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LEGISLATIVE NEWS-ON THE HILL
Maintaining access to specialty medicine, ensuring quality reporting mandates are meaningful and relevant, and securing Medicare physician payment reform were among the primary messages that ASCRS leadership, including members of the ASCRS Government Relations Committee, brought to Capitol Hill this week as part of the Alliance of Specialty Medicine’s Advocacy Conference. ASCRS joined specialty physicians from 11 other medical specialty organizations of the Alliance of Specialty Medicine from across the country in hearing presentations and exchanging ideas with House and Senate members of Congress and healthcare policy leaders from both sides of the aisle in addition to regulatory agencies. The physicians also met with their respective congressmen and senators to discuss the issues that impact both physicians and their patients including: access to specialty care, fair Medicare physician reimbursement (SGR), IPAB repeal, medical liability reform, and quality improvement and value based payment reform.
ASCRS, in conjunction with the Alliance, has been concerned with the deteriorating access to specialty care as a result of failed policies, the largest of which is the broken Medicare physician payment system. During the hill visits, physicians called on Congress to pass a permanent SGR fix prior to the end of the year and support legislation that would empower Medicare beneficiaries to see the physician of their choice by permitting private contracting on a case-by-case basis in addition to supporting IPAB repeal efforts. ASCRS also urged Congress to ensure that physician quality reporting mandates are meaningful and relevant to specialty physicians and their patients and requested a delay in the implementation of the Value-Based Payment Modifier (VBPM).
By coming to Washington and receiving special legislative briefings, visiting with their individual members of Congress and participating in the political process, the physician attendees came away with an appreciation for the intricacies of the workings of the federal government and the legislative process that governs healthcare policy.
On Wednesday, July 11, physician organizations testified at the final Senate Finance Committee roundtable on Medicare Physician Payment Reform. The roundtable was the 3rd in a series of Roundtables held by the Senate Finance Committee in an effort to determine how to replace the SGR. Representatives from the American Medical Association, the American College of Surgeons, the American College of Cardiology, the American College of Family Physicians, and the American Society of Clinical Oncologists presented their proposals for long-term solutions to the SGR. All of the groups stated that in the short term, Congress should repeal the SGR and increase payment slightly while CMS tests new ideas for a replacement. Click on the following link to view testimony from the hearing.
On Wednesday, July 11, the House voted to repeal the healthcare law. It was the 33rd vote to repeal all or part of the law, but the Senate is unlikely to take up the issue. The repeal passed 244 to 185, with 5 Democrats voting with the Republicans.
On July 9, the President signed the FDA Safety and Innovation Act into law. The bipartisan legislation includes the reauthorization of drug and device user fees, as well as reforms to the medical device and drug approval processes.
Earlier this week, CMS announced the addition of 89 new ACOs to its shared savings program, which offers medical groups, hospitals and federally qualified health centers financial incentives for quality improvement and cost control. The selected ACO programs operate in a range of areas nationwide, and nearly half are physician-led organizations that serve fewer than 10,000 beneficiaries. CMS announced that starting this year, applications for ACOs will be accepted annually. The application period is Aug. 1-Sept. 6, 2012 for organizations that want to participate in the Medicare shared savings program starting in January 2013.
CMS included in the recently released proposed 2013 physician fee schedule changes to the physician quality improvement initiatives, including more reporting flexibility for group practices involved in Physician Quality Reporting System (PQRS) and physician quality measures that match incentives for electronic health records use.
Beginning in 2013, as few as two doctors can now report as a group. Previously, 25 doctors were required to report as a group practice. CMS also proposes to decrease the minimum number of patients that practitioners are required to report on using quality measures groups from 30 to 20 for the 2013 and 2014 incentive reporting periods.
In addition, for 2013 and 2014, CMS proposes to include 264 individual measures from which doctors and other healthcare providers can choose to show they are meeting quality measures, including some that would be available for electronic health records reporting and would count under that incentive program as well. CMS also plans to include 26 groupings of measures and to align some group practice reporting measures with those of the ACO Medicare Shared Savings Program.
ASCRS and other physician organizations have been pushing CMS not to use data from 2013 when calculating penalties and incentives beginning in 2015, as it backdates the penalties, but CMS says in the proposed rule that it still plans to use 2013 data to calculate 2015 incentives and penalties and 2014 data for the 2016 calculations.
