This Week – July 21, 2018

This Week in Washington, D.C.

  • ACG Active on Stark Law Reform: Working with Congress and CMS
  • Tri-Society Alert: New CMS Proposed Rule Could Impact GI Practice
  • MACRA Tidbit for the Week: Should the Trend in CMS’ Estimated MIPS Bonuses Raise Some Concern?

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

ACG Active on Stark Law Reform: Working with Congress and CMS

On Tuesday, the House Ways and Means Committee Health Subcommittee held a hearing titled, “Modernizing the Stark Law to Ensure the Successful Transition from Volume to Value in the Medicare Program.”  ACG is currently working with Congress and CMS on much needed reforms and updates to the Stark Law.

You can help! Urge your representatives to support the “Medicare Care Coordination Improvement Act of 2017” (S. 2051/HR. 4206).

Senators Portman (R-OH) and Bennet (D-CO), and Representatives Bucshon (R-IN), Ruiz, MD (D-CA), Marchant (R-TX) and Kind (D-WI), have recently introduced S. 2051 and HR. 4206, the Medicare Care Coordination Improvement Act of 2017.  This legislation seeks to “modernize the physician self-referral prohibitions to promote care coordination in the merit-based incentive payment system and to facilitate physician practice participation in alternative payment models under the Medicare program, and for other purposes.”

Click here to take action now!

On June 25, 2018, the Centers for Medicare and Medicaid Services (CMS) published a formal request for information, seeking comment from ACG members and other stakeholders on how to better promote value-based payments.  Specifically, CMS is asking industry leaders what the Agency can do to break down barriers posed by the federal Physician Self-Referral Law (known as the Stark Law).  It’s a nod that CMS’ desire to get away from fee-for-service is so strong, that it is willing to consider regulatory modifications to the Stark Law. According to the publication, CMS wants to know how the Stark Law has stymied efforts to participate in integrated delivery models, alternative payment models, and arrangements to incentivize improvements in outcomes and reductions in costs.  CMS asks what new exceptions are needed to the Stark Law to promote these arrangements.

ACG will be providing comment based on feedback from membership.  Please forward any specific examples of undue burdens to the ACG staff.

You can also offer a comment directly to CMS.  The deadline for response is August 24, 2018. This is simple using ACG’s advocacy tool.  Click on the link below to provide real-world examples of how the antiquated Stark Law hinders this push towards more value-based care.

Submit your comment to CMS here.


Tri-Society Alert:
New CMS Proposed Rule Could Impact GI Practice

Late Thursday, July 13th, 2018, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2019 Medicare Physician Fee Schedule (PFS) proposed rule, which includes several significant policy and payment changes that will impact gastroenterologists. This year, the PFS proposed rule also includes changes to year three of the Quality Payment Program (QPP).

This communication offers a topline summary of the most important proposed changes to the payment rates and policies for services paid under the Medicare PFS. The PFS proposed rule will appear in the Federal Register on July 17th and can be downloaded here.

Key proposals:

  • Major evaluation and management (E/M) changes aimed at reducing physician burden impact coding and reimbursement.
  • EGD and colonoscopy codes identified by an outside party as potentially misvalued.
  • Weight of the cost performance category under QPP increases from 10% to 15%.
  • CMS proposes adding a GI-specific cost measure for screening/surveillance colonoscopy.
  • QPP performance threshold increases from 15 points to 30 points.

ACG, AGA and ASGE are currently reviewing the details of the proposed rules and will be providing joint comments.

CMS will accept comments until September 10, 2018, and will respond to comments in a final rule to be issued on or around November 1, 2018. We will keep you updated as we learn more.

Medicare Physician Payment

  • 2019 Proposed Conversion Factor: The proposed 2019 PFS conversion factor is $36.05, an increase of .03 percent from the 2018 PFS conversion factor of $35.99. Click here to review 2019 MPFS proposed Relative Value Units (RVUs) for GI services.
  • Reforming Evaluation and Management (E/M) Payment: CMS proposes a major new reimbursement methodology for E/M services effective January 1, 2019. Under the proposal, new patient level 2-5 (99202-99205) and established patient level 2-5 (99212-99215) services would receive one blended payment.

Read the full alert here.


Should the Trend in CMS’ Estimated MIPS Bonuses Raise Some Concern?

Earlier this year, ACG alerted membership that a recent CMS blog unveiled some data and results for the first year of MACRA.  Read ACG’s alert, “CMS Highlights Success of the Quality Payment Program (QPP) Year 1: High on Praise, but Short on Details.

Alphabet Soup Side-Note: CMS does not use the acronym MACRA, but instead, lumps the Medicare Part B reimbursement modified fee-for-service (MIPS) and alternative payment models (APMs) programs into one bucket, dubbed the “Quality Payment Program or QPP.”

When CMS released these data, ACG had hoped more details were going to be released this month, as part of the CY 2019 Medicare physician fee schedule and proposed QPP changes  Well…we’re still waiting.

Here is an excerpt from the CY 2019 proposed rule, released last week:

CMS now anticipates that we will be able to “update these estimates with the data from the first year of MIPS in the CY 2019 Quality Payment Program final rule,”  and provided some data:

  • CMS estimates that approximately 650,000 clinicians would be MIPS-eligible clinicians in the 2019 MIPS performance period. (CMS provides no specialty-specific data). CMS estimates that MIPS payment adjustments will be approximately equally distributed between negative MIPS payment adjustments ($372 million) and positive MIPS payment adjustments ($372 million) to MIPS-eligible clinicians.

How does this compare to estimates from previous years?  The number of MIPS-eligible clinicians roughly continue to stay the same, but the bonuses or estimated positive payment amount continues to fall.  This is important as you prepare for MIPS heading into 2019.  CMS estimates that roughly 9% of these 650,000 MIPS-eligible clinicians will receive a payment cut in CY 2021.  The maximum payment cut a MIPS-eligible clinicians can receive in 2021 is -7%, and the threshold is set at 30 points — while it make sense that more clinicians would receive a payment cut, the MACRA initially promised that the law would provide more bonuses to those who scored well (+7% in 2021).  In fact, however, CMS estimates that the maximum bonuses (even after the exceptional performance bonuses are included) would be 5.6%.

We will see what data CMS releases this fall, but as a comparison:

  • QPP Year 2: CMS estimated that there would be 604,006 MIPS-eligible clinicians in CY 2018, with roughly $618 million in payments. CMS estimated that there are 11,298 MIPS-eligible GI clinicians in CY 2018.  According to CMS estimates, 3% would receive a reimbursement cut in CY 2020, while 97% would be eligible for a bonus, or would at least avoid a payment cut.
  • QPP Year 1: CMS estimated that there would be 676,722 MIPS-eligible clinicians in CY 2017, with roughly $699 million in positive payments.    CMS estimated that there were 12,168 MIPS-eligible GI clinicians in CY 2017.  According to CMS estimates, 4% would receive a reimbursement cut in CY 2019, while 96% would be eligible for a bonus, or would at least avoid a payment cut.

ACG will continue to review the data and potential impact for GI practices.  Stay tuned.