This Week – September 23, 2017

This Week in Washington, D.C.

  • ACA Repeal Watch: Republicans to hold possible vote next week
  • ACG Urges Congress to Make Necessary Changes to MACRA
  • FDA clears first duodenoscope with disposable distal cap
  • CMS granting regulatory waiver for ASC and HOPD facilities hit by hurricanes
  • My Reflections on ABIM MOC, by Dan Pambianco, MD, FACG
  • ACG and GI Societies Comment on Medicare CY 2018 Payment Rules

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

ACA Repeal Watch: Republicans to hold possible vote next week

Last week, ACG informed you that the efforts to repeal and replace the Patient Protection and Affordable Care Act (“ACA”) have returned, after a plan drafted by Republican Senators Lindsey Graham (SC), Bill Cassidy, MD, FACG (LA), Dean Heller (NV), and Ron Johnson (WI) was being touted as the last opportunity to pass health reform in the Senate this year. They are correct, as September 30th is the deadline to use the legislative budget process to pass any repeal bill by a simple majority. This week, Senate Majority Leader Mitch McConnell (KY) announced that he will try and force a vote next week. It is still unclear whether Senate Republicans have the votes needed in order to pass this bill via a simple majority. All eyes are on Sens. Susan Collins (ME), Lisa Murkowski (AK), and Dan Sullivan (AK). Sen. Rand Paul (KY) has already voiced opposition. On Friday, Sen. McCain announced that he will oppose the bill as well, meaning that only one more defector can be afforded in order to pass the bill with the benefit of Vice President Mike Pence’s tie-breaking vote.

There has been much arm-twisting and many private meetings this week. The Congressional Budget Office will release the estimates of the repeal plan early next week, but it won’t be able to produce a detailed analysis of how the legislation would impact health insurance coverage, access to care, and costs to the federal budget for several weeks (after the Sept. 30 deadline).

ACG’s position: As the College has previously stated, we feel that this process has become a test of political strategy and gamesmanship in order to get something/anything passed, as opposed to an opportunity for Congress to improve substantive issues with the ACA, and acknowledge that there is much to improve. ACG remains very concerned over the rushed process, lack clarity, and lack of an objective CBO analysis on how the cuts to Medicaid would impact the states.

Read the full blog here to learn more.


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

ACG Urges Congress to Make Necessary Changes to MACRA

This week, ACG urged Congress to make necessary improvements to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Quality Payment Program (QPP). MACRA provides CMS with flexibility in the first two years of the program. As ACG alerted you earlier this month, this may have major consequences, especially in the MIPS’ cost performance category: CMS is required to increase the weight of the cost performance category to 30% for 2019, the CY 2021 payment year. Greater regulatory flexibility is also necessary in year three of the QPP (2019 reporting year) and beyond. This requires legislative action.

Fortunately, ACG Governors specifically discussed this issue with policymakers back in April, as part of the ACG Board of Governors Washington D.C. fly-in and meeting. ACG discussed this issue in its recent comments to CMS, as well. ACG will continue to work with like-minded organizations in urging Congress to extend CMS’ authority to re-weight MIPS performance categories in Year 3 of the Quality Payment Program and beyond. ACG also continues to work with CMS, and has representatives on a “technical expert panel” in striving to develop accurate and more reliable cost metrics and episodes of care for the MIPS’ cost/resource use performance category. CMS concedes in the MACRA regulations that without new cost metrics in MIPS, CMS will only use measures that were in the value-based payment modifier and have a .4 reliability rating. CMS notes that a .4 reliability rating does not necessarily mean that the measures are only 40% reliable, but rather, indicates “moderate reliability.” That is still not very comforting. Thus, we need better metrics, testing, and review prior to full implementation.

Key takeaway: Without necessary legislative and regulatory changes, one-third of your total MIPS score in 2021 will be based upon metrics that are, give or take, only 40% reliable.

ACG will continue to advocate on behalf of clinical GI and your patients.

ACG members are encouraged to review ACG’s material on MACRA, including the detailed overview of MACRA, “ACG’s “Making $ense of MACRA,” the ACG-CMS webinar on 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” here as well.


From ACG FDA-Related Matters Committee Chair, Tedd Cain, MD, FACG

FDA clears first duodenoscope with disposable distal cap

On Wednesday, the U.S. Food and Drug Administration (FDA) approved the first duodenoscope with a disposable distal cap, a new feature designed to improve access for cleaning and reprocessing (Pentax ED34-i10T). In January 2017, the FDA issued a Safety Communication, alerting health care providers about a design issue with an earlier version of the Pentax duodenoscope.


From ACG Practice Management Committee Chair, Michael S. Morelli, MD, FACG

CMS granting regulatory waiver for ASC and HOPD facilities hit by hurricanes

Due to the devastating impact of Hurricane Irma, the Centers for Medicare & Medicaid Services (CMS) announced that the agency is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to hospitals and ambulatory surgical centers located in affected areas. Facilities will be granted exceptions without having to submit an Extraordinary Circumstances Exceptions (ECE) request if they are located in one of the Florida counties, Georgia counties, Puerto Rico, or U.S. Virgin Islands county-equivalents which have been designated by the Federal Emergency Management Agency (FEMA) as a major disaster area. ACG is seeking clarity from CMS on whether these exemptions could also apply to individual providers and groups participating in MIPS. Stay tuned for further updates.

Click here for the complete details regarding these exceptions.


From ACG Board of Trustees Member, Dan Pambianco, MD, FACG

My Reflections on ABIM MOC

The American Board of Medical Specialties (“ABMS” the parent board of the American Board of Internal Medicine) says, “board certification is a voluntary process, and one that is very different from medical licensure.”

The ABIM states that, “Initial Certification indicates that physicians have met rigorous standards through intensive study, accredited training and evaluation and that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care.” In addition, according to ABIM, “Maintenance of Certification (MOC) is a professionally determined standard that attests that an internist is staying current in knowledge and practice throughout his/her career.” (Source)

Since 1990, the definition of “Board Certified” has changed from a one-time test to an ongoing series of re-certifying exams, clerical convolutions, and fees to maintain certification through the MOC program – a process costing up to $25,000. Lack of participation in any portion of the MOC program results in loss of Board certification. Board certification, either as initial certification or 27 years into maintaining certification, is voluntary!

Traditionally, intrinsic to our profession and title “Doctor of Medicine” was and is the incumbent moral imperative to maintain the respect and trust of our patients. This includes the obligation to pursue ongoing education and to provide the best care possible to our patients. Demonstrably, physicians have always committed to continuing medical education throughout our professional lives – and then some. This is one reason state medical societies require documentation of this education for physicians to remain licensed.

What has changed? Read my full blog here.

ACG and GI Societies Comment on Medicare CY 2018 Payment Rules

On September 11, ACG, AGA and ASGE responded to major provisions proposed in the Centers for the Medicare and Medicaid Services (CMS) calendar year (CY) 2018 Medicare Physician Fee Schedule (PFS) Proposed Rule and the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System (ASC) Proposed Rule. We anticipate that these rules will be finalized by early November.

Our societies addressed several key provisions impacting GI in the CY 2018, including changes to anesthesia reimbursement, calculation of malpractice RVUs in GI, eliminating the disparity in the facility reimbursement rates between hospital outpatient departments (HOPDs) and ASCs, and supporting the proposal to delay the mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) under the ASCQR Program for CY 2018 data collection.

Click here for a summary of the comments.

To read our comment letter on the calendar year (CY) 2018 Medicare Physician Fee Schedule (PFS) Proposed Rule, click here.

To read our comment letter on the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System (ASC) Proposed Rule, click here.