This Week – November 19, 2016

This Week NOT in Washington, D.C.

  • November 2016 State Ballot Summary for ACG Members: Health Care Ballot Issues Around the Country
  • MACRA Tidbit for the Week: Wait… I may not even be required to participate in MACRA next year?

From ACG Board of Governors Chair, Costas Kefalas, MD, MMM, FACG

November 2016 State Ballot Summary for ACG Members

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology’s governance.  The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps ACG make certain it is meeting the evolving needs of the membership. The ACG Governors also act as a grassroots force on important issues facing gastroenterologists at both the national and state levels. Contact your ACG Governor with important local issues.

What were some state health care issues on the ballot in 2016?

California: Health Care Fund

California voters passed a constitutional amendment and state statute that would prohibit lawmakers from raiding a health care fund.  Since 2009, the Golden State has had a hospital provider fee to help it collect more federal matching dollars for Medi-Cal, the state’s version of Medicaid.  The program has helped the state attract an additional $3 billion in federal funds, but the legislature has sometimes tapped into those funds for general expenses. The ballot initiative, Proposition 52, required voter approval before any of that money could be repurposed.

California: Drug Costs

California voted down a proposal (Proposition 61) requiring state agencies to pay no more than what the Department of Veteran Affairs pays for drugs. Managed care programs under Medi-Cal would be exempt from the requirement.

Colorado: Universal Health Care

Colorado did not pass a constitutional amendment (Amendment 69) that would fund ColoradoCare, a universal health care system for the state. If voters had agreed, the system would have been paid for through a 10% income tax increase.  Under the program, residents would have had no deductibles and no copays for preventive and primary care services and could have had other copayments waived if they had caused financial problems.

Colorado:  “Right to Die” 

Colorado approved a controversial campaign to let terminally ill patients access life-ending medication.  This campaign is now moving on to other battlegrounds across the country.  Coloradans approved Proposition 106, a ballot initiative allowing physicians to prescribe lethal drugs to mentally fit, terminally ill adults who want to end their lives. Colorado is the sixth state to allow the practice, following Oregon, Washington, Montana, Vermont and California. Washington, D.C. may take up similar legislation.

Montana: Brain Disease Research & more: read the full blog here.


Wait… I may not even be required to participate in MACRA next year?

Many ACG members and small GI practices are scared and overwhelmed about MACRA and the looming Medicare payment changes next year.  And rightfully so.  This is obviously a stressful time for GI clinicians in private practice.  It is a time of reimbursement cuts and regulatory burdens.  And now MACRA.  Throughout the year, ACG has strived to make learning about MACRA as simple as possible.  So now that CMS released the final details on MACRA, let’s first take a step back, because some of you may not even be forced to participate in MACRA next year.  If you are required, and if you are feeling overwhelmed, you may be surprised to learn how little you need to do in order to meet the 2017 reporting requirements.  Let’s review.

Who has to participate in MACRA?

If you bill more than $30,000 in Medicare Part B charges and provide care to more than 100 Medicare patients per year, and you are:

  1. A physician
  2. A physician assistant
  3. A nurse practitioner
  4. A clinical nurse specialist
  5. A CRNA

Who can be excluded from MACRA?

  1. Clinicians who are newly enrolled in Medicare during the 2017 performance period.
  2. Clinicians who have less than or equal to $30,000 in Medicare Part B charges or see 100 or fewer Medicare Part B patients.

When does MACRA start?

If you’re ready, you can begin January 1, 2017, and start collecting your performance data. If you’re not ready on January 1, you can choose to start anytime between January 1 and October 2, 2017.

Whenever you choose to start, you’ll need to send in your performance data by March 31, 2018.

The first payment adjustments based on 2017 performance go into effect on January 1, 2019.

What do I need to know for 2017? 

The size of your 2019 payment adjustment will depend what you do in 2017

  1. If you make no attempt to participate in 2017, then you receive a 4% payment cut in 2019.
  2. If you submit just a minimum amount of 2017 data, you can avoid a payment adjustment.

Key Takeaway: Are you currently participating in PQRS?  The MIPS “Quality” Category is similar to participating in PQRS.  So submitting just one quality measure for one patient during the 2017 reporting period would suffice, and you would avoid a payment cut in 2019.  Submitting one measure in the new MIPS “Improvement Activities” category will suffice as well.

  1. If you submit a continuous 90-days’ worth of 2017 data, you will avoid the payment cut and be potentially eligible for a bonus payment. (October 2 is the key date)
  2. If you submit a full year of 2017 data, then according to CMS, you may also earn a “moderate” payment bonus.
  3. If you want to participate in a MACRA “advanced” alternative payment model (APM), then you need to participate in MIPS in 2017.  You will send your 2017 reporting data to your APM administrators, and CMS will review the data to determine if you and your APM qualifies.