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ADVOCACY

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Advocacy Update September/ October  2012


Legislative News

  
  ASGE Members Lobby Capitol Hill in September
On September 10, members of ASGE’s Health and Public Policy Committee were on Capitol Hill to lobby on ASGE’s top legislative priorities, which include payment adequacy for ambulatory surgery centers (ASCs), elimination of cost sharing for colorectal cancer screening colonoscopy, repeal of the Medicare physician sustainable growth rate formula, and funding for medical research and colorectal cancer prevention. Meetings were held with 30 congressional offices, including meetings with staff for the committees of jurisdiction over Medicare to discuss the elimination of Medicare beneficiary coinsurance when a screening colonoscopy turns therapeutic.

 
ASGE Continues Push for CRC Screening Bill
On September 21, ASGE, along with 34 other organizations, sent a letter to House committee leaders asking them to take action this year to correct an oversight in current law that requires Medicare beneficiaries to pay a coinsurance when a colorectal cancer screening colonoscopy also involves the removal of polyps or other tissue. ASGE has been aggressively lobbying in support of H.R. 4120, the “Removing Barriers to Colorectal Cancer Screening Act,” since it was introduced in March. H.R. 4120 is a bipartisan bill that would remedy the current coinsurance glitch for Medicare patients. ASGE members are encouraged to talk to their members of Congress while they are home campaigning about the issue and the need for corrective action.

 
FY 2013 Spending Bills on Hold until After Elections
On September 28, President Obama signed a fiscal year (FY) 2013 spending extension, or continuing resolution, which will keep the federal government operating after the start of the new fiscal year, which was October 1. The continuing resolution is necessary because Congress has yet to pass any of its 12 annual spending measures. The extension, which expires on March 27, 2013, funds the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration, among other agencies, at FY 2012 spending levels. While lawmakers could complete action on some or all of the spending bills during the post-election, lame-duck session of Congress, the presumption is that Congress will wait to finalize the spending measures after it reaches a deal on sequestration and the looming fiscal cliff.

 
Sequestration Threat Looms for Providers and Researchers
In roughly three months, across-the-board federal spending cuts will be triggered unless Congress and President Obama reach agreement on how to stop the cuts, or sequestration. Under sequestration, non-defense discretionary (NDD) federal programs will receive an approximate 8 percent cut (about $109 billion) in funding, and Medicare payment cuts to all providers will total 2 percent or $11 billion in 2013.
 
Sequestration is required as a result of a budget deal struck last year by Congress. The Budget Control Act established caps on discretionary spending over 10 years, resulting in $1 trillion in cuts spread across defense and non-defense programs. The law also directed a congressional Joint Select Committee on Deficit Reduction to identify an additional $1.2 trillion in budget savings. Because the Joint Select Committee failed to reach agreement on a deficit reduction plan, an automatic sequestration of both defense and non-defense programs will take effect on January 2, 2013. ASGE joined a letter sent to congressional leaders in September asking them to act to prevent the Medicare physician payment cuts called for under the Budget Control Act, as well as the 27 percent cut scheduled due to the Sustainable Growth Rate formula.
 
Sequestration would mean roughly $2.4 billion less for the NIH in 2013. It is estimated sequestration would force the NIH to fund 2,300 fewer research grants next year, which represents about a quarter of the NIH’s new and competing grants. Testifying before the House Energy and Commerce Committee in June, NIH Director Francis Collins, MD, PhD, said that sequestration could really disrupt and do “serious damage” to the progress that has been made in medical research. Dr. Collins noted that NIH grant success rates are already at their lowest in history and would drop further as a result of sequestration, dealing an unsustainable blow to researchers.
 
Lawmakers will have an opportunity to negotiate a budget deal when Congress reconvenes in November. However, it is possible that Congress will fail to reach a long-term deal and will instead temporarily suspend the cuts and attempt to reach agreement on a broad deficit reduction package next year.
 

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Regulatory News

ASC Quality Reporting Program Started October 1
Beginning October 1, ASCs must begin reporting to the Centers for Medicare and Medicaid Services (CMS) data on five quality measures or otherwise face a 2 percent reduction in their annual payment update in 2014. The reporting period for the 2014 payment determination is October1-December 31, 2013. The ASC Quality Reporting Program applies to ASCs that are independent (e.g., not part of a provider of services or any other facility) and bill the Medicare contractor on Form CMS-1500 or the related electronic data set. If a facility bills Medicare using Form UB-04, it is likely hospital-owned and cannot participate in the ASC Quality Reporting Program. For the three-month reporting period, 50 percent of claims for which Medicare is the primary payer must include quality data codes for successful reporting. On October 1, ASGE, along with the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG), hosted the last in a series of three Webinars  on the ASC Quality Reporting Program. The recorded Webinars and additional information about the program is available on ASGE’s Website under the ASC Quality Reporting Program Resource Center and on the QualityNet Website.

