SGR Tied into Fiscal Cliff Negotiations as 27 Percent Cut Looms
Unless Congress acts, physicians will receive a 27 percent cut on January 1 due to the flawed sustainable growth rate (SGR) formula. Both a temporary patch to prevent the cut, as well as a path toward full repeal of the SGR are part of the latest round of tax and spending negotiations between President Obama and House Republicans as they work to avert the so-called January “fiscal cliff.” The cost to avert the 27 percent and provide physicians with a flat update is $25 billion; the cost of repeal could exceed $245 billion. While recent talks about the SGR repeal is encouraging, it will not likely occur without major changes to Medicare, which could spell cuts to physicians and other Medicare providers. In December, ASGE issued yet another appeal to its members asking them to keep the pressure on Congress to act swiftly to stop the cuts. In October, ASGE joined other national and state medical societies in offering congressional leaders principles and core elements that could form the basis for policy on a transition from the SGR.
In-Office Ancillary Exception under Threat of Elimination
In the latest round of fiscal cliff negotiations, President Obama offered $1.2 trillion in spending cuts, of which it has been reported that $400 billion would come from health care, namely Medicare. Everything is on the table this time around, including removal of the in-office ancillary exception which allows physicians to provide services such as imaging and pathology in their offices without risk of violating the Stark self-referral regulations. House and Senate Committee leaders have asked the Congressional Budget Office (CBO) to estimate the savings if the exception was eliminated. If CBO identifies significant savings, physicians should be concerned. In December, ASGE was on Capitol Hill with other physician organizations lobbying to preserve the in-office exception. While most congressional offices visited seemed sympathetic to retaining the in-office exception, the exception faces the biggest threat in years and will require coordinated lobbying and grassroots effort by those physicians who support the exception to counter the radiologists and pathologists who are advocating for stricter self-referral laws.
ASGE Continues Push for CRC Cost Sharing Relief
In the waning days of the 112th Congress, ASGE continues its push for passage of legislation that would waive Medicare beneficiary cost sharing for a screening colonoscopy that also involves the removal of a polyp or other tissue. Legislation (H.R. 4120) to accomplish that goal is currently pending in the House with the bipartisan support of 48 cosponsors. Despite the bipartisan support and relatively low price tag ($200 million over 10 years) to fix current law, advancing legislation has proven remarkably difficult in the deficit reduction environment on Capitol Hill. ASGE took the lead on a letter, signed by 30 other national and state organizations to Senate Finance Committee leaders asking for their support in eliminating the existing cost-sharing barrier to colorectal cancer screening. ASGE needs it members to educate member of Congress about why some Medicare patients continue to have cost-sharing obligations for this otherwise “free” preventive benefit. Take action today to urge your legislators to support this legislation.
ASGE Endorses EHR Meaningful Use Legislation
ASGE has offered its endorsement of the “Electronic Health Records (EHR) Improvement Act” (H.R. 6598) introduced by Rep. Diane Black (R-TN). Rep. Black worked with the physician community to identify needed changes to the Medicare and Medicaid EHR Incentive Program. ASGE, in collaboration with the Ambulatory Surgery Center Association, worked with Rep. Black’s office to include language in the bill that provides relief from the EHR meaningful use requirements for physicians who practice in ambulatory surgery centers (ASCs). Specifically, the bill would:
- exempt an eligible professional’s patient encounters that occur at an ASC for performance years 2015, 2016, and 2017 when determining whether the eligible professional qualifies as a meaningful EHR user;
- continue to allow an eligible professional who practices in ASCs with a certified EHR system to earn an incentive payment if he or she meets EHR meaningful use requirements; and
- prevent the EHR payment penalty from applying to fee schedule covered professional services provided in the ASC if the eligible professional fails to meet meaningful use requirements in another setting (e.g. office setting).
Rep. Black intends to introduce the legislation again in the next Congress.
CMS Notifies Physicians of Pending Medicare Cuts
On December 19, the Centers for Medicare and Medicaid Services (CMS) issued a notice to physicians of the impending 27 percent Medicare cut to take effect January 1. The notice reminded physicians that clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. CMS intends to issue another notice on or before January on the status of congressional action to stop the cut and next steps. A Medicare Participation Kit is available from the American Medical Association which allows physicians to explore Par, Non-Par and Opt Out/Private Contracting options.
