This Week – September 8, 2018
This Week in Washington, D.C.
- Tri-Society Alert: TAKE ACTION: Tell CMS to Withdraw Harmful E/M Proposals
- ACA Repeal Watch: Dallas is the Setting for the Latest Attempt at Repeal Efforts
- Register for the ACG 2018 Practice Management Course!
Tri-Society Alert: TAKE ACTION!
Tell CMS to Withdraw Harmful E/M Proposals
In July, CMS proposed major changes to documentation and payment for Evaluation and Management (E/M) services billed under Medicare. The core proposal, aimed at reducing documentation requirements, requires a transition to a single blended payment rate for level 2 through 5 office visits for new and established patients. Such a payment system undervalues care provided to our sickest and most vulnerable seniors and other Medicare beneficiaries.
The proposal also includes a multiple procedure payment reduction, which would reduce payment for the least expensive visit or procedure billed on the same day as an E/M service. Several other changes related to E/M services are also included. For instance, the proposal would create new codes for primary care services, certain types of specialty care (but not GI and liver care), and visits that last an hour or more. The proposal would also lift restrictions on same-day E/M visits that are billed for by physicians in the same group and specialty.
Although ACG, AGA, and ASGE share CMS’ objective of reducing physician burden, the Agency’s proposal raises grave concerns.
From ACG Legislative and Public Policy Chair, Whitfield L. Knapple, MD, FACG
ACA Repeal Watch: Dallas is the Setting for the Latest Attempt at Repeal Efforts
As ACG updated you earlier this summer, the constitutionality of the Patient Protection and Affordable Care Act (ACA) is in the courts again.
ACG is monitoring the arguments that began in Texas this week, where 20 state attorney generals have filed another suit on the ACA. What is the background on this latest effort to repeal the ACA? As you may recall, in 2017, Congress effectively repealed the ACA’s “individual mandate” by zeroing-out the penalty for not having health insurance. This was part of the law that revised income tax brackets for individuals and companies, known as the Tax Cuts and Jobs Act. This is significant, as part of the U.S. Supreme Court’s rationale for upholding the ACA in 2012 was that the individual mandate intrinsically links the other parts of the ACA.
These 20 state attorney generals contend that based on the Supreme Court’s logic above, the ACA should now be rendered unconstitutional. The Justice Department in June echoed these arguments when it chose not to defend the ACA. Please note that while the Tax Cuts and Jobs Act may have effectively eliminated the individual mandate, it only zeroed out the penalty beginning in 2019. The law may not have repealed this provision, but rather, just changed the penalty amount. The court’s interpretation will have a significant impact on important ACG objectives, such as coverage protections for pre-existing conditions and preventive care. This Justice Department letter also noted that it agrees with the Justice Department under President Obama— that guaranteed issue for those with pre-existing conditions and community rate-setting should be tied to or “inseverable” with the individual mandate. Thus, according to 20 states, these sections of the ACA should potentially be repealed as well.
Twenty states include: Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, Wisconsin and West Virginia.
ACG will continue to update membership as the case move through the courts.
Register for the ACG 2018 Practice Management Course!
Join us at the ACG 2018 Practice Management Course to learn from colleagues about new and innovative ways to improve operations, enhance productivity, and guarantee success in your practice.
Ralph D. McKibbin, MD, FACG
Jay N. Yepuri, MD, MS
Members, ACG Practice Management Committee