This Week – November 18, 2017

This Week in Washington, D.C.

  • AMA House of Delegates Passes ACG Resolution on Puerto Rico and U.S. Virgin Islands
  • Attention Solo and Small GI Practices: Get Your 2017 MIPS Crash Cart!
  • Congress, Tax Reform, and Impact on ACG Members and GI Practices: What you should know
  • Medicare Seeks Your Feedback on MIPS Colonoscopy Episode

AMA House of Delegates Passes ACG Resolution
on Puerto Rico and U.S. Virgin Islands

Some good news transpired from the 2017 American Medical Association (AMA) House of Delegates meeting.  ACG submitted a resolution (Resolution 235) urging the AMA to increase advocacy efforts in order to adequately fund Medicaid programs in Puerto Rico and the U.S. Virgin Islands, and to encourage the Centers for Medicare & Medicaid Services (CMS) to implement emergency regulatory Medicare and Medicaid waivers.  The resolution passed with overwhelming support.  ACG thanks the AMA, the AMA House of Delegates, and the section council for GI diseases for supporting and passing this resolution.  ACG also thanks Bruce Cameron, MD, FACG for shepherding this resolution through the AMA House of Delegates Meeting.  By passing this resolution, advocating for Medicaid funding and regulatory waivers are now part of AMA’s public policy objectives moving forward.

Why is Medicaid so important to GI practices, health care services, and recovery efforts on the islands?  ACG provided some statistics in the resolution, including:

  • Before the hurricanes, of nearly 3.5 million U.S. citizens residing in Puerto Rico, or roughly one in two, or 49% were enrolled in the island’s Medicaid program;
  • Before the hurricanes, roughly 46% of Puerto Ricans were below the federal poverty level, compared to 15% of residents in all other U.S. states;
  • Unlike the 50 states and D.C., annual federal funding for Puerto Rico is capped. Meaning that once federal funds are exhausted, the island no longer receives federal financial support for its Medicaid program during that fiscal year.

ACG Advocacy Efforts Paying Off for GI Practices – Exemptions for Hard Hit Hurricane Areas

As ACG previously informed you, CMS announced in the Quality Payment Program Year 2 final rule (MACRA) that it is establishing an automatic “extreme and uncontrollable circumstance” policy for the 2017 MIPS performance period.  This policy recognizes that the recent hurricanes (Harvey, Irma, and Maria) and other natural disasters can effectively impede a MIPS-eligible clinician’s ability to participate in MIPS. ACG has advocated for CMS to enact this, and appreciates that CMS has listened to the College and other organizations in announcing this policy change.


Attention Solo and Small GI Practices:
Get Your 2017 MIPS Crash Cart!

During the WCOG at ACG2017, many ACG members from solo and small GI practices conveyed their frustration and confusion with MACRA and meeting MIPS requirements for 2017.

Are you nervous that 2017 is coming to a close?  Do you simply want to do the minimum to avoid any Medicare reimbursement cut?  ACG is here to help.  Check out ACG’s new infographic, the “GI Small Practices Crash Cart,” and follow the 4 easy steps to avoid a Medicare reimbursement cut.  This infographic guides you through the process, by first determining whether or not you even have to participate in MIPS in 2017 (being a small practice may come in handy!), to selecting measures, to showing you a measure that you may be able to report, and where to report the quality measure’s identifying code on a Medicare claims form.

It only requires a one-time effort to avoid a cut – don’t miss your chance!

ACG also has a wealth of MACRA educational material on the 2017 reporting year.  Check out ACG’s “Making $ense of MACRA” series on the ACG website.

Click here to view the infographic.


From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

Congress, Tax Reform, and Impact on ACG Members and GI Practices: What you should know

On Thursday, November 16th, the U.S. House passed the Tax Cuts and Jobs Act (TCJA) by a vote of 227-205. No Democrats voted in favor of the bill, and 13 Republicans voted against it.  The legislation cuts the corporate tax rate to 20% starting in 2018 (down from 35%) and doubles the standard deduction for individuals.  However, the bill also eliminates state and local tax deductions and other popular deductions impacting ACG members, such as medical expenses and student loan interest.  On the other side of the Capitol, the Senate is working on its tax reform proposal.  Like the Patient Protection and Affordable Care Act (ACA) repeal process, the Senate will try and pass tax reform under the “budget reconciliation,” thereby skirting around the traditional process of needing 60 votes to bring a bill to a vote.  This will be another delicate balancing act of getting 50 Senators to agree on the final package.  The Senate bill also contains a provision that repeals the ACA mandate which requires individuals to purchase health insurance.  If passed, the Senate and House will then hold a conference to work out the differences of the packages before voting on a final tax reform bill.  Two issues impacting GI practices in the House bill:

Business Income. Under current law, sole proprietorships, partnerships, limited liability companies, and S corporations are generally treated as “pass-through” entities.  Net income is reported on their individual income tax returns and is subject to ordinary income tax rates, up to the top individual marginal rate of 39.6%.  Under the House bill, however, the first $75,000 (individual) or $150,000 (joint) of an active owner or shareholder’s net business taxable income would be subject to a 9-12% rate, fully phased out at $112,500 (individual) or $225,000 (joint).  The rest of the net income distributed by a pass-through entity may be treated as “business income,” and subject to a maximum rate of 25%, instead of ordinary individual income tax rates, followed by the remaining income taxed at the individual rate.

Medicare cuts on horizon?  On November 14th, the Congressional Budget Office (CBO) warned House Democrats that tax legislation which raises the national deficit by $1.5 trillion over 10 years, without enacting other laws in the current year to offset the deficits, would trigger “sequestration,” or across the board cuts to Medicare providers of up to 4%.  This is due to PAYGO, a law passed in 2010 requiring the federal government to issue automatic spending cuts if deficit estimates go over targets.  The CBO warned that Medicare providers may be cut up to $25 billion in FY 2018.


From ACG Legislative and Public Policy Council Member and ACG Board of Trustee, Caroll D. Koscheski, MD, FACG

Medicare Seeks Your Feedback on MIPS Colonoscopy Episode

As ACG and the GI societies notified you earlier this month, CMS recently announced that it will begin a trial run or test period for a “Screening/Surveillance Colonoscopy” episode of care.  We need your feedback and input!

What does this mean? 

From October 16 to November 20, 2017, ACG members may receive a confidential report with information about their performance on this draft episode of care.  According to CMS, the report is available for group practices and solo practitioners who meet a 10-episode case minimum during the measurement period of 06/01/16 to 05/31/17.

The purpose of this report is to help improve the accuracy and understanding of the process, and for our members to provide feedback to CMS.

Your Feedback is Important- Complete the Survey

CMS will be seeking feedback from all stakeholders through an online survey.   Please complete this survey here.

This survey opened on October 16, 2017 and closes at noon Eastern time on November 20, 2017.  The field test reports for group practices and solo practitioners will be distributed through the CMS Enterprise Portal, which CMS has previously utilized for “Quality and Resource Use” Reports.   If you do not already have an account, you can set one up and get access to a “Physician Quality and Value Programs” role in preparation for the field test report by using this guide.

Some background- Why do we need to do this? Click here to read the full blog.