Washington Watch

Carter L. Alleman, J.D.

CMS Seeks Input on Implementation of New Medicare Payment Systems

The Centers for Medicare & Medicaid Services (CMS) released a request for information (RFI) regarding the implementation of the Merit-based Incentive Payment System (MIPS), promotion of alternative payment models (APMs), and incentive payments for participation in eligible APMs. The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA) created MIPS to replace the Medicare sustainable growth rate (SGR) formula used to calculate updates to the physician fee schedule. MACRA sunsets payment adjustments made under Medicare’s current Physician Quality Reporting System, the Value-Based Payment Modifier, and the Electronic Health Record (EHR) Incentive Program, and consolidates aspects of these programs into the new MIPS. Additionally, MACRA promotes the development of APMs. The RFI seeks public and stakeholder input to inform CMS’ implementation of these provisions.

ACOS is working on its own comments to the RFI. If you would like to have your thoughts or concerns included please contact Carter Alleman at [email protected].

Meaningful Use Stage 3 Again

CMS released a final rule, Medicare and Medicaid Programs; EHR Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017. This rule describes the requirements eligible professionals, eligible hospitals, and critical access hospitals must meet to successfully participate in the EHR incentive program. The final rule allows for a 90-day reporting period in 2015 as opposed to a full calendar year and removes measures that were duplicative or redundant in an attempt to ease the reporting burden.  In addition, the rule establishes the requirements for Stage 3 of the program as optional in 2017 and mandatory beginning in 2018.

CMS is accepting comments on Stage 3 of the meaningful use program, scheduled to start in 2017. The final rule was published in October but it met so much opposition that CMS decided to allow further comments through November 17, 2015.

The new Stage 3 rules continue to build upon the Stage 2 modified rules. CMS told Congressional staff that they are expecting to have another modification rulemaking in 2016 to address issues in Stage 3 similar to the Stage 2 modification. The American Medical Association has launched its own initiative called “Break the Red Tape,” which urges Congress to stop CMS from operating Stage 3 measures.

Graduate Medical Education

Congress is increasing its efforts to reform graduate medical education. Earlier this term, the Resident Physician Shortage Reduction Act (S.1148/HR2124) was introduced. The Act would increase Medicare funding for an additional 15,000 slots. These slots would be assigned for a “cap-relief pool (1/3)” and “priority pool (2/3).” Fifty percent would go to primary care and the remaining fifty percent of those slots would be used for workforce shortage specialties. The bill also directs the National Health Care Workforce Commission, a part of the Patient Protection and Affordable Care Act, to study the medical workforce.

Recently, Representative Kevin Brady (R-TX) introduced the Medicare Indirect Medical Education (IME) Pool Act (HR 3292) which, if passed, would discontinue the Medicare add-on payments to teaching hospitals to offset IME costs. The add-on payments would instead go into a newly established Medicare IME Pool, which would distribute lump sum payments to teaching hospitals according to a new financing methodology. The Medicare IME payments would no longer be linked to Medicare beneficiaries or hospitals providing specialized services to complex patient populations.

Representative Brady also requested that the Government Accountability Office (GAO) update its study on Graduate Medical Education. The GAO is expected to begin its study in January 2016 and release its findings later next year.

Advance Care Planning Payment

Medicare finalized its new policy to pay doctors for conversations about end-of-life care. The new rule requires face to face interaction with the patient, surrogate decision maker, and/or family members. The intent of the rule is that the patient’s values and preferences are discussed and documented for future care for serious illness. Senator Chris Coons (D-DE) is expected to introduce legislation next month that would give Medicare beneficiaries a financial benefit if they set up an advanced-care directive.

21st Century Cures Act to get Senate Companion

The Senate Health, Education, Labor, and Pension (HELP) Committee will release by mid-November its companion bill to the House's 21st Century Cures Act that passed this summer. Much like the House version, the Senate bill will contain new funding for National Institutes of Health (NIH) and the Food and Drug Administration (FDA) as well as a set of elements aimed at speeding approval of innovative drugs and medical devices. It also will have aspects aimed at modifying the meaningful use program and the regulation of electronic health records in response to complaints from providers about the poor usability and interoperability of the current products. One of the key differences between the two bills are the payfors. The House would like to tap into the Strategic Petroleum Reserves and sell off some of those assets while the Senate is looking at trimming funding for NIH.

Global Surgical Codes

As part of the MACRA legislation, CMS is required to collect data on 90 day and 10 day global surgical codes prior to the development of further rulemaking to transition to 0-day surgical codes. In the latest fee schedule update, CMS inserted an RFI asking for suggestions on how best to collect this data. The responses highlighted certain auditable, objective, representative data such as CPT code 99024 and a review of Medicare Part A claims data. For the potential methods of valuing, the comments focused on having CMS focus on individual components of the global surgical package instead of blanket policies and studying the level of postoperative visits especially differences between specialties. CMS responded it would take this into consideration in its future rulemaking. ACOS participated in the RFI process by contributing to the AOA’s comment letter.