This Week – December 10, 2016

This Week in Washington, D.C.

  • Congress passes 21st Century Cures Act- Thank you ACG Members for your advocacy
  • ACG Leaders Participate in the DDNC Annual Winter Board Meeting and Fall Forum
  • MACRA Tidbit for the Week: Muddy waters; ASC Services and the Advancing Care Information Category

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

Congress passes 21st Century Cures Act- What does it mean for clinical GI?

This week, the U.S. Senate passed the 21st Century Cures Act.  The U.S. House passed the bill last week.  After nearly three years of development, the bill seeks to spur medical innovation through additional funding and ease federal research administrative burdens.  President Obama is expected to sign the bill into law.

Congress also used this legislative vehicle to pass year end Medicare-related provisions impacting clinical GI, including items that ACG members advocated for during the April 2016 Washington D.C. fly-in, and throughout 2016 as a whole.  One of ACG’s top legislative priorities for 2016 was to reduce reporting and administrative burdens associated with Meaningful Use.  Thank you ACG Members for your advocacy this year!

In the Cures bill: read the full blog here.


ACG Leaders Participate in the DDNC Annual Winter Board Meeting and Fall Forum

On December 4-5, 2016, the Digestive Disease National Coalition (DDNC), an umbrella organization comprised of over 50 professional societies, including the ACG, patient advocacy organizations, and industry members, met in Washington D.C. for the annual winter Board meeting and Fall Forum. At the Board meeting, ACG member Ralph McKibbon, MD, FACG was elected DDNC President for 2016-2018. ACG Governor for Louisiana and Louisiana Gastroenterology Society Representative to the DDNC, James Hobley, MD, FACG, was elected DDNC Vice-President for 2016-2018. The Chair of the ACG Board of Governors and ACG Representative to the DDNC, Costas H. Kefalas, MD, MMM, FACG, completed his term as DDNC President and is now the DDNC Immediate Past President. Also participating in the Board meeting was ACG Trustee and ACG Representative to the DDNC, Samir Shah, MD, FACG.  Dr. Shah is the current Co-Chair of the DDNC Public Policy Committee, and has been instrumental in drafting the 2017 DDNC Legislative Policy Agenda, which includes ACG legislative priorities.

Read the full summary here.

James Hobley, MD, FACG & Costas Kefalas, MD, MMM, FACG at the DDNC Fall Forum, December 5, 2016

James Hobley, MD, FACG & Costas Kefalas, MD, MMM, FACG at the DDNC Fall Forum, December 5, 2016

 

MACRAbanner

Muddy waters; ASC Services and the
Advancing Care Information Category

As reported, Congress passed the 21st Century Cures Act along with some Medicare-related provisions important to ACG members.  Among those provisions was a section that addresses ASC services, and the lack of certified Meaningful Use health IT systems designed for the ASC setting.  This provision expands a current Meaningful Use exclusion to now include physicians who perform “substantially all” of their services in the ASC setting.  So will this ASC exclusion be available for MIPS and the Advancing Care Information category?

Based on a review of the bill, current law, and the final MIPS regulations, we can report to you that it is a definite, 100%, maybe…

Why?  This requires us to delve into some statutory and regulatory language, so please bear with us, have some coffee, and hopefully stay awake.  If you are having trouble sleeping, reading the following may actually help you fall asleep.

The section in the Cures bill specifically says “TREATMENT OF ELIGIBLE PROFESSIONALS IN AMBULATORY SURGICAL CENTERS FOR MEANINGFUL USE AND MIPS.”  Great.

But then the language under this title specifically says: “no payment adjustment may be made for 2017 and 2018 in the case of an eligible professional with respect to whom substantially all of the covered professional services furnished by such professional are furnished in an ambulatory surgical center.”  OK, not great.

What’s more, this section in the Cures bill is designed to modify a specific part of federal law: Section 1848(a)(7)(D) of the Social Security Act.  CMS specifically discusses this part of federal law in the final MACRA regulation:  “MACRA did not maintain these statutory exceptions for the advancing care information performance category of the MIPS. Thus, the exceptions under sections 1848(a)(7)(B) and (D) of the Act are limited to the meaningful use payment adjustment under section 1848(a)(7)(A) of the Act and do not apply in the context of the MIPS.”  D’oh!

But wait… a completely different section in the Cures bill says this: “CONTINUED APPLICATION UNDER MIPS…..the provisions of subparagraphs (B) and (D) of subsection (a)(7), shall apply to assessments of MIPS eligible professionals ….in an appropriate manner which may be similar to the manner in which such provisions apply with respect to payment adjustments made under subsection (a)(7)(A).’’ Woohoo!

So in review, a definite maybe.  It appears that although the new exclusion for ASC services may carry over to MIPS, there are some issues to work out, especially beginning in 2019.  ACG will be working diligently with CMS and Congress to clarify this.  It is important to remember that CY 2017 is a transition year for MIPS, and any attempt to participate in any MIPS category, will at least help avoid any Medicare payment cut in 2019.

If ACG members working in ASCs are able to claim this Meaningful Use/Advancing Care Information exclusion, then what will happen is the proportion of the Advancing Care Information category of MIPS (25%) will be transferred over to the other MIPS performance categories, such as Quality performance category.  Thus, your quality reporting will be even more important after the CY 2017 transition year.