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ASGE Comments on Medicare Physician Fee Schedule Proposed Rule
On September 4, ASGE, AGA and ACG commented to CMS on its proposed revisions to payment policies under the Medicare physician fee schedule (PFS). Most notably, the GI societies provided extensive comments on the proposed physician value-based payment (VBP) modifier and revisions to the Physician Quality Reporting Program (PQRS) . CMS will issue the Medicare PFS final rule in November. Until then, physicians should begin preparing for 2013 PQRS reporting. Physicians who do not successfully participate in PQRS in 2013 will receive a –1.5 percent payment adjustment in 2015. For the VBP modifier, CMS has proposed that for 2015 the modifier will apply to all group practices with 25 or more eligible professionals. If CMS finalizes this proposal, all group practices will need to self-nominate to participate in the PQRS Group Practice Reporting Option (GPRO) by January 31, 2013. Groups that do not successfully participate in the PQRS GPRO in 2013 will have their VBP modifier set at –1.0 percent. ASGE will be developing additional educational tools, including live Webinars, on both the PQRS and VBP modifier later this year.

 
ASGE Pushes Again for New ASC Update Factor in Comment Letter
Again this year, the ASGE, AGA and ACG expressed disappointment with CMS’ decision to continue using the Consumer Price Index for All Urban Consumers (CPI-U) to update ASC payments in 2013. In the hospital outpatient/ASC proposed rule, CMS states that CPI-U is highly weighted for housing and transportation and may not best reflect the cost of providing ASC services. Yet, CMS continues to reject requests from the ASC stakeholder community to replace CPI-U with the hospital market basket index, which would help to establish better alignment between ASC and hospital outpatient department Medicare payments. The GI societies also offered measure topics for future ASC quality reporting, including equipment reprocessing and sedation safety. The final rule will be published in November.


GI Societies Respond to CMS’ Call for PQRS Measures
In August, ASGE, AGA and ACG responded to CMS’ call for quality measures with a recommendation of including an adenoma detection rate measure and a colonoscopy quality composite measure in PQRS beginning with the 2014 reporting period. Development of the measures was undertaken by all three GI societies. While there have been gradual improvements in the relevancy of PQRS measures for gastroenterologists, ASGE considers the development of GI-specific measures for inclusion in CMS’ quality reporting programs a top priority, as performance data on quality measures will eventually be made publicly available. The GI societies also recommended to CMS the creation of a colorectal cancer screening measures group. It will not be known until next July whether CMS will accept any of the proposed colonoscopy measures for future PQRS reporting.

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Stage 2 EHR Meaningful Use Regulations Released
In August, CMS published the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program. The rule finalizes that the EHR reporting period for the 2015 payment adjustment is 2013 – the same reporting period to receive the incentive for payment year 2013. For eligible professionals (EPs), the reporting period is all of 2013, with an exception for EPs who have never successfully attested to meaningful use as illinstrated in the following table.

 

EPs who demonstrates meaningful use in 2013 for the first time
Payment Adjustment Year
2015
2016
90-Day EHR Reporting Period
2013
 
Full Year EHR Reporting Period
 
2014*
EPs who demonstrates meaningful use in 2014 for the first time
Payment Adjustment Year
2015
2016
90-Day EHR Reporting Period
2014**
2014
Full Year EHR Reporting Period
 
2015
 
* Special three-month reporting period
** 90-day reporting period must begin no later than July 3, 2014

To qualify as an EHR meaningful user, at least 50 percent of an EP’s encounters must be in a location(s) with certified EHR technology. In the final rule, CMS continues to count ASC encounters for purposes of determining whether an EP has met the 50 percent threshold. In its comments on the EHR Stage 2 proposed rule, ASGE argued that encounters that occur in ASCs should be exempted. The rule, however, finalizes several new exceptions that would exempt certain EPs from payment adjustments, including EPs who practice in multiple locations and can demonstrate that they lack control over the availability of certified EHRs for more than 50 percent of their encounters. This exception will benefit those EPs who may be under contract with an ASC to provide services, but is unlikely to be applied in instances where an EP has an ownership interest in an ASC.

CMS recently updated its “Frequently Asked Questions” for the EHR Incentive Program. Additional program information can also be found on the CMS Website.

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CMS Distributes 2011 PQRS and Electronic Prescribing Incentives and Reports
The Centers for Medicare & Medicaid Services (CMS) announced that it has begun distribution of its 2011 Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-Rx) incentive payments and feedback reports. Incentive payments for both programs amount to 1 percent of total estimated 2011 Medicare Part B Physician Fee Schedule allowed charges for covered professional services furnished during reporting period.
 
CMS began to distribute e-Rx incentive payments during the week of September 24, and distribution of feedback reports began this week. CMS is scheduled to begin distributing incentive payments and feedback reports for the PQRS program this week. Incentive payments for both programs will continue through the first week of November. CMS will make a separate payment if the TIN/NPI earned an additional 0.5 percent for successful participation in a Maintenance of Certification program. For more information about successful participation in either the e-Rx or PQRS programs, please review pages 8 and 9 of a recent CMS National Provider Call slide deck. For more information on how to access 2011 PQRS and e-Rx feedback reports, please visit the CMS QualityNet portal.
 
CMS will convene a National Provider Call on October 23 from 1:30–3:00 p.m., Eastern time, to help address questions regarding 2011 PQRS and e-Rx incentive payments and feedback reports.