Washington Update Mollie Gelburd, JD mgelburd@mgma.org - 1 -
Agenda Political and regulatory environment Trending topics Medicare physician payment reform: Mid-year status report Practice executive s watch list: Remainder of 2017 Q&A - 2 -
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American Health Care Act (AHCA), H.R.1628 GOP effort to repeal the Affordable Care Act Passed U.S. House of Representatives on May 4 - Vote tally: 217-213 - CBO score: 14 million more uninsured by 2018; 23 million by 2026. - Read MGMA s letter to House leadership Senate drafted their own version(s), which failed to pass before August recess - Needed 50 votes to pass - 4 -
AHCA: Senate Outlook Better Care Reconciliation Act (BCRA) Failed in 43-57 vote with Cruz amendment Obamacare Repeal Reconciliation Act (ORRA) AKA repeal only Failed in 45-55 vote Health Care Freedom Act (HCFA) AKA skinny repeal Failed in 49-51 vote - 5 -
What s Next for 2018? June 21: Deadline for insurers to participate in ACA exchanges August 16 - Aetna and Humana exiting exchanges Unknown: Pricing for exchange products - Uncertainty about whether this Administration will pay insurance subsidies (i.e., cost-sharing reduction payments) - Insurers expected to price uncertainty into premium increase requests --6 --
County by County Analysis of Projected Insurer Participation in Exchanges 0 carriers 1 carrier 2 carriers >3 carriers Source: CMS, 8/16/17-7 -
2017 Medicare Physician Fee Schedule And Other Trending Topics
2017 Medicare Service Updates Telehealth New covered codes for ACP, ESRD dialysis, critical care consultation; new POS code for distant site practitioners CCM & TCM New payments for complex cases, additional time; reduced billing requirements Prolonged Services New codes for non-face-to-face services & increased payment for patient-facing services Mental Health New billable codes for treating patients with dementia, behavioral health conditions, etc. Download MGMA s analysis of the 2017 PFS and brand new CCM resource - 9 -
Spotlight on Telehealth: Conditions for Medicare Reimbursement 1 Service is furnished by a physician or authorized practitioner via an interactive telecom system 2 To an eligible telehealth individual 3 Located in a telehealth originating site 4 Service being furnished is on the list of covered codes - 10 -
Spotlight on Telehealth: Next Steps CONNECT for Health Act would lift several of Medicare s restrictive coverage requirements Contact Congress to show your support Read MGMA s letter HHS just announced it will begin auditing distant site claims without corresponding originating site claims Take steps to protect your practice now by: Reviewing Medicare guidance on telehealth billing Using HHS originating site eligibility analyzer - 11 -
New Nondiscrimination Rule What is it? Section 1557 of the ACA prohibits discrimination on the basis of race, color, national origin, sex, age, or disability by building on existing federal civil rights laws. Most notable changes impact provision of language assistance services to limited English proficiency individuals Who does it impact? Most medical group practices (any practice that accepts federal financial assistance from any sources other than solely Medicare Part B, including Medicare Parts A or D, Medicaid, or Meaningful Use incentive payments) When? Final rule effective July 18, 2016, with notice requirements due by Oct. 16, 2016-12 -
New Nondiscrimination Rule How do I comply?»formalize and document a language access plan (not required but suggested)»arrange for translation services»post a notice of nondiscrimination in English (can be combined with existing notices)»post taglines in the top 15 languages in your state in your physical office, website, and significant publications»practices with 15+ employees must designate compliance coordinator For more information, visit www.mgma.org/section1557-13 -
Sample Sec. 1557 Tagline ATTENTION: If you speak [insert language], language assistance services, free of charge, are available to you. Call 1-xxx-xxx-xxxx (TTY: 1-xxx-xxx-xxxx). - 14 -
Unprecedented False Claims Act Violation eclinicalworks ordered to pay a $155 million settlement to resolve allegations it misrepresented software capabilities to obtain certification and paid kick-backs. As part of its agreement with OIG, eclinicalworks must: Promptly notify customers of safety issues and include steps to mitigate patient safety risk Provide updated software to customers free of charge Transfer customer data to another EHR vendor upon request without penalties or charges According to this FAQ, CMS does not plan to audit providers who relied on flawed software for their attestation. The agency realizes providers relied on the software for accuracy and likely would have met the requirements using updated CEHRT. - 15 -
