ACA Repeal Update: The Trump administration appeals recent court decision on Medicaid Work Requirements

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

On Wednesday, the Department of Health and Human Services (HHS) formally appealed a recent decision from the U.S. District Court for the District of Columbia on Medicaid and work requirements.

As ACG previously reported, on March 27th, a U.S. district judge from D.C. ruled that HHS’ support of Medicaid work requirements in Kentucky and Arkansas violate the program's primary goal of delivering health care coverage to low-income Americans.  According to the court, the federal government failed to justify that adding employment conditions and other changes to Medicaid in Arkansas and Kentucky advanced Medicaid's basic purpose of providing health coverage.

Meanwhile in Texas: Oral arguments are expected to begin in July for the ongoing case in Texas seeking to repeal the ACA.  Back in September 2018, ACG informed you of the lawsuit filed in Texas by 20 state attorneys general. The lawsuit was based upon Congress’ decision in 2017 to effectively repeal the ACA’s “individual mandate,” by zeroing-out the penalty for not having health insurance, as a part of the Tax Cuts and Jobs Act. The state attorneys argued that the ACA should now be deemed unconstitutional, pursuant to the U.S. Supreme Court’s rationale for upholding the ACA in 2012, holding that the individual mandate intrinsically links the other parts of the ACA.  On December 14, 2018, the Texas court agreed, and ruled that because the individual mandate was effectively repealed and is considered an intrinsic piece of the ACA, the entire law should now be deemed unconstitutional as a result.  On March 25th, 2019, the U.S. Department of Justice officially weighed in support of a December 2018 Texas district court’s ruling invalidating the entire ACA.  

The legal briefs from the federal government and the conservative-led states are due May 1st. The response from the pro-ACA states are due May 22nd.

ACG will continue to update membership as this case and other ACA-related cases go through the judicial system.

At the State and Local Level: ACG Leaders from Rhode Island testify in support of state legislation removing barriers to CRC screening

This week, on Tuesday, April 9th, Drs. Alyn Adrain, ACG Governor for Rhode Island, and Samir Shah, Treasurer of the ACG Board of Trustees, testified in front of the State of Rhode Island General Assembly in support of Senate Bill 679, an "Act Relating to Insurance - Accident and Sickness Insurance Policies." This legislation, introduced by State Senator Maryellen Goodwin (D-RI-1), seeks to prohibit cost sharing for Medicare beneficiaries when a screening colonoscopy turns therapeutic. Dr. Adrain highlighted the fact that while colorectal cancer is currently the 2nd cancer killer in the United States, it is largely preventable, and we must make strides to increase screening and remove any potential barriers to providing access to screening for patients.

Both Dr. Adrain and Dr. Shah joined 100 ACG representatives last week on Capitol Hill for the ACG Board of Governors Legislative Fly-In, where participants advocated for the federal "Removing Barriers to Colorectal Cancer Screening" bills (S. 668; HR 1570). ACG thanks Drs. Adrain and Shah for their steadfast dedication in advocating for clinical gastroenterology and improving patient care.

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.

Contact your Governor today!

FDA Safety Communication: Importance of Following Duodenoscope Reprocessing Instructions

From ACG FDA Related Matters Committee Chair, Stephen Hanauer, MD, FACG

On Friday, April 12th,  the U.S. Food and Drug Administration (FDA) issued a safety communication entitled “The FDA Continues to Remind Facilities of the Importance of Following Duodenoscope Reprocessing Instructions.” This is an update on the postmarket surveillance study results for duodenoscopes used in Endoscopic Retrograde Cholangiopancreatography procedures (ERCP) since the issuance of the December 2018 safety communication. 

Read the statement here.

New! ACG Practice Management Toolbox Article: Adding Anesthesia Services as an Ancillary Service to your Practice or ASC

New this week to the ACG Practice Management Toolbox is an article brought to you by Sapna Thomas, MD, FACG and Samer El-Dika, MD of the ACG Practice Management Committee in the Reimbursement and Revenue category.  Many GI practices with ambulatory surgical centers (ASCs) have benefited from the addition of anesthesia providers as an ancillary service, reporting that incorporating anesthesia to their practice or ASC has resulted in increased efficiency, revenue, and overall improved quality of care. In “Adding Anesthesia Services as an Ancillary Service to your Practice or ASC,the authors outline a general guide and rules to consider for those interested in adding the service to their practice.

Click here to read: "Adding Anesthesia Services as an Ancillary Service to your Practice or ASC."

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 CY 2017 MIPS Participation Data Impacting 2019 Medicare Payments

ACG’s very first “MACRA Tidbit for the Week” discussed the potential problems with MIPS and whether there was actually an opportunity to receive the bonuses as marketed by the Centers for Medicare and Medicaid Services (CMS) and policymakers.  The tidbit was called “MIPS or The Other Guy Must Fail First” Payment System.

CMS recently released data on MIPS participation and payment adjustments rates.  The data confirms this problem ACG highlighted back in 2016, where we must have clinicians who fail in order to provide bonuses to others.  The data also confirm ACG’s concern that MIPS would negatively impact smaller practices.  Thus, ACG has focused on increasing the exemptions from MIPS, as well as educating members on avoiding a payment cut rather than planning for those bonuses as promoted by Congress and CMS  As the cuts in MIPS get higher, however, ACG members should be ready to not only avoid these cuts, but also should be prepared to capture the bonuses provided by others’ payment cuts. ACG continues to educate and advocate on behalf of small and independent GI practices.

Some highlights from the CMS report:

Overall Participation Rate of MIPS-eligible Clinicians

This exceeded CMS’ goal of having 90% of MIPS-eligible clinicians participate during the 2017 performance year.

Overall Participation Count by Reporting Method

According to CMS, these data indicate that group reporting seems to be the preferred option for participating in MIPS.

Participation Rates for Small & Rural Clinicians & more: read the full tidbit here.

MACRA Year 3: Background and Acronyms

ACG's goal is to provide membership with educational guidance in a simple, easy-to-understand fashion. We compiled a detailed overview for you that seeks to make some sense out of this alphabet soup, including acronyms such as MACRA, QPP, MIPS, APMs, etc. – but hopefully in a simplified fashion and in plain English.

Click here to check out our review of Year 3!