This Week – February 25, 2017

This Week in Washington, D.C.

  • MACRA Help: New ACG Quality Reporting Checklist
  • ACA Repeal Watch: ACA repeal and replace focus of town hall events; we need support for HR 1017
  • MACRA Tidbit for the Week: How is your MIPS Quality score actually calculated?

MACRA Help: New ACG Quality Reporting Checklist

Because the Quality category of MIPS represents 60% of your aggregate MIPS score, it is important to utilize this category as much as you can.  ACG is here to help.  The ACG quality reporting checklist walks you through the necessary steps, from selecting a reporting mechanism, to selecting a measure, to knowing how to maximize your performance on these measures.

Visit the ACG Member Checklist: Improving your quality reporting under MIPS.

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

ACA Repeal Watch: ACA repeal and replace focus of town hall events

With Congress being in recess this week, many Democrats and Republicans hosted town hall events in their respective districts and states.  Plans to repeal and replace the Patient Protection and Affordable Care Act (known as “ACA”) was the focus of many meetings, with some discussions cordial, and others quite heated.  Ironically, pundits have compared some of the more heated Republican members’ town hall events to the atmosphere that Democratic members faced when the ACA was being drafted and considered in 2009 (the law passed in 2010).

U.S. House and Senate Republican leaders were quoted in the press this week stating that they expect to release the actual repeal and replace legislation sometime in March or early April.  The legislation could also just be a “repeal” bill as well.  At a rally last weekend, President Trump signaled that the administration may unveil its own plan in “a couple of weeks.”

Some notable issues Congress faces when cobbling together legislation that will pass both the House and Senate include: federal funding for Planned Parenthood, and how to address the 31 states and the District of Columbia that expanded Medicaid under the ACA.  One interesting tidbit: there are 21 Republican senators from states that expanded Medicaid, and their support may be crucial for any bill to pass the Senate.

ACG is actively involved in all health care reform discussions and will keep you updated on any proposed legislation and news affecting ACG members and your patients.  And we need your help.

Last week, Representatives Leonard Lance (R-NJ), Donald Payne, Jr. (D-NJ), and Charles Dent (R-PA) re-introduced the “Removing Barriers to Colorectal Cancer Screening Act.”  The bill fixes a Medicare coverage quirk contained in the ACA.  The bill waives Medicare beneficiary cost-sharing when screening colonoscopies turn therapeutic.  Right now, Medicare only has the authority to waive the patient coinsurance for colonoscopies that remain a “screening.”  Please urge your Representative to cosponsor the bill!

How is your MIPS Quality score actually calculated?

Since the Quality category represents 60% of your total MIPS score, it is important to know what you need to do in order to get the most of your score for this category. Let’s walk through an example of how the points are allotted from each measure that you report.

An ACG member reports MIPS Quality Measure #113, “Colorectal Cancer (CRC) Screening” via Medicare reimbursement claims forms.

First, the member must make sure that data is submitted on at least 50% of applicable patients (the denominator). This is what CMS means by “data completeness.” For measure #113, this is 50% of the Medicare Part B fee for patients aged 50 to 75 years for whom the member provided care for during the reporting period.

A “data completeness” note: ACG members will receive the minimum number of points for this measure if this minimum level of data completeness is unmet, and/or if the number of patients on which the measure reports is less than 20. The minimum number of points for CY 2017 is 3 points.

Otherwise, benchmarks based on historical performance scores will be used to determine the maximum number of points available. Your performance score will be compared to this “benchmark.” (perhaps have the “read more” link here?)

These benchmarks are then assigned to a decile, and the total number of points that can be achieved will be based on the decile in which a physician’s performance rate is found. On the quality reporting program website, the deciles for the CRC screening measure are available for download. Deciles range from “3” to “10” for 2017.

Using the same example, the ACG member would have achieved a performance score of 75% in 2017. This means that 75% of all patients in the dominator were also confirmed to have received a CRC screening, and met the data completeness as well as the minimum case number. The 2017 benchmark results place a 75% performance score in decile 6 (decile 6’s range is 64.41 – 75.4%).

Thus, the provider would receive roughly 6 points for that measure.

TIP: Know the measure’s specifications! It is important to stress that ACG members should study the denominator for each measure and understand what exactly needs to be performed in order to meet the measure’s requirements. For example, measure #113 does not require you to actually perform the screening, but instead, to confirm that the patient has been screened for colorectal cancer. Since 60% of your total MIPS comes from the Quality category, you need to understand how to maximize your points. ACG is here to help.