Washington Watch

Carter L. Alleman, J.D.

EHR Incentive Programs: New Attestation Resources

The Electronic Health Record (EHR) Incentive Programs attestation system  is open through February 28. Providers must attest by the deadline to avoid a 2018 payment adjustment. Centers for Medicare & Medicaid Services released two attestation worksheets for eligible professionals and eligible hospitals and critical access hospitals. Visit the 2016 Program Requirements webpage for more information.

2017 Medicare Payment Penalties in Effect as of January 1

Centers for Medicare & Medicaid Services (CMS) released a fact sheet in late December 2016 regarding penalties that are being imposed in 2017 through the Electronic Health Record Incentive Program, also known as meaningful use. Surgeons and other eligible professionals (EPs) who did not meet meaningful use reporting requirements in 2015 are facing a 3 percent Medicare payment penalty in 2017. According to CMS, approximately 171,000 EPs will experience the negative adjustment.

To avoid a penalty in 2018, surgeons may attest to 2016 meaningful use through February 28, 2017. More information about attestation is available through the CMS Registration and Attestation System.

CMS Accepting Applications for CPIA Study

The Centers for Medicare & Medicaid Services (CMS) is conducting a Clinical Practice Improvement Activity (CPIA) study to examine clinical workflows and data collection methods that use different submission systems. The goal is to gain an understanding of the challenges that clinicians encounter when collecting and reporting CPIA data. Clinicians and group practices that are eligible for the Merit-based Incentive Payment System (MIPS) and that successfully participate in the study, will receive full credit for the improvement activities performance category of MIPS.

Participants in the 2017 study must meet the following requirements throughout 2017:

•    Complete at least three survey questionnaires
•    Participate in at least three focus groups
•    Submit at least three clinician quality performance measures to CMS

For more information and to apply to participate in the study, visit the CMS website. CMS is accepting a limited number of participants into the study, so applications should be completed as early as possible. Completed applications should be submitted to [email protected] by January 31.  

CMS Releases 2017 QPP Quality Measure Benchmarks

If a physician or practice plans to fully participate in 2017 Quality Payment Program (QPP) Merit Based Payment System (MIPS) with the goal of receiving a bonus in 2019 it is highly recommended that they review the recently released 2017 QPP Measure Benchmark information. The 2017 quality benchmark information does not apply to physicians who only plan to participate in 2017 to avoid a 2019 penalty (submit one measure, one time in 2017).

The 2017 QPP benchmark information was released late last week by the Centers for Medicare & Medicaid Services (CMS) and posted to the QPP website. The benchmark calculations for the 2017 performance year use data that was submitted for the Physician Quality Reporting System (PQRS) in 2015 by clinicians that were a QPP provider type eligible for MIPS and were not newly enrolled in 2015, or groups with at least one (1) such clinician. When a clinician submits measures for the QPP Quality Performance Category, each measure is assessed against its benchmarks to determine how many points the measure earns. A clinician can receive anywhere from 3 to 10 points for each measure (not including any bonus points). Benchmarks are specific to the type of submission mechanism: electronic health records, qualified clinical data registries, consumer assessment of healthcare providers and systems (CAHPS), and claims. For clinician and group consumer assessment of healthcare providers and systems, the benchmarks are based on two sets of data, 2015 PQRS CAHPS and 2015 Accountable Care Organization CAHPS data. Submissions via CMS Web Interface will use benchmarks from the Shared Savings Programs.

Each benchmark is presented in terms of deciles. Points will be awarded within each decile (see Table 1). Clinicians who receive a score in the first or second decile will receive 3 points. Clinicians who are in the 3rd decile will receive somewhere between 3 and 3.9 points depending on their exact position in the decile, and clinicians in higher deciles will receive a corresponding number of points. For example, if a clinician submits data showing 83% on the measure, and the 5th decile begins at 72% and the 6th decile begins at 85%, then the clinician will receive between 5 and 5.9 points because 83% is in the 5th decile. For measures where a positive performance is seen in a lower score, the scores are reversed in the benchmark deciles.

CMS Releases Patient Facing Encounter Codes

CMS released and posted to the QPP website the list of patient-facing encounter codes. The list is used to determine the non-patient facing status of MIPS eligible clinicians. Given the flexibility in program requirements for non-patient facing clinicians, the encounter codes are critical for CMS to identify MIPS eligible clinicians. A non-patient facing MIPS eligible clinician is:

•    An individual MIPS eligible clinician that bills 100 or fewer patient-facing encounters (including Medicare telehealth services defined in section 1834(m) of the Act) during the non-patient facing determination period, and
•    A group provided that more than 75 percent of the clinicians billing under the group’s tax-id number meet the definition of a non-patient facing individual MIPS eligible clinician during the non-patient facing determination period.

The list of patient-facing encounter codes are categorized into three overarching groups of codes (Evaluation and Management Codes; Surgical and Procedural Codes, and Visit Codes). The utilization of Evaluation and Management Codes, Surgical and Procedural Codes, and Visit Codes classifies MIPS eligible clinicians as non-patient facing and patient-facing.

Health Industry Calls for Stabilization

Executives from major insurance and pharmaceutical companies and hospitals are pressing the incoming Trump administration to shore up the health insurance marketplaces. Companies like Aetna, Blue Cross Blue Shield of Tennessee, Johnson and Johnson and Novartis, who are members of the Healthcare Leadership Council, outlined policy proposals that the group agrees "should be taken immediately to stabilize the health insurance marketplace," according to a release. They asked Congress to pour more federal money toward the sickest consumers, to provide refundable tax credits to help people afford coverage, to repeal the health law's health insurance tax and to reduce federal oversight of the insurance marketplaces.

The companies' requests come just as Republicans on Capitol Hill and in the administration, are ramping up for an aggressive effort to repeal the law. Vice President-elect Mike Pence met with Republicans to discuss the administration's plans to repeal parts of the law through executive action, and to press lawmakers to get a repeal bill to the new president's desk before February 20, according to members who attended the meeting. Lawmakers have suggested they will include a transition period in their repeal plans to ensure people who currently have coverage under the health law are not kicked off their plans immediately. That also will give Republicans some time to come up with a replacement plan.

The threat of repeal has worried nearly every sector of the health care industry. Hospitals argue they stand to lose hundreds of billions of dollars if the law is annulled. Insurers have long decried the current marketplaces as unstable. They caution that repeal and replacement efforts must be measured and deliberate to minimize disruption.

Health Law Repeal Could Spur Job Losses, Report Says

Repealing provisions of the health care law, such as the Medicaid expansion and the tax subsidies that help those in lower income brackets purchase individual plans, could result in millions of jobs lost over the next few years. The analysis, by the Commonwealth Fund and researchers at the George Washington University Milken Institute School of Public Health, predicts a $140 billion federal cut in health spending in 2019, resulting in 2.6 million jobs lost. The authors acknowledge that they cannot yet incorporate other policies, such as an anticipated Republican plan to replace the health law into their analysis.

The health care sector makes up about one-fifth of the economy, but the researchers say the jobs will not just be lost in health and insurance: the loss of federal funding could have a cascading impact on the construction, real estate and retail industries as well, including in states that have not pursued a Medicaid expansion. “Because economic benefits and losses flow across state lines, even states that did not expand Medicaid would experience losses if Medicaid expansions were canceled,” the report says. President-elect Donald Trump and has proposed Medicaid block grants, and the researchers note that if the grant levels incorporate the expansion, that could help blunt the economic impact.

Overall, by 2023, the researchers predict $2.6 trillion could be lost in business output and $48 billion lost for state treasuries due to revenue decreases and the increasing cost of uncompensated care.