This Week – July 15, 2017

This Week in Washington, D.C.

  • ACA Repeal Watch: Senate Republicans Clinging to Health Reform Bill While ACG Fighting for Clinical GI and Patients
  • ACG Member Call To Action: Get Involved in MOC Legislation in State Houses Across the Country
  • CMS Releases Proposed 2018 Medicare Payments Regulations
  • MACRA Tidbit for the Week: Learn More about Using GIQuIC to Fulfill 2017 MIPS Reporting Requirements

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

ACA Repeal Watch: Senate Republicans Clinging to Health Reform Bill While ACG Fighting for Clinical GI and Patients

On Thursday, Senate Republicans released their latest iteration of the bill to repeal and replace the Patient Protection and Affordable Care Act (ACA).  Majority Leader Mitch McConnell (R-KY) canceled a previously planned vote before the July 4th recess on the “Better Care Reconciliation Act of 2017.”  The original bill was released in late June and is the Senate Republican’s response to the Republican House-passed bill, the “American Health Care Act of 2017.”  (Click here for the side-by-side comparison).

This week, Majority Leader McConnell released the “Better Care Reconciliation Act of 2017” 2.0.  Thus far, Senate Republicans have still been unable to come together and agree on a final version.  The next steps include a revised cost and coverage estimate from the Congressional Budget Office (CBO) early next week, followed by a procedural vote to bring the bill to the Senate floor.  It is unclear at this time whether Republican leadership has secured the 50 votes necessary to even bring the bill to the floor to begin the debate.

ACG remains discouraged over each iteration of the bill and will continue to use all opportunities to change the legislation to strengthen patient essential health benefits (EHBs), protection for those with pre-existing conditions, and patient cost-sharing.  As the College has previously stated, this process has become a test of political strategy and gamesmanship in order to get something/anything passed, as opposed to an opportunity for Congress to improve substantive issues with the ACA.  And there is plenty to improve: the misvalued code initiative (the ACA provision that led to Medicare cuts in upper and lower endoscopy fees), the cost-sharing quirk when screening colonoscopy turns therapeutic, the creation of the Independent Payment Advisory Board (IPAB), among other ACA provisions.  Congress is not dealing with these important items (the bad) while trying to change important patient-related coverage and cost-sharing provisions impacting ACG members’ patients (the good).  This has a real world, clinical GI impact, as many of these patients have, or will be labeled to have, a pre-existing condition, such as liver disease, IBD, IBS, GERD, or other diseases that ACG members treat every day.

The IPAB issue almost surfaced this week, as well.  The annual Medicare’s trustees report was released on Thursday, predicting that Medicare costs will grow from 3.6% of gross domestic product (GDP) to 5.6% by 2041.  Medicare’s hospital trust is now expected to be insolvent in 2029, a year later than originally estimated in 2016.  Why is this important?  When spending is projected to be higher than estimated, the ACA mandates an IPAB review to reduce costs, including provider reimbursement cuts.  Fortunately, the IPAB remains dormant and only a possibility.  The report says that IPAB may not have be activated until until 2021.  Yet ACG believes that the time to repeal IPAB is now, and continues to work with Congress in achieving repeal on your behalf.

What is in the revised Senate bill?  A review of what ACG flagged for you in early July:

Let’s review: read the full blog here.


ACG Member Call To Action:
Get Involved in MOC Legislation in State Houses Across the Country

We need your support to use our legislative voices to call for a rational approach to Maintenance of Certification (MOC) to statehouses across the country. Help ACG raise awareness of state legislative options prohibiting high stakes exams and costly maintenance of board certification requirements for state licensure, hospital privileges, credentialing, and employment and/or insurance payment.

We need your help: Contact Your State Legislators!

To help make an impact, your state legislators need to hear from you, and the ACG website makes this process quick and simple.  Use the ACG website to advocate your support for these MOC bills.

You can view the available action alerts for the current active MOC-related legislation on the home page of the linked site below. Also, by clicking on the “Bills” section and scrolling down to the “Key State Legislation” map, you can view information about all MOC-related bills. See one missing from your state? Let us know!

Click here to take action in your state now!

As ACG President Dr. Carol A. Burke wrote in March, ACG has heard the discontent and significant concerns of our membership.  ACG leadership has also recently tasked the College’s Governors to be active on these MOC legislative issues at the state level, including helping to get bills introduced in your respective states.  Preliminary data of a recent ACG survey of gastroenterologists highlights the overwhelming dissatisfaction with current MOC programs, regardless of certification longevity, or type of practice.

ACG is still committed to working to make MOC more about life-long learning, rather than testing, if you choose to maintain certification.  ACG continues to support the principles of lifelong learning, as evidenced by ongoing CME activities.  Thus, ACG believes the time is long-overdue for physicians to stand up, join together and advocate for professional and practical activities that are important to the quality and value of care we provide for our patients.


CMS Releases Proposed 2018 Medicare Payments Regulations


Late Thursday of this week, CMS released two calendar year (CY) 2018 proposed rules that include policy and payment changes for the Medicare Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASCs) Payment System. The ACG, AGA and ASGE are currently reviewing the details of the proposed rules and will provide a more extensive summary soon.

The PFS proposed rule will appear in the Federal Register on July 21 and OPPS and ASC proposed rule on July 20.

This communication offers a topline summary of the proposed changes to the payment rates and policies for Medicare services paid under the Medicare PFS and OPPS.

Here’s an overview of the most significant recommendations:
Read the full trisociety alert here.

Learn More about Using GIQuIC to Fulfill
2017 MIPS Reporting Requirements

In follow-up to the announcement that the GIQuIC Registry has been approved as a Qualified Clinical Data Registry (QCDR) for reporting to the Merit-Based Incentive Payment System (MIPS) for the 2017 reporting year, GIQuIC has hosted a series of webinars about the QCDR reporting option and provided further information on reporting via the GIQuIC QCDR.

The recording of the informational webinar “GIQuIC and the MIPS 2017 QCDR Reporting Option Part II” is now available on the GIQuIC web site. Listen to and view the presentation of Dr. Brett Bernstein and GIQuIC staff as they review program specifics and how the GIQuIC QCDR can serve as your reporting mechanism to the Quality, Improvement Activities, or Advancing Care Information performance categories.  To access the slide deck from the webinar click here.  To access a recording of the hour-long webinar click here.

The Registration and Consent Process for 2017 reporting via the GIQuIC QCDR will open in October and the Part III webinar in the series will be held at that time. In the interim, we recommend bookmarking the GIQuIC Quality Reporting Programs web page and visiting it often for the latest information.