This Week – July 8, 2017

This Week in Washington, D.C.

  • ACA Repeal Watch: Senate Returns Next Week for Latest Round of Repeal Talks
  • MACRA Tidbit for the Week: The Transition into MACRA Continues

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

ACA Repeal Watch: Senate Returns Next Week for Latest Round of Repeal Talks

The U.S. Senate returns next week to rekindle talks on forging an agreement 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.”  This bill was released two weeks ago and is the Senate Republican’s response to the Republican House-passed bill, the “American Health Care Act of 2017.”  However, Senate Republicans have thus far been unable to come together and agree on a bill, so it remains unclear whether a weeklong recess will hurt or help these discussions.  ACG has voiced concerns with the House and Senate bills, as the goal has now 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.

The announcement to delay the vote came on the heels of the Congressional Budget Office’s (CBO) cost and coverage estimate released on Monday, June 26.  The major headline from the CBO score:

“The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation. By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

ACG has utilized this time to educate policymakers and staff on certain aspects of the CBO analysis.  The CBO score reinforces ACG’s position that these policies could be detrimental to patient cost-sharing, essential health benefits, and protections for pre-existing conditions.  ACG continues to use the additional time to improve the Senate bill on behalf of clinical GI and your patients.

The Transition into MACRA Continues

Last week, ACG highlighted the proposed MACRA eligibility requirements for the 2018 reporting year, and compared these to the current eligibility requirements for providers in 2017.  CMS continues to ease providers into MACRA by providing low reporting thresholds in avoiding payment cuts.   As you know, 2017 is a “Transition Year.”  Providers can choose to report a full calendar year, or 90 consecutive days of 2017 data to potentially earn a bonus in 2019.  If you don’t send in any 2017 data, then you receive a 4% payment cut in 2019.  If you submit a minimum amount of 2017 data to Medicare, you can avoid a payment cut.  You just need to submit one measure, one time, in the Quality performance category, or attest to any Improvement Activity performance category.

How would this change in 2018?

In 2018, CMS plans to slowly ramp up the requirements you need to complete in order to avoid a payment cut.  Providers could earn a bonus by reporting a full year’s worth of data for the MIPS’ Quality performance category, and 90 continuous days of data for the MIPS’ Advancing Care and Improvement Activities performance categories.  Providers who do nothing will receive a 5% payment cut in 2020.  If you submit a minimum amount of 2018 data to Medicare, you can avoid a payment cut.  To illustrate, CMS notes some ways that you could avoid a cut in 2020 (not an extensive list):

  • by meeting the MIPS’ Improvement Activities performance category,
  • or by meeting the MIPS Advancing Care Information performance category’s base score and satisfactorily submitting 1 measure in the MIPS’ Quality performance category,
  • or by meeting the MIPS’ Advancing Care Information performance category base score and submitting one “medium weighted” Improvement Activity,
  • or by satisfactorily submitting 6 measures in the Quality performance category.

Your 2017 reporting impacts your CY 2019 Medicare payments. Know what you need to know. ACG is here to help.

ACG members are encouraged to use the College’s various MACRA resources, including the detailed overview of MACRA, “ACG’s “Making $ense of MACRA,” the ACG-CMS webinar on MIPS program, ACG’s “quality reporting checklist,” a list of each measure in the MIPS Quality, Advancing Care, and Improvement Activities categories, as well as each measure’s specifications. Check out the comprehensive list of ACG’s “MACRA Tidbit for the Week” here as well.