This Week – February 24, 2018

This Week in Washington, D.C.

  • ACG Co-hosting Meeting with FDA: GREAT 5 for Pediatric Irritable Bowel Syndrome and Pediatric Functional Constipation
  • In ACG Magazine: Strategic Options for Independent GI Practices
  • MACRA Tidbit for the Week: the Basics: “MIPS 101”

ACG Co-hosting Meeting with FDA

GREAT 5 for Pediatric Irritable Bowel Syndrome and Pediatric Functional Constipation

The ACG, American Gastroenterological Association (AGA), North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and FDA will be cosponsoring a public workshop in Silver Spring, Maryland on March 28, 2018, titled the Gastroenterology Regulatory Endpoints and the Advancement of Therapeutics, or GREAT 5.

The focus of this public workshop is Pediatric Irritable Bowel Syndrome and Pediatric Functional Constipation.  The co-sponsored workshop will facilitate the ongoing dialogue among relevant parties on issues related to these pressing topics.

On-site registration will not be available.

Register here.

Click here for more information.

In ACG Magazine: Strategic Options for Independent GI Practices

In the latest issue of ACG Magazine, ACG Practice Management Committee Chair, Louis J. Wilson, MD, FACG (Wichita Falls Gastroenterology Associates), joins Gary W. Herschman, JD (Epstein, Becker & Green LLC) in providing strategic options for independent GI practices to consider in these current times of increasing consolidation and decreasing reimbursement.  Independent GI practices and physician leadership in health care are under severe pressure, and ACG is here to help members.

Read the article here.

Click here to read the latest issue of ACG Magazine.

ACG members: click the image below to visit the ACG Practice Management Toolbox for more guidance and educational materials.

The Basics: “MIPS 101”

What is the “Merit-Based Incentive Payment System (MIPS)”?

  • MIPS consolidates the former Medicare quality reporting programs: PQRS, the Value Modifier, and the EHR “Meaningful Use” program into one composite program.

  • MIPS is broken down into 4 performance categories, with different weights for each category.

  • CMS will develop a “composite score,” or total performance score from each category, using a scoring scale of 0 to 100.  This target score will be based upon previous years’ actual composite score data or other quality reporting data if no prior year data exists (i.e. in 2019 and 2020).

  • This aggregate score from each performance category will be compared to the CMS “target score.”

  • The provider’s reimbursement will be adjusted (bonus, cut, or no change) on a sliding scale based on a comparison of all other providers’ scores.  Remember that there is a 2 year lag: your 2018 reporting impacts your 2020 reimbursement.

  • The provider still submits Medicare fee-for-service claims, but you or your group practice also reports additional information via other mechanisms.

  • You have the option of participating in MIPS, as either an “Individual” (using your national provider identifier (NPI) and each tax identification number (TIN) you are assigned to), or as part of your “Group Practice” (defined as 2 or more clinicians under the single TIN).

What are the MIPS performance categories and weights for CY 2018?

Quality Reporting

Cost Improvement Activities Advancing Care Information (“Meaningful Use”) Total Score
50% of total MIPS score 10% of total MIPS score 15% of total MIPS score 25% of total MIPS score


It gets a little complicated here: providers will have individual scores for each MIPS performance category.  The scores for each category have their own separate scoring system.  CMS will then take the scores from each category, multiply that score by the respective conversion weight, which will convert your score to a numerical 0-100 aggregate score.

MIPS Aggregate Scoring System

Quality Performance category score x quality performance category weight


Cost Performance category score x cost performance category weight


Improvement Activities performance category score x improvement activities performance category weight


Advancing Care Information performance category score x advancing care information performance category weight

= Your final MIPS score

MIPS Scoring- Target is at least 15 points

CMS set a low bar to meet the MIPS target score in 2017.  For 2017 MIPS, the “target score” threshold was 3 points.  Any effort to participate would be sufficient to avoid a payment cut in 2019.

In CY 2018, CMS increased this threshold to 15 points.  This means that you must score at least 15 points in order to avoid a payment cut in CY 2020.  The size of your cut will depend on the amount of data you submit for CY 2018, with up to a maximum cut of 5% of Medicare Part B allowable charges.

Clinicians who achieved a final score of 70 or higher may have been eligible for the “exceptional performance adjustment,” funded from a pool of $500 million.

The bare minimum: How I can avoid the cut and achieve 15 points?

Examples of how to do this include:

  • Meeting the Improvement Activities performance category
  • Meeting the Quality performance category
  • Meeting the Advancing Care Information performance category’s base score, and then submitting 1 measure in the Quality performance category
  • Meeting the Advancing Care Information performance category’s base score, and then submitting 1 medium-weighted measure in the Improvement Activities performance category

Stayed tuned for examples of MIPS scoring in each performance category.

ACG Hopes to Keep This Simple.  We have compiled a detailed overview for you that seeks to make some sense out of this alphabet soup – but hopefully in a simplified fashion and in plain English.  Read the summary and potential impact to GI. 

Dissecting MACRA:
Year 1

Year 2