Data Breaches MGMA, AMA, AHA, and other stakeholders joined an HHS initiative to combat WannaCry, a global ransomware attack that impacted some US hospitals. To date there have been no reports of attacks on physician practices, but practice leaders should take steps to take to protect their practices, including: Cyber security action steps for medical practices Conducting a HIPAA Security risk assessment Keeping your operating system and antivirus software up to date Encrypting systems and files that contain patient information Instructing staff not to open emails, attachments or links in emails from unfamiliar senders Practices using Windows or older operating systems should be extra vigilant. - 16 -
Medicare Physician Payment Reform Q3 Status Report on MIPS and APMs
MACRA/Quality Payment Program Choose your own adventure MIPS APMs - 18 -
MIPS Pick your Pace Options for 2017 Pick your pace All-in Report some data Definition Report full MIPS data for at least 90 consecutive days (up to a full year) Report 1 or more of the following for at least 90 consecutive days: - More than 1 quality measure - More than 1 improvement activity - More than 4 ACI base measures Test the program Report at least one of the following: - 1 quality measure; OR - 1 improvement activity; OR - 4 ACI base measures Do nothing Report no data ++ bonus + bonus neutral adjustment 4% penalty - 19 -
MIPS Score ECs assigned final score of 0-100 points based on performance in 3 categories Final score compared to a performance threshold set by CMS each year Scores above threshold result in a bonus; scores below threshold get a penalty Budget neutrality: bonuses must equal penalty pool 2017 Thresholds Exception: high performers receive additional bonus up to 10% each year through 2026-20 -
Projected 2019 MIPS Payment Adjustments MIPS Payment Adjustment Factor 4% 3% 2% 1% 0% -1% -2% -3% -4% MIPS Performance Threshold Exceptional Performance Threshold 3 70 100 MIPS Score - 21 -
MIPS Group Reporting Entire practice gets same MIPS score Select 1 reporting mechanism per MIPS performance category Not every clinician needs to report data for every quality measure so long as data completeness requirements are met Only 1 clinician needs to attest to completing an improvement activitya - 22- -
2017 MIPS Tips: Quality 2017 approved registry list and QCDR list now available Quality 60% Benchmarks for same measure vary by reporting mechanism Bonus points are awarded for all reported measures even if the measure not counted (up to the 10% cap) 3-point minimum, even if measures fail data completeness criteria Data completeness thresholds are based on the proportion of applicable patients, not the number of clinicians who report data - 23--
2017 MIPS Tips: Improvement Activities CMS will not be releasing more detailed activity-level specifications Criteria was purposefully kept broad to recognize ongoing efforts Supporting documentation is suggested for each activity Report via yes/no attestation in early 2018 Only one clinician needs to attest to completing an activity for a group to count it - 24--
2017 MIPS Tips: Advancing Care Information ACI 25% Report base measures via yes/no attestation or one-patient denominator in early 2018 Focus on health information exchange and patient access measures, which count as both base and performance measures Maximize bonus points for data you were already reporting in Meaningful Use (e.g., registry reporting) - 25--
2017 AAPMs About 10% of clinicians will participate in Advanced APMs in 2017 MSSP ACO Tracks 2 & 3 Next Generation ACOs Comprehensive ESRD Care (2-sided risk) Comprehensive Primary Care Plus Oncology Care Model (2-sided risk) Comprehensive Care for Joint Replacement (CEHRT track) - 26--
MIPS & APMs: Group Practice POV Positives Stable fee-for-service payment updates from which to launch MIPS andapms Resets penalties (Max. -9% PQRS, MU, VM) Leverages benefits of the group practice model 90-day MIPS reporting options (vs. full year) MIPS improvement activity category rewards practices for ongoing clinical improvement efforts Challenges Lack of actionable feedback Overly complex MIPS scoring methodology No MIPS risk-adjustment in 2017 Retains check-the-box measure reporting over clinical improvement Limited AAPM pathways - 20 27 -
Physician Practice Action Steps Assess performance under past reporting programs Evaluate vendor readiness & costs (ask about 2015 CEHRT!) Protect yourself against a MIPS penalty Determine your MIPS goal; establish a reporting strategy Comply with deadlines (CAHPS, Web Interface, MSSP, etc.) Analyze data at year-end; hone final reporting strategy Engage in ongoing learning; keep an open mind in 2018+ Check out MGMA s QPP participation checklist >> - 28 -
MGMA Resources Washington Connection (mgma.com/washington) Weekly e-newsletter with breaking updates and everything you need to know from our nation s capital MACRA/QPP Resource Center (mgma.com/macra) Your one-stop shop for new resources & information - Downloadable MACRA slides - MACRA FAQs Dedicated MIPS/APMs e-group Get your questions answered and engage in a dialogue with your MGMA peers about all things MACRA - 29 -
