This Week – December 22, 2018

This Week in Washington, D.C.

  • Government shutdown still looms (at the time of this writing)
  • An update on the recent ACA lawsuit
  • CMS Provides 2017 National Healthcare Spending Estimates: $10,730 per person
  • ACG Members: Don’t forgot about your 2018 MIPS Reporting Requirements!

Government shutdown still looms
(at the time of this writing)

The likelihood of a partial government shutdown grows (at the time of this writing) if the U.S. House and Senate fail to reach an agreement on a short-term spending bill. The Senate passed a short-term spending bill on Wednesday night to keep the federal government open until February 8th.  However, the House passed a different bill on Thursday.  The House rejected the Senate bill as passed, adding $5.7 billion in funding for a wall along the U.S.-Mexico border, and nearly $8 billion for disaster aid, and returned the revised bill to the Senate.  Republicans in the U.S. Senate and House have effectively jammed each other, trying to force the other’s hand before the December 21st deadline.

Majority Leader Mitch McConnell (R-KY) must again put his acumen for Senate procedure and vote-whipping to the test and find a resolution.  The Senate, where rules require 60 votes for spending bills to proceed, requires Sen. McConnell to gain support from at least 9 Democrats, as well as all 51 Republican senators to pass the House bill.  A few Republican senators on Friday also stated their objection to passing a bill by a simple majority, thereby circumventing traditional procedural rules.  Democrats will take over the U.S. House beginning next year.

Please note: there are portions of the federal government which Congress has already funded, and will not be impacted by the shutdown.  These agencies include the Departments of Defense, (most of) Health and Human Services (HHS), and Veterans Affairs.  However, there are some healthcare departments which will be impacted due to the status of their funding for fiscal year 2019, and these include the Food and Drug Administration (FDA), the Indian Health Service (IHS), and the Agency for Toxic Substances and Disease Registry (ATSDR).  Medicare and Medicaid have already been funded.

HHS has provided a contingency plan in the event of a shutdown. The contingency plan notes that the FDA and other agencies will be deemed “essential” and will continue during the shutdown.  In the case of the FDA, response to emergencies, management of high-risk recall, investigations of imminent threats to human health and public health issues would continue, but routine regulatory, compliance, and research activities would not be deemed “essential.”

ACG will continue to update membership as the developments occur in Washington.


An update on the recent ACA lawsuit

Back in September of this year, ACG informed you of the lawsuit filed in Texas by 20 state attorneys general. The lawsuit was based upon Congress’ effective repealing of the Affordable Care Act’s (ACA’s) “individual mandate,” which zeroed-out the penalty for not having health insurance, as a part of the Tax Cuts and Jobs Act. The state attorneys argued that the ACA now be deemed unconstitutional, as part of the U.S. Supreme Court’s rationale for upholding the ACA in 2012 was that the individual mandate intrinsically links the other parts of the ACA.

On Friday, December 14th, Texas federal judge Reed O’Connor ruled that because the individual mandate played such a pivotal role in the ACA, the entire law is now considered unconstitutional. ACG members should note that this decision will not be effective immediately, as the appeal process will likely continue to take place over the next few years.  On Sunday, the Center for Medicare and Medicaid Innovation (CMMI), an organization created by the ACA,  stated that “the recent federal court decision is still moving through the courts and the work of the Innovation Center will continue unchanged.  We remain committed to our current and future models as well as our focus on better health outcomes at lower cost.”   ACG will keep a close watch on this ruling, as important issues including state Medicaid expansion, coverage protections for pre-existing conditions, and preventive care may be at stake in the future.

Meanwhile…year-over-year ACA insurance signups declined from 8.8 million last year to 8.5 million this year.  This final number is better than expected, especially after there were reports of sign-ups lagging as much as 13% earlier this year.  Like last year, there was a surge in enrollments in the week before the deadline, when at least 4 million people enrolled in coverage.


