This Week – December 2, 2017

This Week in Washington, D.C.

  • Congress, Tax Reform, and Impact on ACG Members and GI Practices: What you should know
  • Attention Solo and Small GI Practices: Get Your 2017 MIPS Crash Cart!
  • MACRA Tidbit for the Week: Is MACRA Hurting America’s Sickest Patients?

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

Congress, Tax Reform, and Impact on ACG Members and GI Practices: What you should know

At the time of this writing, the U.S. Senate looked poised to pass the Tax Cuts and Jobs Act.

Like the Patient Protection and Affordable Care Act (ACA) repeal efforts, the Senate is looking to pass tax reform under the “budget reconciliation,” thereby skirting around the traditional process of needing 60 votes to close the debate and bring a bill to a final vote.  Unlike the ACA repeal efforts, however, Senate Republicans seem able to come to a consensus and successfully perform a delicate balancing act of getting 50 Republican Senators to agree on the final package.  The Senate bill also contains a provision that repeals the ACA mandate which requires individuals to purchase health insurance.  The Joint Committee on Taxation (JCT) estimates this provision increases revenues (reduces deficit) by $318 billion over 10 years.

On November 16th, the U.S. House passed their version of the Tax Cuts and Jobs Act by a vote of 227-205.  No Democrats voted in favor of the bill, and 13 Republicans voted against it.  Repealing the ACA mandate requiring individuals to purchase health insurance was not included in the House version.  However, the House bill eliminates deductions for medical expenses and graduate student loan interest.  These issues may impact many ACG members and patients.  If the Senate passes the bill, the Senate and House will hold a conference to work out the differences between the two versions before holding another vote to pass the final package.

Medicare cuts on horizon?  When planning for tax reform legislation via the budgetary process in early 2017, congressional Republicans allowed themselves a blueprint for increasing the deficit by $1.5 trillion over 10 years.  This has been the guidepost for the bills’ drafts.

How does this impact GI?  This week, the JCT estimated that the U.S. Senate’s version of the Tax Cuts and Jobs Act would add more than $1 trillion to federal deficits over 10 years, even after economic growth is taken into account.  This analysis is consistent with a November 14th Congressional Budget Office (CBO) warning that tax legislation raising the national deficit by $1.5 trillion over 10 years, without enacting other laws in the current year to offset these deficits, would trigger “sequestration,” or across the board cuts to Medicare providers of up to 4%.  This is due to a law passed in 2010 requiring the federal government to issue automatic spending cuts if deficit estimates go over targets.  The CBO warned that Medicare providers may be cut up to $25 billion in FY 2018.  However, late Friday afternoon, Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan released a joint statement assuring that Congress wouldn’t actually allow these across-the-board cuts to take place, including Medicare.  At least 8 Democrats would need to support that vote in the Senate for this to happen.  It is unclear whether Democrats will do this and help Republicans pass the tax reform legislation.

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

During the WCOG at ACG2017, many ACG members from solo and small GI practices conveyed their frustration and confusion with MACRA and meeting MIPS requirements for 2017.

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!

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.

Is MACRA Hurting America’s Sickest Patients?

A recent article suggested that doctors are avoiding some of the nation’s sickest patients out of concern that deaths or other poor outcomes following treatment could cause Medicare to cut their payments, due to poor scores on quality/cost measures.

MACRA is new, so the data does not yet exist.  However, a recent study concluded that doctors who served higher-risk patients under Medicare’s program formerly known as the Value-Based Payment Modifier had lower quality scores, ultimately giving them fewer bonuses and more penalties.  The Value-Based Payment Modifier is essentially identical to the current MIPS’ Cost performance category at this time.  In 2017, CMS assigned a 0% score for the MIPS’ Cost Performance category.  However, in 2018, the weight will increase to 10% of your total MIPS score.  In 2019+, it shoots up to 30% of your total score.  Yet the performance category, as of today, uses the same metrics as the former Value-Based Payment Modifier.

A legislative fix is necessary:   ACG Governors specifically discussed this issue with policymakers back in April, as part of the ACG Board of Governors’ Washington D.C. fly-in. ACG discussed this issue in its recent comments to CMS, as well.  In September, ACG urged Congress to make necessary improvements to the MIPS’ Cost performance category.

ACG is currently working with CMS to improve this MIPS Cost performance category: ACG and other societies have physician representatives on a panel to improve the Cost performance category, replacing these metrics from the Value-Based Payment Modifier with GI-specific “episodes of care,” as mandated by MACRA.  Learn more here.

CMS also finalized in the 2018 MACRA final rule that providers can earn a 5% MIPS score bonus for treating complex patients, based on medical complexity as measured by the Hierarchical Condition Category (HCC) risk score, and a score based on the percentage of dual eligible beneficiaries.  Clinicians or groups must submit data on at least 1 performance category in an applicable performance period to earn the bonus.