This Week – December 16, 2017

This Week in Washington, D.C.

  • Important Date: MIPS Advancing Care Hardship Exemption- Due December 31
  • Patient and Physician Advocates Testify at Massachusetts State House: Urge Support for Step Therapy Exemption bills (S.551/H.492)
  • Attention Solo and Small GI Practices: Get Your 2017 MIPS Crash Cart!

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

Important Date: MIPS Advancing Care Hardship Exemption- Due December 31

As ACG reported last week, the Centers for Medicare and Medicaid Services (CMS) recently released regulatory guidance for clinicians participating in the Merit-Based Incentive Payment System (MIPS) who have been adversely impacted by Hurricanes Irma, Harvey and Maria, as well as the ongoing Northern California Wildfires.

This is welcomed news, as ACG has been urging CMS to grant these exemptions for ACG members impacted by these natural disasters.  ACG also championed a resolution at the recent American Medical Association (AMA) House of Delegates meeting, which urges the AMA and others to advocate for more regulatory waivers for providers impacted by the recent hurricanes.

Learn more here.

Other ACG members can claim a hardship exemption from the Advancing Care Information performance category for 2017.  This application is due December 31, 2017.

MIPS-eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0 of the final score if they meet the criteria outlined below.  CMS would then reweight the 25% to the MIPS Quality performance category (currently at 60% of your total MIPS score).  Simply lacking certified electronic health record technology (CEHRT) does not qualify the MIPS-eligible clinician or group for reweighting.

A MIPS-eligible clinician (or group) may submit a Quality Payment Program Hardship Exception Application, citing one of the following specified reasons for review and approval:

  • Insufficient Internet Connectivity
  • Extreme and Uncontrollable Circumstances
  • Lack of Control over the availability of CEHRT

Click here to learn more about Hardship Exceptions.

Patient and Physician Advocates Testify at the Massachusetts State House:
Urge Support for Step Therapy Exemption bills (S.551/H.492)

On Thursday, December 14th, ACG, along with the Massachusetts Gastroenterology Association and several patient advocacy organizations, participated in the Pharmacy and Medical Malpractice hearing before the Massachusetts Joint Committee on Financial Services in support of the “Acts to Reduce Health Care Costs Through Improved Medication Management (S.551/H.492).”  Step Therapy necessitates the “fail first” drug therapy requirements, in which patients are forced by insurers to try and fail with one or more medications before the cost of the medication their doctor originally prescribed will be covered.  This legislation, introduced by State Representative Jennifer Benson (D-MA) and State Senator Barbara L’Italien (D-MA), would allow for exemptions to be made to the Step Therapy protocol, in order to remove the current barriers in allowing patients to gain access to the medication they need at a faster pace.

Patient advocates passionately cited their frustrations with the current Step Therapy protocol.  Onerous regulations and costs, extended waiting periods, loss of valuable time and quality of life, and the inability to treat each patient with the individualized care that they need were echoed throughout the testimonies.

ACG will continue to work with state legislators in Massachusetts to help get these bills passed.

ACG is here to help other states nationwide, as well.  Please use the ACG Legislative Action Center to support ongoing efforts in your states, and encourage your state medical and/or state GI society to get involved in introducing patient-focused legislation in your respective states.

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

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!

Are you a part of a larger practice? You too can use this infographic to avoid a payment cut.  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.