This Week – July 14, 2018

This Week in Washington, D.C.

  • President Trump’s Nominee for the Supreme Court: Potential Impact to ACG Members and Patients
  • New! ACG Practice Management Toolbox Article: Reviewing and Updating the Informed Consent Process in your Practice
  • MACRA Tidbit for the Week: CMS Releases MIPS 2017 Performance Feedback User Guide

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

President Trump’s Nominee for the Supreme Court: Potential Impact to ACG Members and Patients

On Monday evening, President Trump nominated Brett Kavanaugh, a judge on the U.S. Court of Appeals for the District of Columbia since 2006, to replace retiring Supreme Court Justice Anthony Kennedy.  Brett Kavanaugh was once a law clerk for Justice Kennedy.

What does this mean for GI and patient care?

In short, it is unclear, as we will describe below.  It is important to note that ACG is focusing only on potential GI health care policy issues.  We leave the larger and higher-profile issues to other organizations and our membership’s individual opinions.

What is also unclear is whether one should assume that a judge considered a “judicial conservative” is automatically politically conservative.  For example, legal scholars point to Judge Kavanaugh’s dissenting opinion in 2011, when reviewing the Patient Protection and Affordable Care Act (ACA).   A recent article explains how a 2011 dissenting opinion from Judge Kavanaugh perhaps helped Chief Justice Roberts and the U.S. Supreme Court uphold the constitutionality of the ACA.  The Supreme Court in 2015 later upheld the ACA’s ability to provide federal assistance for insurance exchanges created by the states.

In 2011, the D.C. Appellate Court upheld the ACA mandate as a valid exercise of Congress’ power under the Commerce Clause.  However, Kavanaugh dissented, not on the merits, but because he viewed that it was premature for the court to hear the case.  In his view, the Anti-Injunction Act prevents individuals from challenging the validity of taxes in court until after they have paid them (the earliest a court could hear a challenge on the individual mandate would have been 2015, or 1 year after the penalty took effect).   In his view, judicial-restraint was warranted.  Kavanaugh further explained in this opinion the individual mandate may be construed as a penalty or a tax, and that Congress has the power to pass tax legislation. Thus, courts must give deference to the legislature.  This is significant, as when the case reached the Supreme Court in 2012, the Supreme Court ruled that the ACA’s individual mandate was unconstitutional under the Commerce Clause (disagreeing with the D.C. Court of Appeals) but that the mandate is within Congress’s power to “lay and collect Taxes” (agreeing in part with Judge Kavanaugh’s dissent).

There are also additional health care policy issues currently in lower courts that soon may wind up at the U.S. Supreme Court. Medicaid work requirements and mandates on pre-existing conditions are a few issues that Judge Kavanaugh may hear as a member of the Supreme Court.  While legal scholars look to his dissenting opinion on the ACA as a “moderate” position, others point to a 2015 dissenting opinion, stating that ACA contraceptive coverage requirements could infringe upon the rights of religious organizations.  Health policy experts are also using this dissent to gauge how he could potentially rule in cases on other ACA coverage requirements, such as mandatory coverage for those with HIV or hepatitis C.

The constitutionality of the ACA is in the courts again: read the full blog here.


The latest article added to the ACG Practice Management Toolbox, titled “Reviewing and Updating the Informed Consent Process in your Practice” in the Patient Engagement category, is one you should be sure not to miss.  Authors Stephen T. Amann, MD, FACG, Digestive Health Specialists Partner, and Brian B. Baggott, MD of the Cleveland Clinic give detail on all of the necessary information you need in order to adequately practice informed consent with your patients. Striving for the best possible communication and understanding between the provider and the patient is one of the College’s top priorities, and this article provides a handy guide to ensure that you and your colleagues are meeting these concerns.  Specific elements of informed consent for the GI practice and key concepts and examples are outlined for your use.

Click here to read this latest Toolbox article.

What is the Practice Management toolbox?

Gastroenterologists in private practice find themselves working in a time of unprecedented transformation. Pressures are high as they make important management decisions that profoundly affect their business future, their private lives, and their ability to provide care to patients. The ACG Practice Management Committee has a mission to bring practicing colleagues together to explore solutions to overcome management challenges, to improve operations, enhance productivity, and support physician leadership. It was in this spirit that the Practice Management Toolbox was created.

The Toolbox is a series of short articles, written by practicing gastroenterologists, that provide members with easily accessible information to improve their practices. Each article covers an issue important to private practice gastroenterologists and physician-lead clinical practices. They include a brief introduction, a topic overview, specific suggestions, helpful examples and a list of resources or references. Each month a new edition of the Toolbox will be released and will then remain available here along with all previous editions. The Practice Management Committee is confident this series will a provide valuable resource for members striving to optimize their practices.


CMS Releases MIPS 2017 Performance Feedback User Guide

While CMS finalizes 2018 MIPS reporting requirements, it is important to check and see how you performed in 2017.  CMS recently posted the 2017 Performance Feedback User Guide to help ACG members understand 2017 MIPS performance feedback. This User Guide:

  • Discusses who can access MIPS performance feedback;
  • Highlights the differences between preliminary performance feedback and final performance feedback; and
  • Provides step-by-step instructions for accessing your feedback

CMS also recently posted its 2017 Performance Feedback Fact Sheet, which offers an overview of what performance feedback is, who receives the feedback, and how to access it on the Quality Payment Program website.

Click here to access your individual MIPS portal.

For More CMS Information: Visit the Quality Payment Program Resource Library

MAKING $ENSE OF MACRA

CMS….SGR… MACRA… MIPS… APMs… QCDRs… ACOs… Why does Washington D.C. love acronyms and complicated payment systems?  What the heck is going on here?  ACG Hopes to Keep This Simple.   We 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 2