This Week – September 9, 2017

This Week in Washington, D.C.

  • ACA Repeal Watch: Congress Back from August Recess; ACA repeal and Medicaid reforms on the docket?
  • Back by Popular Demand: Joint ACG-FDA Fellowship Program
  • ACG’s MACRA Tidbit for the Week: MACRA Revisions Are Already Necessary

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

ACA Repeal Watch: Congress Back from August Recess; ACA repeal and Medicaid reforms on the docket?

Congress returned to Washington D.C. this week to some news regarding the deadline to pass legislation repealing the Patient Protection and Affordable Care Act (known as the ACA).  The Senate parliamentarian (office that determines procedural order in the Senate) noted that Congress has until September 30th to pass an ACA repeal measure using “budget reconciliation,” allowing the Senate to pass a bill with a simple majority.  The parliamentarian ruled that current budget reconciliation rules expire when the 2017 fiscal year ends, meaning any repeal effort beyond that date needs 60 votes to overcome a filibuster.  The House budget resolution for fiscal year 2018 does not include language on repealing the ACA.

On ACG‘s radar screen: Will Republican Leadership have an opportunity for certain reforms this fall?

As ACG alerted you this summer, September 30th is also an important deadline for another significant health care issue, in which Congress must reauthorize the Children’s Health Insurance Program (CHIP) that is part of Medicaid.  Nearly 36 million individuals are enrolled in CHIP or are children enrolled in the Medicaid program, according to the June 2017 enrollment report.  A must-pass reauthorization could provide leverage to include Medicaid policy changes. Conversely, it could continue to fracture the Republican Party and cause more headaches for Republican leadership. This is especially important, as Congress must pass a budget or continuing resolution to keep the government open, increase the federal debt/borrowing limits, as well as pass legislation to help victims and recovery efforts from Hurricane Harvey (and possibly Irma at the time of this posting), and stabilize individual health insurance markets.

ACG remains focused on important issues impacting clinical GI and patients, and will continue to use this opportunity to advocate on your behalf.

Back by Popular Demand: Joint ACG-FDA Fellowship Program

Current fellows are invited to submit their application for a one-month rotation at the FDA, sponsored by ACG. The candidate chosen will have the opportunity to participate in daily FDA activities, and will gain first-hand knowledge of the drug and device approval process. The College will provide a stipend for travel and daily living expenses. All applications must be submitted directly to ACG, and will be reviewed by the ACG FDA Related Matters Committee along with staff at the FDA.

Upon completion of the rotation (while you are a fellow), the candidate will be invited by ACG to present his or her experiences at the following ACG Annual Scientific Meeting. The application process is now open. All applications must be submitted by September 22, 2017. The candidate will be chosen and notified of acceptance by November 2017.

For complete details regarding the FDA-ACG Fellowship Program, click here.

MACRA Revisions Are Already Necessary

As ACG members know, 2017 and 2018 (proposed) are “transition” years for MACRA and MIPS.  This is welcomed news for ACG.  It also appears CMS could really use the time to “transition” into MACRA.  For example, let’s review the Cost (Resource Use) MIPS performance category.

This category is similar to the old “value-based payment modifier” that impacted medium and larger GI group practices in the past.  It applies to all MIPS-eligible ACG members now.  CMS looks at your Medicare reimbursement claims data to attribute costs to you and determine whether your practice is cost-efficient when compared to other practices submitting similar claims to Medicare.  To address public comments on the cost performance category, CMS weighted this MIPS category at 0% for 2017, and proposes to do the same for the 2018 reporting year.  ACG has voiced concerns regarding the level of familiarity and understanding of cost measures among clinicians, and agrees that an additional year in which costs do not count towards the final MIPS score will help ease providers into MIPS.

Looking ahead though, things look a bit frightening.  Why?

MACRA provides CMS with flexibility in the first two years of the program.  This may have major consequences, especially in the MIPS’ cost performance category: CMS is required to weigh the cost performance category to 30% for the CY 2021 payment year.  ACG Governors discussed this issue with policymakers back in April, and 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 discussed this issue in its recent comments to CMS as well.

ACG 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 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 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, 40% reliable.