This Week in Washington DC – June 26, 2020

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

In an effort to keep ACG members up-to-date on important updates in the wake of the COVID-19 outbreak, please find below the latest information tailored for GI practices.

ACG Members Can Opt-Out of MIPS: The Centers for Medicare and Medicaid Services (CMS) announced this week that ACG members and others can file a hardship exemption and opt-out of the Merit-based Incentive Payment System (MIPS) due to the COVID-19 Public Health Emergency. Individual clinicians and group practices have until December 31, 2020, to complete the hardship application. Clinicians will have the option to opt-out of MIPS partially or completely. Clinicians and groups submitting this application would be held harmless from a Medicare Part B payment cut in CY 2022. Please note: Submitting any MIPS data to CMS will override the hardship exception application. You will be scored on any submission.

CMS Releases Medicare Beneficiary Data on COVID-19: On Tuesday, CMS released Medicare beneficiary data reviewing the impact of COVID-19. According to CMS, the data shows that older Americans and those with chronic health conditions are at the highest risk for COVID-19 and confirms disparities in health outcomes for racial and ethnic minority groups, as well as low-income populations. The data includes the total number of reported COVID-19 cases and hospitalizations among Medicare beneficiaries between January 1 and May 16, 2020.

The data breaks down COVID-19 cases and hospitalizations for Medicare beneficiaries by state, race/ethnicity, age, gender, dual eligibility for Medicare and Medicaid, and urban/rural locations. More than 325,000 Medicare beneficiaries had a diagnosis of COVID-19 between January 1 and May 16, 2020. This translates to 518 COVID-19 cases per 100,000 Medicare beneficiaries. The data also indicate that nearly 110,000 Medicare beneficiaries were hospitalized for COVID-19-related treatment, which equals 175 COVID-19 hospitalizations per 100,000 Medicare beneficiaries.

End-stage renal disease (ESRD) patients had the highest rate of hospitalization among all Medicare beneficiaries, with 1,341 hospitalizations per 100,000 beneficiaries. According to CMS, patients with ESRD are also more likely to have chronic comorbidities associated with increased COVID-19 complications and hospitalization, such as diabetes and heart failure. The second-highest rate was among those beneficiaries enrolled in both Medicare and Medicaid (also known as “dual eligibles”), with 473 hospitalizations per 100,000 beneficiaries. Among racial/ethnic groups, Black Medicare beneficiaries had the highest hospitalization rate, with 465 per 100,000. Hispanic Medicare beneficiaries had 258 hospitalizations per 100,000. Asian Medicare beneficiaries had 187 per 100,000. White Medicare beneficiaries had 123 per 100,000. Of note, Black Medicare beneficiaries were hospitalized with COVID-19 at a rate nearly four times higher than white beneficiaries. Click here for the fact sheet also released by CMS.

FDA to Providers- Do not use certain serology tests: On Wednesday, the U.S. Food and Drug Administration (FDA) alerted health care providers to cease using serology tests recently added to the FDA's “removed” test list. The FDA recommends laboratories and health care providers:

• Stop using the antibody tests listed on this FDA “removed” test list.
• Evaluate, given the patient’s clinical presentation and medical history, whether prior test results generated using these tests may have been incorrect, and whether the patient should be retested using an FDA-authorized test.
• Remove from your inventory any remaining tests that are listed on FDA’s “removed” test list.
• Report any issues with using COVID-19 tests to the FDA.

Hospital Rates and Transparency: On Tuesday, a federal district court in Washington, D.C. upheld the U.S. Department of Health and Human Services (HHS) requirement for hospitals to publish rates they negotiate with health insurers beginning January 2021. The hospital organizations unsuccessfully challenged this rule as a violation of the industry's First Amendment rights but have vowed to appeal the decision. As ACG alerted members, this rule was finalized in November 2019 and applies to 300 common "shoppable" procedures and services, with a requirement that the negotiated prices for at least 70 services be published. Of note for GI: Among the list of these 70 required services: new patient E/M services (CPT codes 99203-99205), patient consultations (CPT codes 99243, 99244), new patient preventive medicine evaluations (CPT codes 99385 and 99386), EGD (CPT code 43235), EGD with biopsy (CPT code 43239), diagnostic colonoscopy (CPT code 45378), colonoscopy with biopsy (CPT code 45380), colonoscopy with lesion removal (CPT code 45385), and colonoscopy with EUS (CPT code 45391).

One important note for ACG members: ASCs are not covered under this regulation impacting hospitals.

The fine for violating the policy will be up to $300 per day. Critics allege that it is too little to force major hospital chains into compliance.

ACG will continue to update on the latest public policy news impacting clinical GI and our patients.