This Week – June 11, 2016

This Week in Washington, D.C.

  • House of Representatives Passes Medicare Hospital Payment Package: Includes One of ACG’s Legislative Priorities
  • At the State Level: Prior Authorization Bill Passed in Ohio
  • FDA Issues Two Safety Alerts Impacting GI
  • ACG’s MACRA Tidbit for the Week

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

Thank you, ACG Governors: Medicare Payment Package for Hospitals Includes Meaningful Use Help for ASCs

In April, over 45 ACG Governors met with over 250 members of Congress as part of the 2016 ACG Board of Governors’ Washington D.C. Fly-in.  ACG Governors urged Congress to pass the Electronic Health Fairness Act of 2015 (S. 1347 & HR 887).  This bill excludes patient encounters at an ambulatory surgical center (ASC) from counting towards a provider’s “Meaningful Use” denominator of eligible services requiring the use of certified health IT.   ACG Governors conveyed the burdens of trying to shoe-horn certified EHR software into the ASC facility setting.

On Tuesday, The House of Representatives passed the Helping Hospitals Improve Patient Care Act (HR 5273), which makes a number of changes to hospital reimbursements under the Medicare program.   This package helps address the issue ACG Governors advocated for in April: Providers performing substantially all of their services in the ASC setting would not be subject to penalties under the EHR Incentives Program (“Meaningful Use”) as well as its successor program under MIPS, “Advancing Care Information.” The exclusion would sunset after 3 years and once the Secretary determines that certified EHRs are readily available in the ASC setting.

Read the full blog here.

From ACG Governors for Ohio, Ashley L. Faulx, MD, FACG and David G. Mangels, MD, FACG

Some good news out of Ohio: OH Prior Authorization Bill to Become Law

A bill that will significantly reform Ohio’s prior authorization rules is heading to Gov. John Kasich’s desk, who is expected to sign it into law within the next few weeks.

Prior authorization is a process that requires physician offices to ask for permission from a patient’s insurance company before prescribing certain medications or performing medical treatment.  As ACG members know, insurance carriers will often later deny or drop these medical services once commenced. This bill seeks to correct these problems:

Read the full blog here to learn more about these changes.

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 76 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.

Contact your ACG Governor today.

From FDA Related Matters Committee Chair, Tedd P. Cain, MD, FACG

Recent FDA Safety Alerts Impacting GI  

On Tuesday, June 7th, the FDA warned the public about serious heart problems with high doses of the antidiarrheal medicine loperamide (Imodium): taking higher than recommended doses of both the non-prescription, over-the-counter (OTC) and prescription diarrhea medicine loperamide (Imodium), including through abuse or misuse of the product, can cause serious heart problems that can lead to death. The risk of these serious heart problems, including abnormal heart rhythms, may also be increased when high doses of loperamide are taken with other medications.

On Monday, June 6th, the FDA warned the public about the risk of serious bleeding when using nonprescription aspirin-containing antacid products to treat heartburn, sour stomach, acid indigestion, or upset stomach. Many other products for these conditions are available that do not contain aspirin.

The ACG FDA Related Matters Committee hosts these safety alerts and recalls on ACG’s website.  The FDA Related Matters Committee continues to work closely with the FDA on other issues impacting your practice and patients.  Please let ACG know how we can help you and your patients.


The “partial qualifying” APM participant….
Dipping your toes in the waters of different payment systems at the same time?

As you head to the beach or pool this weekend, ACG hopes that you are NOT thinking about MACRA.

But if you are, some of you have asked what CMS means to by allowing providers to be a “partial qualifying APM participant”?  The recently released proposed regulation establishes the Merit-Based Incentive Payment System (MIPS), which a modified fee-for-service system.  This proposed rule also establishes incentives for participation in certain approved alternative payment models (APMs), which would exempt providers from these MIPS requirements.

However, providers must meet Medicare payment and patient volume requirements in order to be considered qualifying “Advanced APM participants.”  In 2017 (the “performance year”), 25% of Medicare payments must go through the APM as well as 20% of the provider’s Medicare patients.  These payment and patient thresholds are gradually increased to 75% of payments and 50% of patients.

Approved APM participants can also be considered a “partial qualifying APM participant.” If the provider has 20% of the Medicare payments through a qualifying Advanced APM and 10% of their Medicare patients through the Advanced APM, these providers have the option of opting out of MIPS to avoid any payment adjustment or can participate in MIPS if the provider believes he/she will be eligible for a bonus based on their overall MIPS performance.

2017? Wait, I thought all of this stuff begins in 2019?  That’s correct but please note 2019 reimbursement will be based on your CY 2017 services (the “performance year”).  All providers will participate in MIPS in 2017.  CMS will determine your eligibility for APM status from there.

More on MACRA: ACG Hopes to Keep This Simple.   We compiled a detailed overview for you, hopefully in a simplified fashion and in plain English.  Read the summary and potential impact to GI: Making $ense of MACRA