 days. Many observers anticipate Congress will adjourn a week earlier than scheduled, leaving even fewer days for legislative work.  The post-election period, or “Lame Duck session,” is scheduled to last approximately four weeks, from November 14 through December 16, with a week off for Thanksgiving.  How long Congress stays in town and what gets done the remainder of this year is highly contingent on the election outcomes on November 8.

Among the Outstanding Issues

FY 2017 Federal Budget: The Fiscal Year (FY) 2017 budget and appropriations process slowed amid disagreements over proposed amendments.  The House passed five spending measures and the Senate passed just three, leaving Congress with unfinished appropriations work that will need to be addressed following the summer recess.  None of the individual appropriations bills were sent to the President, and it is likely that a stop-gap (continuing resolution) or “omnibus” spending bill will be needed to fund the federal government past the end of the fiscal year on September 30.

Medicare and Chronic Conditions: The Senate Finance Committee is working separately to develop legislation to improve health outcomes for Medicare patients with multiple chronic conditions.  Several Finance Committee Members have expressed interest in moving legislation by the fall.  ACG is monitoring these developments and working with congressional staff on issues important to clinical GI.

MACRA: Congressional Committees are continuing their active oversight of physician payment reforms legislated under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.  During a July 13 Senate Finance Committee hearing on MACRA implementation, CMS Acting Administrator Andy Slavitt suggested that federal officials are open to a possible delay of the timetable for implementing the proposed payment reforms.  ACG has also urged CMS to delay MACRA in the College’s recent comment letter to the proposed rule.

Medicare Part B Drug Reimbursement & more: read the full post here.

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CMS Overemphasizing EHR Communications?

JAMA published a report on Tuesday, August 3 that found only 18% of participants in the National Health and Aging Trends Study obtained health information online in 2014.   What’s more, among all 7,609 initial study participants, only 8% said they filled prescriptions online, and 7% used the internet to get in touch with their doctors.  How is this related to MACRA?  CMS continues to mandate electronic communications between patients in order to successfully achieve Meaningful Use, or the “Advancing Care Information” category under MACRA.

In June, ACG submitted its formal comments to CMS on MACRA, focusing on the theme of lowering practice management burdens and reducing reporting thresholds in MIPS and APMs.  The College has always conveyed that among the many major problems in Meaningful Use, one major difficulty is that it often requires elements outside of the provider’s control to successfully meet an objective or measure.  The College recognizes that among the goals of health IT adoption is greater coordination of care and information exchange among providers and patients.  However, CMS must also recognize that a provider’s performance should not be conditional to the actions of others, including: a patient (choosing not to communicate electronically), another clinician or facility (choosing not to use certified health IT), a software vendor (not updating a pharmacy formulary), or pharmacy (choosing not to use e-prescribing IT software).

According to the Medicare Payment Advisory Committee (MedPAC), roughly 40% of Medicare beneficiaries are currently aged 75+.  Also, while the average age of the Medicare population will initially skew younger than it has in the recent past, the number and share of beneficiaries ages 85 and older will grow rapidly (MedPAC; June 2015).  This is significant, as a provider’s “Advancing Care Information” score depends largely upon the electronic health care exchange participation of a “rapidly growing” aging patient population — many of whom, either do not wish to participate in electronic communications or do not have the knowledge to do so.  It is unfair and unreasonable for ACG members to make the efforts to achieve a higher MIPS score, but are limited due to the actions of others outside of your control.

Lowering practice management burdens and continuing this uphill battle against Medicare reimbursement cuts continues to be ACG’s top public policy goals this year.