Physician Fee Schedule and ASC Final Rules Released
On November 1, the Centers for Medicare and Medicaid Services (CMS) released the CY2013 Physician Fee Schedule (PFS) Final Rule, and the CY2013 Hospital Outpatient Prospective Payment System (HOPPS) / Ambulatory Surgical Center (ASC) Final Rule. In addition to setting payment rates for 2013, the PFS Final Rule details requirements for Medicare quality improvement programs, including the Physician Quality Reporting System and the new physician value-based payment modifier.
The HOPPS/ASC final rule was void of any significant regulatory changes for ASCs. However, ASGE was disappointed that CMS chose, once again, to update ASC payments using the Consumer Price Index for all Urban Consumers (CPI-U) despite repeated requests by ASGE and other stakeholders to use an inflation index (such as the hospital market basket) that more appropriately reflects ASC costs. For 2013, the payment update for ASCs will be 0.6 percent. CMS projects the CPI-U to be 1.4 percent, which is adjusted downward, as required by law, by a multi-factor productivity adjustment of 0.8 percent. By comparison the ASC update for 2012 was 1.6 percent.
ASGE-Sponsored PQRS Webinar January 7
On Monday, January 7 at 12:00pm-1:00pm EST, ASGE will host Webinar to help ASGE members successfully participate in the Physician Quality Reporting System (PQRS). Physicians must meet PQRS reporting requirements in 2013 to avoid a 1.5 percent downward payment adjustment in 2015. Register now for the Webinar – "Medicare’s 2013 Physician Quality Reporting System: Helping GI Physicians Avoid Payment Penalties in 2015 and Beyond."
Medicare QRURs Now Available to Physicians in Nine States
CMS is required by law to provide confidential reports to physicians that measure the resources involved in furnishing care to Medicare fee-for-service beneficiaries. The law also authorizes CMS to include information about the quality of care provided to these patients. Quality Resource Use Reports (QRURs) are available to individual physicians who are members of a medical group with 25 or more eligible professionals in nine states: CA, IA, IL, KS, MI, MN, MO, NE and WI. Physicians can access their reports through April 2013 at www.QRURinfo.com. Information contained in these reports will not affect physician Medicare payments; however, ASGE members in practices of 25 or more eligible professionals are strongly encouraged to retrieve their reports and provide feedback on the usefulness of the report, as well as on how information in the report is presented. Between January and March, CMS will host a series of conference calls with physicians in the nine states to answer questions and receive feedback on the reports. The first call is January 8 with California physicians. Details regarding the conference calls are available at www.QRURinfo.com.
CDC to Evaluate Colorectal Cancer Control Program
The Centers for Disease Control and Prevention (CDC) will undertake an evaluation of its Colorectal Cancer Control Program (CRCCP) to determine whether it has increased state-level colorectal cancer screening rates and other proximal outcomes. Currently 25 states and four tribal organizations receive CDC funds for colorectal cancer screening programs for those 50-64 years of age. The evaluation will include three grantee states (Ala., Neb., and Wa.), and three control states (Tenn., Okla., and Wisc.). The evaluation will be completed over a three-year period and will include a general population survey, a survey of primary care providers, and cases studies based on interviews with CRCCP staff, evaluators, and partners. On October 19, ASGE sent a letter in support of the evaluation. In its letter, ASGE suggested that the CDC survey ask primary care providers whether they are counseling patients regarding potential cost-sharing obligations and whether the prospect of a financial obligation is a deterrent to colorectal cancer screening colonoscopy. ASGE has been advocating over the past two years for the elimination of patient cost sharing when a screening colonoscopy also involves the removal of a polyp or other tissue. The CDC agreed to ASGE’s request for the inclusion of such questions in the survey.
ASGE Comments on Proposed Safety Standards for Magnets
On November 19, ASGE submitted comments to the Consumer Product Safety Commission (CPSC) in support of its proposed safety standards for high-powered magnet sets. Based on data collected by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, there is a growing incidence of ingestion of high-powered magnets by children. The CPSC is proposing to define magnet sets as any aggregation of separable, permanent magnetic objects that are marketed primarily as a manipulative or construction desk toy for general entertainment, such as sculpture or stress relief. If a magnet set contains a magnet that fits within the small parts cylinder that CPSC uses for testing toys, magnets from that set would be required to have a flux index of 50 or less or would otherwise be banned. CPSC must now consider the public comments it received on its proposed safety standard before issuing a final regulation.