This Week – January 20, 2018

This Week in Washington, D.C.

  • CMS Releases Data on 2018 Medicare Value-Based Modifier Bonuses/Cuts: Why is this important to ACG members?
  • ACG Updates 2018 Medicare Reimbursement Data for GI Services
  • At the State and Local Level: Step therapy bills introduced in Virginia and Washington state

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

CMS Releases Data on 2018 Medicare Value-Based Modifier Bonuses/Cuts: Why is this important to ACG members?

On January 12, CMS released data on the 2018 Medicare reimbursement changes based on clinicians’ and group practices’ value-based payment modifier score and 2016 quality reporting.  The value-based modifier (VBM) was a provision contained in the Patient Protection and Affordable Care Act (known the “ACA”) that measured providers’ costs of services compared to other providers by looking at Medicare claims data.  The VBM was repealed when Congress passed MACRA in 2015, but it serves as the precursor to the MIPS’ Cost performance category.  In fact, the two measures that CMS will use when determining how well ACG members score in the MIPS Cost category are derived from this VBM program.

How did clinicians do?
According to CMS’ release, “over 20,000 clinicians will receive between 6.6% to 19.9% more on their Medicare physician fee schedule payments as a result of their high performance on quality and cost measures in 2016.”  Great, right? No, not at all.  In fact, this a major concern.  A deeper dive into the data tells the real story.  While 20,481 clinicians and 3,478 group practices will receive a reimbursement bonus in their 2018 Medicare Part B professional fees, this only represents 1.8% and 1.7% of all clinicians and group practices, respectively.   What’s more, 296,475 clinicians and 121,642 group practices are slated for a reimbursement cut due to failing to meet the reporting requirements in 2016.  This is over 25% and 58% of clinicians and groups practices, respectively, and therefore a major concern for ACG.  Roughly 65%, or 746,556 clinicians will not be impacted by the VBM in 2018.

Why is this important to you in 2018, especially if you are in a group practice?
CMS will use these two measures to determine 10% of your MIPS score in 2018.  This increases to 30% of your MIPS score in 2019 and beyond, absent changes by Congress.  Because it is written into MACRA, a change in the law is required.  There are hardship exemptions and bonus points for solo and small practices.  However, this may significantly impact larger group practices.  This is why ACG led advocacy efforts to urge changes to the MIPS’ Cost performance category last year, and will continue to advocate for these changes in 2018.

How can ACG help you?  
CMS noted that practices receiving cuts in 2018 failed to report the minimum reporting requirements in 2016.  Don’t let this happen to you — use ACG’s Making $ense of MACRA summary as well ACG’s MIPS “quality reporting checklist” so that you’re meeting the minimum reporting requirements.  Do not let all the administrative hassles of submitting this data to CMS all be for naught!

Don’t forget about 2017 quality reporting! 
This impacts your 2019 Medicare Part B payments.  You can still submit your 2017 reporting data.  Use ACG’s “small practices crash cart” as guidance.  Individuals in larger practices can also use this as guidance to avoid a payment cut in 2019.  There’s still time!


From ACG Practice Management Committee Chair, Louis J. Wilson, MD, FACG

ACG Updates 2018 Medicare Reimbursement Data for GI Services

In November, ACG and the GI societies provided the summaries of the final rules outlining the 2018 Medicare professional and facility fees, among other policy changes.  In CY 2018, ACG members will receive an annual fee schedule update of .41%, absent anything you may have done during the CY 2016 reporting year.  Under MACRA, providers receive an annual update of .5% through December 2019.  However, CMS is also obligated to implement budgetary and other policy changes.  Thus, in 2018, the Medicare fee-for-service 2018 update is .41% as opposed to .5%.

What are the national average Medicare professional fees and relative value units (RVUs) for many GI services?

ACG is here to help.  ACG has updated its 2018 Medicare reimbursement professional fees chart for many GI services.  This chart also provides the RVUs for each service, as well as a comparison from 2017.

CMS also made changes to GI anesthesia services beginning 2018.  ACG is here to help here as well.  Check out ACG’s Guidance on GI Moderate Sedation and GI Anesthesia Changes- What do you need to know?


At the State and Local Level:
Step therapy bills introduced in Virginia and Washington state

Last month, ACG participated in the Pharmacy and Medical Malpractice hearing before the Massachusetts Joint Committee on Financial Services in support of the Step Therapy exemption bills at the Massachusetts State House.  Good news for members in Virginia and Washington: your state representatives have just introduced similar legislation this month!  In Virginia, State Senator Bill DeSteph and State Delegate Glenn Davis have introduced the “Health insurance; step therapy protocols” bills (SB.574/HB.386).  In Washington state, State Senators Cleveland, Rivers, Kuderer, Fain, and Conway have introduced the bill “Addressing step therapy protocols for prescription drugs” (SB.6233).

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.  These bills 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.  Last year, Representative Brad Wenstrup (R-OH) introduced the federal bill, entitled “Restoring the Patient’s Voice Act of 2017,” which currently has 35 cosponsors and strong bipartisan support.  ACG is keeping a close watch on any sprouting Step Therapy-related legislation, as additional states follow suite.

To help make an impact, your state legislators need to hear from you directly, and the ACG website makes this process quick and simple.  Use the links below to advocate your support. Be sure to contact your ACG Governor to bring light to any additional local issues that are important to you.

ACG members in Virginia: click here to take action now!

ACG members in Washington: click here to take action now!

All ACG members: click here to view our complete list of action alerts.