This Week – June 24, 2017

This Week in Washington, D.C.

  • CMS Releases MACRA Proposed Rule for 2018
  • ACA Repeal Watch: Senate Releases Anticipated Health Reform Draft
  • MACRA Tidbit for the Week: Don’t Forget about 2017!

CMS Releases MACRA Proposed Rule for 2018

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2018 Medicare Quality Payment Program (QPP) proposed regulation. This regulation outlines the proposed requirements for the Merit-based Incentive Payment System (MIPS), as well as for qualified or “advanced” alternative payment models (APMs) under MACRA.

CMS provided a side-by-side comparison that summarizes the proposed changes to the requirements for MIPS and APMs for calendar year 2018 compared to 2017.  You can review the QPP Year 2 Proposed Rule here.

CMS estimates that there are 10,900 MIPS-eligible GI clinicians; roughly 3.5% would receive a reimbursement cut in CY 2020.  ACG is currently reviewing the proposed rule’s impact to clinical GI.  Here is a top-line summary:


ACG is encouraged that CMS continues to ease into reporting requirements and thresholds in year 2 of MACRA, especially for smaller and rural GI practices.  For example, CMS aims to assist smaller providers by allowing them to be excluded from MACRA altogether.  For 2018, CMS proposes to increase the threshold to exclude ACG members or groups with ≤ $90,000 in Part B allowed charges or ≤ 200 Part B beneficiaries.  The current exclusion includes clinicians or groups with ≤$30,000 in Part B allowed charges OR ≤ 100 Part B beneficiaries.  Starting with the 2019 MIPS performance period, CMS proposes to let clinicians opt-in to MIPS if they exceed 1 or 2 of the low-volume threshold components.

The payment cut for the 2020 payment year is 5% for those who do not report MIPS measures in CY 2018.  This is a deeper cut from the 4% payment adjustment for not participating in MIPS in 2017, which impacts the payment for CY 2019.

Quality Payment Program Year 2 Proposals: MIPS & APMs: click here to read the full blog post.

From ACG National Affairs Committee Chair, Whitfield L. Knapple, MD, FACG

ACA Repeal Watch: Senate Releases Anticipated Health Reform Draft

On Thursday, June 22, 2017, the Republican Leadership in the U.S. Senate released the much anticipated health reform draft: the Better Care Reconciliation Act of 2017.  This is the Senate’s version of the bill to repeal and replace the Patient Protection and Affordable Care Act (ACA).  Republican leaders hope to have a vote prior to the July 4th congressional recess.  The Senate can pass this legislation by a simple majority as the bill is being shepherded through the Senate via the budget reconciliation process (the same process the Senate used to pass the ACA in 2010).  However, Majority Leader Mitch McConnell (R-KY) must first deal with fractions within the Republican Party in order to secure a majority vote.

What is ACG doing?  The College remains discouraged over potential changes to patient cost-sharing, essential health benefits, and coverage for those with pre-existing conditions.  Whenever legislators are forced to vote on “taking away” a benefit, it is always an uphill battle politically.  It appears that important substantive policy issues are getting eclipsed by the importance of getting something/anything passed. However, this may afford more opportunity to improve the bill.   ACG continues to advocate on behalf of GI patients and GI practices (small businesses) with like-minded organizations to improve this draft prior to any vote occurring next week or over the summer.

ACG has compiled a brief side-by-side overview of some of the major issues in each bill.

Click here to check out the side-by-side comparison charts.

Remember what you need to do in 2017

Your 2017 reporting impacts your CY 2019 Medicare payments.  Know what you need to know.  ACG is here to help.

To participate in MIPS via the CMS Web Interface and/or elect to administer the CAHPS for MIPS survey, you must register by June 30, 2017 (this is only for group practices with 25+ employees).  You do not have to register prior to June 30th if you want to participate as a group via a different reporting mechanism.

ACG members are encouraged to use the College’s various MACRA resources, including the detailed overview of MACRA, “ACG’s “Making $ense of MACRA,” the ACG-CMS webinar on MIPS program, ACG’s “quality reporting checklist,” a list of each measure in the MIPS Quality, Advancing Care, and Improvement Activities categories, as well as each measure’s specifications. Check out the comprehensive list of ACG’s “MACRA Tidbit for the Week” here as well.