CMS Provides 2017 National Healthcare Spending Estimates: $10,730 per person

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple MD, FACG

CMS recently released a report finding that U.S. health care spending in 2017 increased 3.9%, reaching $3.5 trillion, or $10,739 per person.  According to CMS, health care spending growth in 2017 was similar to 2008-2013, which preceded the faster growth experienced during the 2014-15 period, marked by insurance coverage expansion and high rates of growth in prescription drug spending.

The overall share of gross domestic product (GDP) related to health care spending was 17.9% in 2017, similar to 2016 (18.0%).

Here is a breakdown of some notable health spending by type of service:

  • Hospital Care (33%): Spending for hospital care increased 4.6% to $1.1 trillion in 2017, which decreased from the 5.6% growth in 2016. According to CMS, the growth in 2017 was driven by slower growth in services.
  • Physician and Clinical Services (20%): Spending on physician and clinical services increased 4.2% to $694.3 billion in 2017. The percentage growth for physician and clinical services also slowed in 2017.
  • Retail Prescription Drugs (10%): Growth in retail prescription drug spending slowed in 2017, increasing 0.4% to $333.4 billion. The slower growth in 2017 followed 2.3% growth in 2016.  This is the lowest growth in retail prescription drug spending since 2012, when several blockbuster drugs lost patent protection.  According to CMS, the key drivers of the slower growth were a continued shift to lower-cost generic drugs, and slower growth in the sales volume of some high-cost drugs.

Find the full breakdown here.

Here is a breakdown of who provided the spending:

  • Out of pocket spending: Co-payments, deductibles, and anything not covered by insurance consisted of $365 billion, or 10%.
  • Public and private health insurance: health insurance spending consisted of $2,604 trillion, or roughly 75%.  This includes:
    • Private health insurance: $1.184 trillion, or 34%
    • Medicare: $706 billion, or 20%
    • Medicaid (federal share): $361 billion, or 10%
    • Medicaid (state share): $221 billion, or 6%
    • VA, CHIP, Department of Defense: $132 billion, or 4%
  • Other third-party payers public programs: 8%
  • Investment: 5%
  • Other government public health programs: 2-3%

Find the full breakdown here.

Read the full report: National Health Care Spending In 2017: Growth Slows To Post–Great Recession Rates; Share Of GDP Stabilizes

ACG will continue to monitor heath care spending in the nation, as it is an important indicator of future legislative and regulatory policies impacting GI practices and patient care.


ACG Members: Don’t forgot about your 2018 MIPS Reporting Requirements!

December 31st is right around the corner, and ACG is here to help. If you have to participate in MIPS, please ensure that you are meeting MIPS reporting requirements as you prepare to submit your MIPS performance data to CMS early next year.

How do you know if you need to participate in MIPS? Please click here.

Guide for Obtaining an EIDM Account and ‘Physician Quality and Value Programs’ Role for the Quality Payment Program (QPP)

CMS….SGR… MACRA… MIPS… APMs… QCDRs… ACOs… Why does Washington D.C. love acronyms and complicated payment systems? ACG Hopes to Keep This Simple. We compiled a detailed overview for you that seeks to make some sense out of this alphabet soup – but hopefully in a simplified fashion and in plain English. Read the summary and potential impact to GI.

Dissecting MACRA: Year 2

Impact on Smaller and Rural GI Practices: 15 or fewer eligible clinicians in your practice

ACG continues to look out for the small and independent GI practices. Do you need to report measures? Read ACG’s summary to learn more on whether you have to participate in the Merit-Based Incentive Payment System (MIPS), and if so, what scoring bonuses are available to your practice. CMS has recently released guidance for the CY 2018 reporting year, as well as for each MIPS performance category. Check them out here:

MIPS Scoring 101 Guide for Year 2 (2018)

MIPS Participating in the Promoting Interoperability Performance Category in 2018 (Year 2)

MIPS Participating in the Quality Performance Category in 2018 (Year 2)

MIPS Participating in the Cost Performance Category in 2018 (Year 2)