CMS also included in its recently released 2013 MPFS proposed rule parameters for the budget-neutral value–based payment modifier. As we have reported, the ACA requires Health and Human Services (HHS) to pay certain physicians and physician groups based on the quality and cost of care provided to Medicare beneficiaries compared to others in their geographical area, starting January 2015. The policy must be extended to all physicians and groups by no later than Jan. 1, 2017.
All group practices that consist of 25 or more eligible professionals will be subject to the value–based payment modifier effective January 1, 2015. All physician groups must participate in PQRS in order to avoid a payment reduction, and CMS proposes a 1 percent payment reduction under the modifier for groups that do not participate in PQRS in addition to the 1.5 percent reduction required under the PQRS for failing to meet the reporting criteria. CMS is not providing a specific percentage for possible increases, but will give groups that are high quality and low cost the highest adjustments.
CMS has already determined that the initial performance period for the 2015 payments will be based on calendar year 2013, and proposes to use CY 2014 as the performance period for 2016 and will gradually increase the scope of the modifier to all physicians and more quality measures by January 1, 2017. The proposed regulation further says that starting in 2013, CMS intends to use confidential Physician Feedback reports to inform physicians about their value modifier score. ASCRS remains opposed to the implementation of the budget-neutral value-based purchasing modifier and has been pushing for the program to be delayed.
On July 11, MedPAC informed CMS that that they support letting states automatically enroll dual-eligible beneficiaries in duals demos as long as the “passive” enrollment meets certain conditions, a move coming just weeks after the advisers told lawmakers they had strong reservations with passive enrollment and as a key senator raised legal issues with the approach. MedPAC had stated in its report to Congress last month that it was wary of auto-enrollment because some states may not have the wherewithal to use “intelligent assignment” and some plans may not be good enough, even if it worked. However, the report did not take a position on the policy. The payment advisors now say they support passive enrollment so long as states notify beneficiaries, give them several chances to opt out and incorporate additional beneficiary protections, such as requiring plans to permit beneficiaries’ to receive care from their existing providers if those providers are not in-network. The letter reiterates concerns that the demonstration is too broad and goes beyond CMS' original target of 3 million people. CMS should consider implementing the demonstration in only a few states. It also calls for CMS to collect a core set of information to measure access to care and quality during the demonstrations, although it acknowledges measuring quality within the duals population is difficult. MedPAC says another set of measures should be gathered to evaluate the demonstration's effectiveness.
On Tuesday, July 17, CMS will host a National Provider Call with question and answer session on the PQRS and electronic prescribing. CMS subject matter experts will provide an overview of the proposed changes to the 2013 Physician Quality Reporting System & Electronic Prescribing Incentive Program as outlined in the 2013 Medicare Physician Fee Schedule Proposed Rule.
The presentation will be posted at least one day before the call at: in the "Downloads" section. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call.
On October 20, 2011, CMS issued a final rule under the Affordable Care Act to establish the Medicare Shared Savings Program (Shared Savings Program), along with a notice for the Advance Payment Model that will provide additional support to physician-led and rural Accountable Care Organizations (ACOs) participating in the Shared Savings Program.
On Tuesday, July 31, 2012, CMS is hosting a National Provider Call, where subject matter experts will provide an overview and updates to the Shared Savings Program application and Advance Payment Model application processes for the January 1, 2013 Shared Savings Program start date. A question and answer session will follow the presentations.
The Shared Savings Program Application and the Advance Payment Model web pages have important information, dates, and materials on the application process. Call participants are encouraged to review the applications and materials prior to the call.
Make Your 2012 eyePAC Contribution Today
On May 22, all ASCRS members who have not contributed to eyePAC in 2012 were asked to make their annual contribution. You can make your contribution online at the ASCRS web site by going to Government Relations and clicking on eyePAC in the drop-down box or clicking here to download a contribution form to fax back. Thank you in advance for making a contribution. If you have questions, please contact ASCRS PAC/Grassroots Specialist Gerrie Gray-Benedi at
703-591-2220 or by email at email@example.com.
To find out more about the articles in this communication or to read more about legislative and regulatory issues that affect you and your practice, visit the ASCRS and ASOA websites. You can also visit http://www.specialtydocs.org/, the web site of the Alliance of Specialty Medicine.
© 2012 ASCRS/ASOA