Regulatory Relief Opportunities 2017 MGMA. All rightsreserved. - 30-
MGMA 2017 Regulatory Burden Survey MGMA conducted member research in July 2017 to better understand the cost and challenges of complying with federal government regulations Survey includes responses from 750 group practices, with largest representation from independent medical groups with 6-20 physicians >>Read more at mgma.com/regrelief The magnitude of regulatory demands on physicians forces medical group practices to needlessly focus precious time and resources on administrative tasks instead of patient care Dr. Halee Fischer-Wright, MD, MMM, FAAP, CMPE, President and CEO at MGMA - 31 -
Top 5 Regulatory Burdens Percentage of respondents who rated the issue as very or extremely burdensome Medicare Quality Payment Program (MIPS/APMs) Lack of electronic attachments for claims and prior authorization 82% 74% Audits and appeals 69% Lack of EHR interoperability 68% Payer use of virtual credit cards 59% - 32 -
This MIPS takes rocket scientists to be successful -MGMA Regulatory Relief Research participant, June 2017 2017 MGMA. All rightsreserved. - 33-
A reduction in Medicare s regulatory complexity would allow our practice to reallocate resources toward patient care. 13% disagree or strongly disagree 4% neutral 84% agree or strongly agree
Executive Order: 2-for-1 Regulations - 29- https://www.whitehouse.gov/the-press-office/2017/01/30/presidential-executive-orderreducing-regulation-and-controlling 2017 MGMA. All All rightsreserved. reserved.
Ways & Means Red Tape Relief House Committee is asking for ways to reduce regulatory and legislative burden in Medicare. MGMA is recommending: Stark law reform Repeal it entirely or increase flexibilities Reimburse practices for translation services provided to comply with Sec. 1557 Validate and adjust CLFS rates after lab reporting period Reduce reporting burdens Decrease MIPS requirements Increase opportunities to participate in APMs - 36 -
Practice Executive s Watch List: Remainder of 2017 2017 MGMA. All rightsreserved. - 37 33--
Legislative Watch List Health care reform in the Senate - What will happen after recess? Looming deadlines - Government budget expires Sept. 30 - Deadline for CHIP reauthorization is Sept. 30 - Exceptions process for outpatient therapy caps expires Dec. 31 CONNECT for Health Act, S. 870 - Expands Medicare coverage for telehealth services and remote patient monitoring - MGMA letter of support and grassrootsadvocacy - 38 -
Regulatory Watch List Proposed Rules: June or July Final rules: Oct. or Nov. 60-day comment period Proposed 2018 Physician Fee Schedule - 2018 conversion factor payment update - Appropriate use criteria for imaging services Proposed regulation modifying MIPS and APMs for 2018 - Scope and timeline for EHR certification requirements - Implementation of MIPS cost component - Potential ramping up of MIPS requirements - 39 -
Key proposals would: Delay mandate to use 2015 CEHRT; 2018 MIPS and APMs proposed rule Offer new facility-based scoring option for hospital-based clinicians; Increase the low-volume threshold, excluding 63% of clinicians; Delay implementation of the cost component of MIPS; and Anticipate APM participation will double due to new MSSP Track 1+ and growth in existing models - 40--
MGMA Comments on 2018 QPP Proposal Permanently shorten quality & ACI reporting periods to 90 days Simplify MIPS redundencies by awarding cross-category credit Finalize proposed expansion of the low-volume threshold and refine how it applies to groups Finalize the proposal to allow MIPS and APMs to use 2014 or 2015 CEHRT in 2018 Streamline the ACI performance category Provide feedback about MIPS performance at least every quarter Overhaul advanced APM criteria and expand list of qualifying models Seek opportunity to adopt private sector payment models and PCMHs as advanced APMs >>Read MGMA s comments to CMS - 41 -
2018 physician fee schedule proposed rule Key proposals would: Set 2018 Medicare payment rates; Delay the Appropriate Use Criteria program until 2019; Retroactively lower PQRS reporting requirements to six measures; Reduce Value-Based Payment Modifier penalties and hold groups harmless if they met minimum quality reporting requirements; and Seek input about opportunities to reduce regulatory burdens on physician practices >>Read MGMA s Regulatory Analysis on 2018 MIPS/APMs and PFS Proposed Rules - 42--
2017 MGMA. All All rightsreserved. reserved. - 43 - MGMA: Your Voice in Washington MGMA and coalition express concern over planned implementation of the Social Security Number Removal Initiative (SSNRI) MGMA calls on CMS to pilot test episode-based cost measures MGMA signs onto letter urging delay of lab reporting under PAMA MGMA submits letter to FCC defending practice billing communications MGMA calls for delay in EHR certification mandates
Thank you. - 44 -