Regulatory Relief

ASCRS/ASOA is committed to advocating for regulatory relief to alleviate the financial and administrative burden federal programs place on phsyican practices.

Medicare Red Tape Relief Project

ASCRS•AOSA submitted recommendations for regulatory relief to the Health Subcommittee of the House Ways and Means Committee in conjunction with the recently announced “Medicare Red Tape Relief Project.” The new initiative, spearheaded by subcommittee Chairman Pat Tiberi (R-OH), is seeking feedback from physicians and other healthcare stakeholders on how Congress can help alleviate burden either through legislation or by working with CMS to modify regulations. This week, Tiberi announced the subcommittee would hold a series of roundtables with physicians and the healthcare industry when Congress returns in September and hopes to develop legislation after reviewing submitted comments and the roundtables.

ASCRS•ASOA has developed a robust list of recommendations to reduce regulatory burdens on physicians and practices, including the following:

  • Extending the transition period for MACRA to allow for three additional years before the MIPS threshold is based on the previous year’s mean or median scores, and to maintain the 0% weighting for the Cost category.
  • Modifying the requirements of the previous quality reporting programs (PQRS, VBPM and Meaningful Use) to align with the requirements under MIPS and ensure physicians can easily avoid the associated penalties in 2018.
  • Modifying the Drug Quality and Security Act (DSQA) to allow physicians to obtain compounded medications for office use from traditional 503A compounders.
  • Curbing the use of chart audits by Medicare Advantage (MA) plans to ensure the plans are only conducting audits within CMS’ requirements.
  • Ensuring MA plan networks are robust and include enough specialists, and prohibiting plans from removing physicians from the network in the middle of the benefit year without cause.
  • Streamlining and limiting the use of prior authorization by MA and Part D plans to ensure the requests are uniform and electronic.

Quality Reporting Programs

ASCRS has joined with the American Medical Association (AMA), and 85 specialty societies and state associations—including all members of the Alliance of Specialty Medicine—seeking relief from the potential penalties facing physicians in 2018 based on 2016 reporting from the following programs: Meaningful Use (MU), Physician Quality Reporting System (PQRS), and the Value-based Payment Modifier (VPBM). Based on careful analysis of the statutes regarding these programs, the secretary of Health and Human Services has the administrative authority to withhold penalties against physicians and practices who attempted to comply with the existing programs and still give practices who believe they will be eligible for bonuses under the VBPM an opportunity to receive those payments.

Specifically, our recommendations to CMS include:

  • Meaningful Use - We recommend CMS establish a new “Administrative Burden” category of hardship exemption for the 2016 MU performance year. Eligible providers should not be penalized for focusing on providing quality patient care rather than the arbitrary “check the box” requirements of MU.
  • PQRS - We recommend that CMS reduce the reporting requirements for this program so that any physician who successfully reported on at least one PQRS measure in 2016 would avoid the 2% penalty in 2018. Physicians who did not successfully complete one measure in 2016 would be subject to the penalty.
  •  VBPM – We recommend that CMS continue their current policy that any physician who avoided the PQRS penalty in 2018, including through the reduced reporting requirement requested above, would be exempt from any automatic VBPM penalties. Under the current program, physicians who are not successful in PQRS receive an automatic VBPM penalty. Under our recommendation, physicians who wanted to try for a bonus under the voluntary tiering system could do so but at their own risk. Therefore, a physician would only be penalized under the VPBM if he or she voluntarily chose to compete, and then scored poorly in the tiering process. It is important to retain this option since the statute requires that all physicians must be included in the VBPM by 2017—and there must be differential payment.

The recommendations were developed after careful study of the current statute and within the parameters of President Trump’s Executive Order, which directs cabinet secretaries to take action to reduce regulatory burden within the scope of the current statute. The recommendations represent a consensus among the signatory groups regarding what was within that scope of the law, what would be acceptable to CMS, and what would be fairest and provide the most relief to the greatest percentage of physicians and healthcare providers. In addition, the request for a voluntary opportunity to seek a VBPM bonus ensures that groups, especially large multispecialty groups, who took action in 2016 to position themselves for a VBPM bonus would still be able to achieve one, and be able to support medical community efforts for regulatory relief.

Coalition letter to HHS Secretary Tom Price Seeking Relief from 2018 Penalties.

Regulatory Relief Task Force

ASCRS is working with the AMA and the medical community and is a member of the AMA’s regulatory relief task force. The task force identified numerous issues, including prior authorization, drug prices, and drug compounding as areas in which to advocate for relief, but has first prioritized eliminating potential penalties facing physicians in 2018 based on 2016 reporting from the PQRS, EHR/MU, and the VBPM programs. The task force will continue to have high-level meetings with HHS and CMS. We will keep you updated.