This Week – May 11, 2012

This Week in Washington DC:

  1. ACG Submits Comments to Proposed Meaningful Use “Stage 2” Regulation; Offers Membership a Practice Assessment When Preparing for Meaningful Use
  2. House Bill Proposes New Medicare Reimbursement System

ACG Submits Comments on Meaningful Use “Stage 2” Proposed Rule
On Monday, May 7th, ACG joined the AGA and ASGE in submitting comments to the Medicare and Medicaid Electronic Health Record Incentive Program “Stage 2” Proposed Rule. The proposed rule was published in the Federal Register on March 7, 2012. The societies conveyed the appreciation for allowing greater flexibility in meeting meaningful use “Stage 2” requirements for providers who have already met “Stage 1” as well as for those providers who have yet to meet “Stage 1” objectives. CMS proposes to give these providers until October 2014 to fully complete “Stage 1.” For those providers who have already met “Stage 1” meaningful use requirements, CMS proposes to use 2013 as the reporting year when determining the 2015 Medicare payment adjustment. In subsequent years, CMS also proposes to employ a 2 year look-back when determining future payment adjustments. The GI societies urged CMS to instead use the previous year when assessing whether to apply a payment adjustment as this 2 year back-dating approach is both unfair and unnecessary.

GI societies also expressed the concern that many of the health information technology objectives and measures depend upon others out of the individual physician’s control, are not useful for improving care in gastroenterology, or are simply inapplicable to the GI practice. This is important because many ACG members may be forced into expensive HHS-certified health IT with little to no value to the practice beyond avoiding a Medicare payment adjustment. For example, the GI clinician practicing in an ambulatory surgical center may require certain technological needs that office-based health IT does not capture nor does HHS seek to measure. However, the provider will still be forced into HHS-certified health IT, only to attest that the provider is unable to meet some of CMS’ technological objectives. Also, there are very few clinical quality measures the GI clinician will be able to use, meaning providers will be reporting “zero” in the denominators of various clinical quality measures simply to meet meaningful use thresholds. According to CMS estimates, it will cost providers an estimated $54,000 to invest in or upgrade to HHS-certified health IT, with annual maintenance costs of up to $10,000. This is obviously a substantial financial commitment in order to avoid future Medicare reimbursement cuts that range from 1% of total Medicare Part B charges in 2015 to 3-5% beginning in 2017.

Please click here to read the joint-society comment letter.

How much does HHS-certified health IT cost and what are the estimated administrative costs in meeting meaningful use?

ACG has reviewed the proposed regulation and analyzed the assumptions CMS uses in developing the program. This document is not intended to discourage ACG members from participating in meaningful use. However, ACG believes it is important to provide facts relevant to GI clinicians that will fully prepare members for the costs associated with successfully participating in the meaningful use program.

Click here to access the ACG “Meaningful Use Practice Management Assessment”

ACG will continue to educate membership on the proposed meaningful use requirements.

House Bill Seeks to Replace Medicare SGR Formula
On Wednesday, May 9th, Reps. Allyson Schwartz (D-PA) and Joe Beck (R-NV) introduced the Medicare Physician Payment Innovation Act (HR 5707), a bill to replace the current Medicare sustainable growth rate (SGR) formula with various CMS-established payment models from which a Medicare provider would choose to participate, including remaining in the traditional Medicare fee-for-service model (albeit at reduced rates). The bill would provide for a 5 year transition period while CMS develops the new payment models.

Absent a legislative fix or full SGR repeal this year, Medicare providers face a 30% reimbursement cut in 2013.

The Medicare Physician Payment Innovation Act:

  • Permanently replaces the SGR formula and prevents the 30% physician reimbursement cut scheduled for January 2013. Providers would receive 2012 rates for the entire 2013 calendar year
  • In 2014 – 2017, all providers will receive annual updates of .5%
  • Also in 2014 – 2017, the bill provides annual increases of 2.5% for “primary care, preventive and care coordination services provided by clinicians for whom 60% of the Medicare allowable charges are from those same services.” 
  • By October 2016, CMS must issue regulations creating no fewer than 4 payment models for Medicare providers to choose from.
  • Providers would receive the traditional fee-for-service 2017 payment rates through 2018 to further ease the transition into one of the CMS-approved payment models
  • Beginning January 2018, physicians participating in the CMS-approved payment models will be reimbursed pursuant to the design of those selected payment models, with the opportunity to earn additional payments for achieving certain quality and patient care objectives.
  • Providers will also have the option participating in 2 value-based care or “alternative fee-for-service” options that would include incentives for care coordination, managing high-risk patients, and achieving certain clinical quality measures. 
  • Physicians choosing to remain in the current Medicare fee-for-service model would receive reimbursement cuts of:
    • 2019: -2%
    • 2020: -3%
    • 2021: -4%
    • 2022: -5%

According to the Congressional Budget Office, the cost to repeal the SGR formula is $316 billion over 10 years. Reps. Schwartz and Beck propose to offset these costs from the savings otherwise funding military operations in Afghanistan and Iraq.

ACG applauds Reps. Schwartz and Beck for their efforts to repeal the SGR formula and replace it with a more sensible Medicare reimbursement system. ACG is currently reviewing the legislation and working with Reps. Schwartz and Beck in order to fully grasp the impact to clinical GI and ACG membership. ACG will update its membership as more details are released.

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 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

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

Brad Conway