This Week – June 10, 2017

This Week in Washington, D.C.

  • ACA Repeal Watch: Senate in Spotlight, what ACG is doing and monitoring
  • MACRA Tidbit for the Week: Will my physician assistants and nurse practitioners be subject to MIPS? What do I need to know?

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

ACA Repeal Watch: Senate in Spotlight

On June 6th, the Senate Budget Committee officially announced that the American Health Care Act (AHCA), the bill which was passed by the U.S. House of Representatives last month to repeal the Patient Protections and Affordable Care Act (ACA), complies with Senate budget reconciliation rules.  This clears an important procedural hurdle, as budget reconciliation rules allow the AHCA bill to pass the Senate with 51 votes, rather than needing the typical 60-vote threshold to allow bills to move towards a final vote.  This ensures that Democratic support is not needed to pass a bill.  However, various Republican Senators have expressed doubt that they can pass a bill before the targeted July 4th congressional recess, let alone come up with any agreement.

Regardless, the Senate can now use the House-passed AHCA as their “legislative shell” or vehicle to pass their own version of the ACA repeal by a simple majority. On Tuesday, Republicans seemed to gain a little more momentum after an all-conference meeting, stating that while the details are not finalized, they’re coming close to an agreement.   As Senate Republicans finalize their ACA-repeal plan, ACG is working with Senate staff and like-minded organizations on the important substantive issues that affect ACG members and their practices, including coverage protections and cost-sharing requirements.

What else is ACG watching?  The curious case of ACA subsidies.  As ACG discussed previously, the Trump Administration and Republicans must soon decide how to precede with insurance premium subsidies.  Unfortunately, this issue has become more heated, as Congress and the Trump Administration are still formulating a plan on whether to authorize premium support for insurers in ACA exchanges as they finalize a plan to repeal the ACA. At the same time, insurers continue to announce that they will be pulling out of various individual ACA exchange markets across the country.  This week, Anthem announced its plan to leave Ohio’s individual ACA exchange markets in 2018.  Only 6 out of the 11 plans will participate in the state of Washington’s individual exchange market.  Iowa, Kansas, Nevada, and Missouri are all states that may have little to no individual ACA exchange market options in the coming year as well.   ACG continues to remind Congress and the Administration that these issues have significant real-world consequences on GI patients.

Will my physician assistants and nurse practitioners
be subject to MIPS?

As ACG highlighted in a previous MACRA Tidbit for the Week “Am I included in MIPS?,” you can use an online tool to help determine whether or not you will be required to participate in MIPS this year.  Click here and enter your 10-digit National Provider Identifier (NPI) number.

What about your physician assistants and nurse practitioners?  It is essential to determine if your colleagues will need to participate in MIPS as well.  This is especially important for those practices choosing to report MIPS via a group reporting option—this “one for all, all for one” reporting option could trigger reimbursement cuts in 2019 if your practice’s physician assistants and nurse practitioners are neglecting to report MIPS measures in 2017.

Background: Who has to participate in MACRA?

  1. If you are a: physician, a physician assistant, a nurse practitioner, a clinical nurse specialist, or a CRNA; and
  2. If you bill more than $30,000 to Medicare, and provide care to more than 100 Medicare patients per year.

CMS reported in May that 806,879 clinicians will not be evaluated under MIPS in 2017.  That’s an increase from the October 2016 predictions of 780,000 clinicians.  In October 2016, CMS also estimated that 642,000 physicians were subject to reporting MIPS data, but that number has now dropped to 418,849.

If you’re exempt from MIPS with the first review, you won’t need to do anything else for MIPS this year.  CMS will do another round of reviews later in 2017.  If you are included in MIPS, you may be exempt from the second review of eligibility determinations at the end of 2017.

Do my physician assistants and nurse practitioners need to participate?  Click here.

What do I need to do if my practice WANTS to report MIPS measures as a group?

Important notes on group practice reporting:

  • Under MIPS, a group is defined as a single Taxpayer Identification Number (TIN) with 2 or more eligible clinicians (including at least one MIPS eligible clinician), as identified by their NPI, who have reassigned their Medicare billing rights to the TIN.
  • For 2017, groups are able to choose from a list of available data submission mechanisms, including: a CMS web interface (only available to groups with 25 or more eligible clinicians), a Qualified Clinical Data Registry (QCDR) like GIQuIC, an electronic health record (EHR), by administrative claims, and the CAHPS for MIPS Survey (only available to groups with 2 or more eligible clinicians).
  • To participate in MIPS via the CMS Web Interface and/or elect to administer the CAHPS for MIPS survey, you should register between April 1 – June 30, 2017. You do not have to register prior to June 30th if you want to participate as a group via a different reporting mechanism. (remember this is for groups practice 25+)
  • Click here to learn more and stay tuned for additional information from ACG on group practice reporting.

ACG members are encouraged to use the various MACRA resources, including the detailed overview of MACRA, “ACG’s “Making $ense of MACRA,” the ACG-CMS webinar on the 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 Tidbits for the Week” on our website as well.

Learn more about MIPS eligibility by visiting the CMS’ “Quality Payment Program” website.

Learn more on how GIQuIC can help satisfy your 2017 MIPS reporting requirements.  Register today.