This Week – September 3, 2016

This Week in Washington, D.C.

  • Update from the Hill: What ACG Members Need to Know
  • At the State Level: ACG Governor for Kansas to Serve on Medicare Contractor Advisory Committee
  • MACRA Tidbit for the Week: The Potential Benefits of GIQuIC when dealing with MACRA

From ACG National Affairs Committee Chair, Whitfield L. Knapple, MD, FACG

Update from the Hill: What ACG Members Need to Know

Last month, ACG updated membership on the outstanding issues that remained when members of Congress left for the August recess.  Well, Congress comes back into session next Tuesday…for a whopping 17 days, until they leave again to ramp up the campaign and election season.  So what is ACG focusing on as we head into this session and post-election “lame duck” Congress to close out 2016?

Potential Delay in MACRA?

As mentioned in previous posts, during a July 13 Senate Finance Committee hearing on MACRA implementation, CMS Acting Administrator Andy Slavitt suggested that federal officials are open to a possible delay of the timetable for implementing the proposed payment reforms.  ACG has also urged CMS to delay MACRA in the College’s recent comment letter to the proposed rule.  ACG has joined other stakeholders and is independently working with Congressional staff on the possibility of delaying MACRA until more details and guidance are released, giving ACG members and practices more time to prepare for this seismic change in Medicare reimbursement.  This also affords staff an opportunity to discuss other areas of concern that are outlines in ACG’s MACRA comment letter, such as reducing burdens under the Advancing Care Information category (formerly known as Meaningful Use).

Legislation specific to GI: read the full blog here.

At the State Level: ACG Governor for Kansas to Serve on Medicare Contractor Advisory Committee

ACG Governor for Kansas, Stanley Brand, MD FACG, was recently nominated by ACG and subsequently selected to serve on a local Medicare Contractor Advisory Committee.  The goal of the committee is to improve the relations and communication between Medicare contractors and the physician community.   By serving on this committee, Dr. Brand will be able to provide the GI clinician and patient’s perspective on related coverage proposals.  Dr. Brand can also educate contractors on conflicting policies, or policies inconsistent with the appropriate standard of care.

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 76 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.  Contact your ACG Governor today.


The Potential Benefits of GIQuIC when dealing with MACRA

ACG members are encouraged to check out Dr. Colleen M. Schmitt’s blog on “GIQuIC and the Tennessee Colonoscopy Episode of Care: Insights into a New Gain-Sharing Model in TN

How is this relevant to MACRA?

CMS is mandated by Congress to develop “episodes of care” as a part of the MIPS “Resource Use” category.  The Resource Use category is somewhat similar to the current value-based payment modifier, where CMS looks at claims data at the practice level to determine whether group practices are cost-efficient compared to other practices.  This will now occur at the provider level.  The Resource Use category will comprise 10% of the total composite MIPS score in 2019, 15% in 2020, and 30% in 2021+.   Similar initiatives have already started in Tennessee and Ohio, thus making Dr. Schmitt’s blog very insightful on how you can prepare for what may be coming down the pike.

CMS quote in proposed MACRA rule: “We propose that for resource use measures, lower costs represent better performance. In other words, MIPS eligible clinicians in the top decile would have the lowest resource use.”

What is an “Episode of Care?”

The goal of an “episode of care” is to group all the care related to a defined medical event (e.g. a procedure, chronic condition), including the care for the event itself, any pre-cursors to the event (i.e. diagnostic tests, pre-operative visits), as well as follow-up care.

Please note that these episodes are different from bundled payments or other episode-based alternative payment models.  If you participate in MIPS, you will still be submitting fee-for-service claims.  However, CMS will review these claims, organize the services into a defined period of time (the “episode”), and then compare your attributed costs and utilization to others.

CMS has invited ACG physicians and other stakeholders to help develop and review future episodes of care in GI.  This is important because it allows ACG to be proactive and collaborate in the early stages of this process, thus hopefully mitigating policy and practice management challenges brought on by MACRA.

Managing MACRA

ACG views GIQuIC as an important and integral piece to managing MACRA, as well as a way to incorporate more meaningful quality metrics into MACRA.  ACG does not endorse simply linking reimbursement to quality and/or resource use reporting.  However, when policymakers mandate reporting as a condition to payment, it is ACG’s goal to minimize practice management burdens and protect GI reimbursement as much as possible. Check out other ways participating in a registry such as GIQuIC may potentially help your practice deal with MACRA, including the Quality Reporting Category, Advancing Care Information, and Clinical Practice Improvement Activities.