This Week – March 27, 2015

This Week in Washington DC:

  1. House Overwhelmingly Repeals SGR Formula – Senate Delays Action: ACG Members will not experience SGR cuts beginning April 1st.
  2. SGR Reform Update: Why does ACG Support the House-Passed Bill? Why Should You?

House Overwhelmingly Repeals SGR Formula – Senate Delays Action

The House on Thursday overwhelmingly approved a bipartisan bill to permanently repeal the flawed sustainable growth rate (SGR) formula and fund a children’s health insurance program for two more years. The bill was approved, 392-37 in the House, with the support of 212 Republicans and 180 Democrats – a rare show of unity on a policy negotiated by House Speaker John Boehner and House Minority Leader Nancy Pelosi. A total of 33 Republicans and 4 Democrats opposed.

The Senate, however, declined to take up the bill during an all night voting session on the budget. Instead, Senate leaders say they will “quickly pass the bill” upon returning from congressional recess in mid-April.

Despite assuring the public that the Senate will “quickly pass the bill” after recess, this delay provides more time for Senators to revise the bill and consider other offsets. This is discouraging but also has concerned ACG all along. ACG conveyed this to members last week. With a rare and overwhelming bipartisan support in the House, as well as support from President Obama, there is little reason why the Senate should not have quickly passed the bill before adjourning for recess early Friday morning.

What will happen on April 1st if the Senate will not address the bill until mid-April?

ACG members will not experience any cuts beginning April 1st. Absent congressional action, all Medicare providers are scheduled to receive a 21% cut in Medicare beginning April 1st. However, Medicare is required by law to hold claims for two weeks prior to issuing payment, and can hold claims longer, when the Senate returns on April 13th to address these cuts.

ACG truly appreciates the hundreds of members who contacted their congressional delegation urging support. Thank you! Please keep it up!

Why does ACG support the House-Passed SGR reform bill?

ACG continues to work hard on your behalf to improve this legislation and supports the House-passed bill. This legislation is a positive step for the House of Medicine. With that said however, there is much more work to do in improving access to GI patient care, adequately reimbursing ACG members, and easing administrative burdens for GI practices. ACG will be very busy this spring and summer on Capitol Hill dealing with these issues.

Some reasons why ACG supports the House legislation:

  1. SGR Formula is Repealed: ACG and its members have long urged Congress to repeal this broken SGR formula. A looming threat of significant Medicare reimbursement cuts every 6 months to 1 year impacts patient care and prevents GI practices from making important business and planning decisions. Congress has had to step in 17 times to avert cuts over the years. Clearly, the SGR formula is broken.
  2. Predictable Updates: ACG is disappointed in the paltry annual percentage updates. However, the bill does provide stable/positive updates for the foreseeable future instead of looming cliffs. In 13 out of the 17 times Congress was forced to step in and avert SGR looming cuts, the update was .5-0%. So while ACG is disappointed to see these reimbursement freezes in this bill – and realize we must do more to change this – ACG members are essentially no worse under this bill than under the continuous pattern of temporary freezes or patches over the years to avert SGR.
    • 0% update to June 2015,
    • .5% update from July to December 2015,
    • .5% update for 2016-2019,
    • 0% update from 2020-2025, and
    • .25-.75% updates from 2026 and beyond.
  3. Reducing Reporting Burdens: ACG has worked with Congress to reduce administrative and regulatory burdens borne by GI practices. It is encouraging to see your advocacy efforts paying off as the House bill aligns Medicare quality programs such as the physician quality reporting system (PQRS), meaningful use, and the value-based purchasing modifier. The bill also requires HHS to further encourage the use of clinical quality registries to streamline reporting requirements. This is good news for GIQuIC users. For example, the bill allows practices to participate in PQRS via quality clinical database registries (QCDRs) as a group beginning 2016, whereas only individuals are currently allowed participate in QCDRs.
  4. Offsets: Thus far, the list of offsets to pay for SGR repeal does not include eliminating of the in-office ancillary services exception for services like pathology, paying for SGR repeal by increasing the Medicare savings targets via the “misvalued code review,” or other issues important to ACG members and their practices.

    Once an idea is on a list of potential offsets, however, it is difficult to get off this list. That is why ACG will continue to monitor these issues potentially impacting ACG members.

  5. Quality Reporting & Reimbursement Cuts: Assuming Congress would always step in and avert a looming SGR cut (a safe assumption given the history), ACG reviewed and analyzed the impact and risks of not participating in quality reporting under in this newly created MIPS program in the House-passed bill vs. current law. The chart below demonstrates that estimated overall cuts in failing to participate in the MIPS are less severe than under the current law.

If you choose not to participate – A Comparison of Cuts:

  Non-Participation: MIPS Non-Participation: Current Law
     
2019 -4%
  • PQRS: -2%
  • Meaningful Use: -3 to -5%
  • Value-Based Purchasing Modifier**:  -2% to -4% (depending on practice size)

** Estimated. Based on CMS published data for 2017 payment year

     
2020 -5%
  • PQRS: -2%
  • Meaningful Use: -3 to -5%
  • Value-Based Purchasing Modifier**:  -2% to -4% (depending on practice size)

** Estimated. Based on CMS published data for 2017 payment year

     
2021 -7%
  • PQRS: -2%
  • Meaningful Use: -3 to -5%
  • Value-Based Purchasing Modifier**:  -2% to -4% (depending on practice size)

** Estimated. Based on CMS published data for 2017 payment year

     
2022+ -9%
  • PQRS: -2%
  • Meaningful Use: -3 to -5%
  • Value-Based Purchasing Modifier**:  -2% to -4% (depending on practice size)

** Estimated. Based on CMS published data for 2017 payment year

(Note: these are estimated comparisons based upon the data published in previous CMS payment rules)

Please stay tuned for further updates. Please also share and discuss your thoughts with fellow ACG members on the ACG GI Circle. To login and share your comments, go to gi.org and sign in as a member. Once you have done so, click here and then click the orange "Visit ACG GI Circle" button to be taken to the GI Circle site. If you have not yet activated your ACG GI Circle account, please email us at acgcirclefeedback@within3.com.

Contact Brad Conway, VP Public Policy, with any questions or for more information.

Brad Conway
bconway@gi.org
301-263-9000