Quick notes “from the Hill”: Busy Week in Senate Finance Committee; Medicare For All Bill Released
Senate Finance Committee Holds Hearing with Drug Company CEOs
On Tuesday, February 26th, executives from the pharmaceutical companies, AbbVie, AstraZeneca, Bristol-Myers Squibb, Merck, Pfizer, Sanofi, and Johnson & Johnson's pharmaceutical unit, Janssen all testified before the U.S. Senate Finance Committee’s hearing, entitled ”Drug Pricing in America: A Prescription for Change.” The Finance Committee is led by Chair Charles Grassley (R-IA) and Ranking Member Ron Wyden (D-OR). Throughout the hearing, members of the committee, both Republicans and Democrats, asked contentious and poignant questions on drug list prices, drug rebates and pharmacy benefit managers, Medicare Part D, U.S. patent protections for drugs, and industry research and development costs. Of note to ACG members, the hearing and testimony also mentioned drugs treating inflammatory bowel disease.
ACG members can access the testimonies and watch the hearing by clicking here.
ACG expects Congress and the Trump Administration to focus more on prescription drugs and policies to constrain the costs, especially as we head toward the election season in 2020.
Senate Finance Committee looking at non-profit hospitals
Senate Finance Committee Chairman Grassley is also reopening a probe into tax-exempt hospitals, among concerns that non-profit hospitals are not prioritizing community needs. Sen. Grassley wrote a letter last week to IRS Commissioner Charles Rettig, asking the IRS to explain its recent oversight of tax-exempt hospitals and the industry's recent financial performance.
Stay tuned for more updates on this inquiry.
House Democrats Releases “Medicare for All” Bill
This week, a group of House Democrats introduced the anticipated "Medicare for All (MFA)" bill. The bill is cosponsored by 107 Democrats, but does not yet include a cost estimate, or a plan to finance the new system. Rep. Pramila Jayapal (D-WA) is the lead sponsor. Some basic information:
- MFA calls for a comprehensive benefits and services with limited to no patient cost-sharing.
- All state and federal exchanges and pay for performance/value-based payment arrangements would be sunset once MFA is enacted.
- The transition to MFA would occur in two years. One year after the date of enactment, persons over the age of 55 and under the age of 19 would be eligible for the program. Two years after the date of enactment, all people living in the U.S. would be eligible for the program.
- Of note, providers and physician practices will be paid on a fee for service (FFS) basis. The Secretary of HHS would be required to establish a national fee schedule and establish a new “physician consultation review board” to assess fair reimbursement. There would also be a standardized documentation and review process of relative values of physician services to determine the appropriate FFS payment. On the hospital and facility side, the bill calls for a lump-sum global payment on a quarterly basis for covered items and services.
- Participating providers would also be prohibited from entering into private contracts with individuals to provide MFA covered-services (i.e., no concierge medicine or direct primary care models). Entering into such a contractual arrangement would bar the provider from participating in MFA for one calendar year. Providers would be allowed to entire into such private contracts with individuals ineligible for benefits under MFA or for non-covered services.
Stay tuned for more coverage on these and other important healthcare-related issues impacting ACG members and our patients.
Call to Action: Ask your representatives to support the Continuing Coverage for Preexisting Conditions Act of 2019!
We need your help! Another important bill regarding the protection of preexisting conditions needs your support. Representative David Joyce (R-OH) has introduced the “Continuing Coverage for Preexisting Conditions Act of 2019 (H.R.383).” This legislation allows the section on protecting those with pre-existing conditions in the Patient Protection and Affordable Care Act (ACA) to remain in law, in the event if the recent lawsuit filed in Texas by 20 state attorneys general finds the ACA to be deemed unconstitutional.
How can I get involved?
What are some important bills impacting GI in Congress? In your state? How can you easily voice your support?
ACG’s Legislative Action Center is your one stop resource to review and advocate for various federal and state bills impacting your profession, practice, and patients.
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.
New! ACG Practice Management Toolbox Article: Improving Patient Portal Engagement in Your Practice
New this week to the ACG Practice Management Toolbox is an article brought to you by Srinivas Kalala, MD, FACG and Shajan Peter, MD, of the ACG Practice Management Committee in the Patient Engagement category. As the need for immediacy and rapid access to information continues to grow and be expected in most aspects of our society, the utilization of patient portals within a practice is becoming increasingly widespread. In “Improving Patient Portal Engagement in Your Practice,” you are guided toward a better understanding of the benefits of properly utilizing the portal with your patients, and some helpful tips on what to consider to ensure that all bases are being covered.
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.
Let’s Focus on Small GI Practices
As discussed in last week’s tidbit, ACG members must meet certain criteria to be “eligible” for MIPS. This is where being a solo practitioner or practicing in a small practice (15 or fewer QPP-eligible clinicians) may help you.
CMS has a “low volume threshold” that some independent practices do not meet. This means that you would not have to participate in MIPS. The 2019 “low volume threshold”:
- Medicare Part B allowed charges that are less than or equal to $90,000, or
- See less than or equal 200 Medicare Part B patients, or
- Provide 200 or fewer covered professional services in a year.
In other words: you must meet all three categories of the “low volume threshold” to be eligible for the QPP.
Impact on Smaller and Rural GI Practices- 15 or fewer eligible clinicians in your practice
You may be excluded from the QPP and not have to do anything. According to CMS, small practices did not have to participate in MIPS during the 2019 reporting year due to this low-volume threshold. As mentioned above, a GI practice is below the 2019 “low volume threshold” if the individual’s Medicare Part B allowed charges are less than or equal to $90,000, or sees less than or equal 200 Medicare Part B patients, or provides 200 or fewer covered professional services within a year.
In addition to the “low-volume” threshold, solo practitioners and groups of 15 or fewer clinicians automatically earn 6 bonus points in the MIPS Quality performance category. Please note that this replaces the “small practice bonus” added to the total MIPS score in CY 2018 reporting year. CMS also awards small practices 3 points for submitted quality measures that do not meet the data completeness requirements. Small practices can also continue to submit quality data for covered professional services through the Medicare Part B claims submission type for the Quality performance category.
Can I volunteer to participate in the QPP and “opt in?”
Yes. If you meet one of the “low volume threshold” criteria, you may opt-in MIPS and submit your data. Please note: if you decide to opt-in, you could be eligible for a payment bonus, but you could also be subject to a payment cut.
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.