ASCRS Joins with Alliance of Specialty Medicine in Letter to Congressional Committee Leadership Advocating Positive Payment Updates to the Conversion Factor
Last week, ASCRS joined with the Alliance of Specialty Medicine in a letter to the chairmen and ranking members of the Senate Finance, House Energy and Commerce and Ways and Means Committees to reiterate our recommendation that Congress enact positive payment updates to the Medicare physician fee schedule conversion factor. Despite concentrated advocacy from the entire medical community, the update was not included in the year-end spending package. We urge Congress to take swift action on this issue in 2020. We are working to identify a potential legislative vehicle for the payment update, which will likely be the extension of certain Medicare and Medicaid programs that expire in May.As a reminder, MACRA included five years of a 0.5% update from 2015 to 2019. Beginning in 2020 and through 2025, the update is 0%. ASCRS, the Alliance and the medical community argue that even before the 0% update, Medicare payments were not keeping pace with inflation, and therefore, positive payment updates should be extended in 2020 and beyond.
2020 Cataract Episode-Based Cost Measure Specifications Retain Omidria; No Other Pass-Through Drugs Added to the Measure
This week, CMS released the measure specifications for the 2020 Cataract Episode-based Cost Measure. Unfortunately, CMS retained the pass-through drug Omidria in the measure and added its new J-code (J1097) to replace the previous C-code used to bill for the drug. ASCRS has strongly opposed the inclusion of any drug on pass-through in the episode measure because it defeats the purpose of pass-through to collect unbiased usage data on the drug for up to three years before it is included in the facility fee. While CMS did not remove Omidria from the measure, it did not add any other pass-through drug for 2020. Omidria remains the only drug on pass-through in the measure. ASCRS has continually advocated for Omidria to be removed and no additional pass-through drugs to be included and has had conversations with CMS staff. CMS has notified ASCRS that it intends to respond to our comments in detail. We will provide additional information as it becomes available.Similar to 2019, the cost of Omidria will not impact a clinician’s cost score in 2020 if it is used on a patient with exclusionary criteria, such as a comorbidity or in conjunction with complex surgery (66982). As a reminder, only Medicare Part B patients that undergo uncomplicated cataract surgery (66984) and do not have any ocular comorbidities will be included in the measure. The list of exclusionary ocular comorbidities is identical to those of Quality measure 191, Cataracts, 20/40 or Better Visual Acuity 90 Days following Cataract Surgery. We will be following up with CMS to reiterate our opposition to including Omidria in the measure.
For complete details on the measure with all included costs and exclusionary criteria, download our 2020 Cataract Episode-Based Measure guide. If you have additional questions, please contact Allison Madson, manager of regulatory affairs, at [email protected] or 703-591-2220.
CMS Opens 2019 MIPS Submission Portal; Data Must Be Submitted by March 31, 2020
This week, CMS opened the submission portal for 2019 MIPS data. Eligible clinicians have until March 31, 2020 to submit 2019 performance data that will impact 2021 payments.Please note: If you are using a third-party vendor to submit MIPS data, such as the IRIS Registry, you do not need to submit data through the CMS portal. Once data has been submitted on your behalf by the third party, you can log in to the CMS portal to review it. In addition, third-party vendors may have alternative deadlines to complete data entry. Please consult with your vendors for specific details.
Logging into the CMS QPP Portal
To sign in and submit data, clinicians will need to register in the HCQIS Authorization Roles and Profile (HARP) system. For clinicians who need help enrolling with HARP, please refer to the QPP Access User Guide.
ASCRS ASOA Resources
ASCRS and ASOA members continue to have full access to the MACRA Center, which includes both 2019 and 2020 MIPS information. If you need additional assistance, please contact Allison Madson, manager of regulatory affairs, at [email protected] or 703-591-2220.
CMS Releases 2020 MIPS Quality Measure Benchmarks; Continues to Cap Measure Points for Several Ophthalmology Measures
This week, CMS released the Quality Measure Benchmarks for the 2020 performance year, which impacts 2022 payments. Measures are benchmarked based on historical performance on the measures and scored on a ten-point scale. Measures that have consistently high performance rates year to year may be considered “topped out” and have their scores capped at seven points, even if the clinician scores in the 8th or higher decile. ASCRS opposes CMS’ topped-out measure methodology and advocates that physicians should continue to receive full credit for maintaining high performance.
Capped measures that are outcome, high priority, or electronically submitted are still eligible for bonus points.
Capped measures for 2020 are:
Claims measures
- 12, Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
- 14, Age-Related Macular Degeneration (AMD): Dilated Macular Examination
- 117, Diabetes: Eye Exam
- 130, Documentation of Current Medications in the Medical Record
Registry Measures
- 12, Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
- 14, Age-Related Macular Degeneration (AMD): Dilated Macular Examination
- 19, Diabetic Retinopathy: Communications with the Physician Managing Ongoing Diabetes Care
- 117, Diabetes: Eye Exam
- 130, Documentation of Current Medications in the Medical Record
- 191, Cataracts: 20/40 or Better Visual Acuity with 90 Days Following Cataract Surgery
- 402, Tobacco Use and Help with Quitting Among Adolescents
EHR Measures (reported when interfaced with IRIS Registry)
- 130, Documentation of Current Medications in the Medical Record
CMS Delays Opening of 2019 ASC Quality Reporting Program Web Portal
This week, CMS announced that due to ongoing maintenance of its web portal, QualityNet, it was delaying its opening for reporting 2019 web-based measures. The portal will be opened on January 17, 2020. The following measures are web-based:
- ASC-9: Endoscopy/Polyp Surveillahonce: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients
- ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (Voluntary)
- ASC-13: Normothermia
- ASC-14: Unplanned Anterior Vitrectomy
- All other ASC Web-based Measures are available for submission.
The submission period for Payment Determination Year 2021 is still scheduled to close May 15, 2020.
For further assistance, please use the Ambulatory Surgical Centers Questions and Answers tool at https://cmsqualitysupport.service-now.com/qnet_qa, or call toll-free 866-800-8756 weekdays from 7:00 a.m. to 6:00 p.m. ET.