This Week – December 9, 2017

This Week in Washington, D.C.

  • MACRA exemptions for ACG members affected by recent hurricanes and wildfires
  • ACG MA Members Call to Action: upcoming hearing for MA Step Therapy bill
  • Attention Solo and Small GI Practices: Get Your 2017 MIPS Crash Cart!

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

MACRA exemptions for ACG members affected by recent hurricanes and wildfires

The Centers for Medicare and Medicaid Services (CMS) recently released regulatory guidance for clinicians participating in the Merit-Based Incentive Payment System (MIPS) who have been adversely impacted by Hurricanes Irma, Harvey and Maria, as well as the ongoing Northern California Wildfires.

ACG Advocacy Paying Off – Exemptions for
Hard Hit Hurricane Areas

This is welcomed news, as ACG has been urging CMS to grant these exemptions for ACG members impacted by these natural disasters.  ACG also championed a resolution at the recent American Medical Association (AMA) House of Delegates meeting to urge the AMA and others to advocate for more regulatory waivers for providers impacted by recent hurricanes.

The “Extreme and Uncontrollable Circumstances” policy grants certain clinicians exceptions without having to submit an extraordinary circumstances exception request.  What do extreme and uncontrollable circumstances mean for the MIPS Transition Year scoring?

Here’s how your scoring will be affected if you’ve faced extreme and uncontrollable circumstances:

  • CMS will assign a weight of 0% in the MIPS final score for each performance category in which data is not submitted by the applicable deadline.
  • If you don’t submit any data in 2017, you will not receive a MIPS payment cut in 2019.
  • If you’re eligible for reweighting due to extreme and uncontrollable circumstances but still choose to report on one or more performance categories (either as an individual or group), you will be scored on those performance categories, and your MIPS payment adjustment will be based on your final score. The performance category or categories won’t be reweighted to 0% in the 2017 final score, and you may be eligible for a MIPS bonus.
  • Group practices will only be scored as a group if they submit information to MIPS as a group. If a group is located in an affected area and does not submit any data, clinicians in that group will be treated as individual reporters: they will each receive a MIPS final score equal to the performance threshold, and will avoid a payment cut.
  • Please note: If you are eligible for reweighting due to extreme and uncontrollable circumstances but still choose to report on one or more MIPS performance categories (either as an individual or group), you’ll be scored on those performance categories and your MIPS payment adjustment will be based on your final score.
  • Please note: This policy does not apply to MIPS-eligible clinicians in MIPS alternative payment models (MIPS APMs) in 2017.

Key takeaway for impacted providers and groups: only submit MIPS data if you are sure you will at least avoid a payment cut and could potentially receive a payment bonus.

How do I know if I am located in an impacted area? Click here to read the full blog.


ACG MA Members Call to Action:
Upcoming hearing for MA Step Therapy bills (S.551/H.492)

The “Acts to Reduce Health Care Costs Through Improved Medication Management” (S.551/H.492) have been introduced in both the House and Senate, by State Representative Jennifer Benson (D-MA) and State Senator Barbara L’Italien (D-MA).  ACG is working with the Massachusetts Gastroenterology Association in support of these bills in advance of the Joint Committee on Financial Services hearing regarding Pharmacy and Medical Malpractice, occurring next week on December 14th.

Step Therapy necessitates the “fail first” drug therapy requirements, in which patients are forced by insurers to try and fail with one or more medications before the cost of the medication their doctor originally prescribed will be covered.  This legislation would allow for exemptions to be made to the Step Therapy protocol, in order to remove the current barriers in allowing patients to gain access to the medication they need at a faster pace.

 

Please urge the members of the Joint Committee on Financial Services to support these bills!  To help make an impact, these legislators need to hear from you directly, and the ACG website makes this process quick and simple.  Use the link below to advocate your support for these important patient-focused bills.


Attention Solo and Small GI Practices:
Get Your 2017 MIPS Crash Cart!

During the WCOG at ACG2017, many ACG members from solo and small GI practices conveyed their frustration and confusion with MACRA and meeting MIPS requirements for 2017.

Are you nervous that 2017 is coming to a close? Do you simply want to do the minimum to avoid any Medicare reimbursement cut? ACG is here to help. Check out ACG’s new infographic, the “GI Small Practices Crash Cart,” and follow the 4 easy steps to avoid a Medicare reimbursement cut. This infographic guides you through the process, by first determining whether or not you even have to participate in MIPS in 2017 (being a small practice may come in handy!), to selecting measures, to showing you a measure that you may be able to report, and where to report the quality measure’s identifying code on a Medicare claims form.

It only requires a one-time effort to avoid a cut – don’t miss your chance!

ACG also has a wealth of MACRA educational material on the 2017 reporting year. Check out ACG’s “Making $ense of MACRA” series on the ACG website.

Click here to view the infographic.