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ADVOCACY

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             Advocacy Update                                                                July 2013

 

 

 
Legislative News
 
ASC Payment and Quality Bill Introduced in Congress
In June, the Ambulatory Surgical Center Quality and Access Act of 2013 (S. 1137 / H.R. 2500) was introduced in the Senate and House. The bipartisan bill is being led by Rep. Devin Nunes (R-CA) and Sen. Ron Wyden (D-OR). The bill closely resembles legislation introduced in the previous Congress, which was developed with ASGE’s input. The bill includes four components: 1) requires the Centers for Medicare and Medicaid Services (CMS) to use the hospital market basket index for determining annual ambulatory surgery center (ASC) payment updates; 2) requires and provides a framework for CMS to develop a value-based purchasing program for ASCs by January 1, 2015; 3) adds a representative from the ASC community to the Advisory Panel on Hospital Outpatient Payments; and 4) requires transparency in the Medicare process for approving procedures that are allowed to be performed in the ASC. ASGE endorses the bill and will initiate grassroots action throughout the remainder of the year. Please use ASGE's advocacy tool to contact your members of Congress to ask for cosponsorship. If your members are already a cosponsor, the tool will automatically generate a thank you letter from you for their support.

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House Committee Releases Latest Draft Physician Payment Reform Bill
On July 8, ASGE responded to an advanced legislative framework released by House Energy and Commerce Committee Republicans to repeal the Medicare sustainable growth rate (SGR) formula and reform the physician payment system. According to committee leaders, the latest legislative draft incorporates feedback received from a broad range of bipartisan lawmakers and more than 80 stakeholder organizations. The letter is ASGE’s fourth response since February to committee requests for feedback on the proposal at various stages.  It is expected that the Energy and Commerce Health Subcommittee will formally consider, or mark-up, its SGR legislation next week, with consideration by the full Energy and Commerce Committee occurring before the August congressional recess.  One thing missing from the mark-up will be how to pay for the bill which could cost upward of $150 billion depending on how long and to what level the legislation ultimately allows for a period of physician payment stability.  The House Ways and Means Committee, which also has jurisdiction over Medicare, is likely to develop its own physician payment bill following a framework similar to that in the Energy and Commerce bill.  Before an SGR bill can be brought to the House floor for consideration, a number of factors will need to be ironed out including how to pay for SGR repeal and payment reform, which is likely to include cuts to providers, and whether the bill should include larger Medicare program reforms, such as raising the Medicare eligibility age.  

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Number of H.R. 1070 Cosponsors Grows
The “Removing Barriers to Colorectal Cancer Screening Act” (H.R. 1070) now has the cosponsorship support of 37 House lawmakers. Help ASGE reach its goal of 50 cosponsors by August 1. H.R. 1070 would waive Medicare beneficiary coinsurance for colorectal cancer screening colonoscopy when a polyp is removed. Please use ASGE's advocacy tool to contact your representative’s office and ask for cosponsorship. If your representative is already a cosponsor, the tool will automatically generate a thank you letter  from you for their support.

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Senate Appropriators Aim to Restore Medical Research Funding
On July 11, the Senate Appropriations Committee agreed to a FY 2014 Labor, Health and Human Services (HHS), and Education spending bill.  The bill funds the National Institutes of Health (NIH) at $30.95 billion, which fills the $1.5 billion funding hole caused by sequestration this year and provides an additional $324 million increase.  Funding for the Centers for Disease Control and Prevention (CDC) Colorectal Cancer Control Program would also be restored to its pre-sequestration level of $43 million.  The Senate Labor, HHS, and Education spending bill totals $164.33 billion, which is $14.6 billion above current spending levels. Comparatively, the House’s Labor-HHS-Education spending bill allocation is $121.8 billion, which is $27.8 billion (or 18.6 percent) below current sequester-level spending. While the Senate action is welcomed news, the prospect for passing a Labor-HHS-Education spending bill at the Senate level is unclear and will hinge largely on whether Congress can research a deal on avoiding another sequester of federal funding in 2014.  

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Regulatory News
 
ASCQR Web-Based Measure Reporting is Underway
To fulfill 2013 reporting requirements for the Ambulatory Surgery Center Quality Reporting (ASCQR) Program and avoid a 2 percent payment update reduction in calendar year 2015, ASCs must report two web-based measures.  Due to the delay in the launch of the online system for submission of quality measures for the ASCQR, the deadline to report these web-based measures has been extended to August 23, the original deadline was August 15.  ASCs must report for services furnished between January 1, 2012 and December 31, 2012. The measures are ASC-6 (Safe Surgery Checklist Use) and ASC-7 (ASC Facility Volume Data on Selected ASC Surgical Procedures).  

An ASC must have an active security administrator to submit measures ASC-6 and ASC-7. Registration information is available online through QualityNet.org. ASCs should submit paperwork immediately for the security administrator because of a high-volume of applications being processed.  Web-based measures cannot be submitted until a user ID and initial passcode for the My QualityNet user site has been provided. Useful tips for reporting on ASC-6 and ASC-7 are available online.

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Preliminary ASCQR Data Released
The Centers for Medicare and Medicaid Services (CMS) has released preliminary Ambulatory Surgery Center Quality Reporting (ASCQR) data for the fourth quarter of 2012.  Nationwide, 82.4 percent of all ASC claims submitted had accurate quality data codes. For gastroenterology, the rate was 81 percent. Overall, ASCs with a larger number of Medicare claims or higher Medicare payer mix had higher quality data code utilization. For ASC measures 1-4, events were rare and isolated. Per 1,000 visits, the rates for gastroenterology were: ASC-1 Patient Burn (0.38); ASC-2 Patient Fall (0.23); ASC-3 Wrong Procedure/Site/Patient (0.01); and ASC-4 Hospital Transfer (0.84).  The preliminary data also show that for gastroenterology, IV antibiotics for the prevention of surgical site infection were administered on time 83 percent of the time. To access the data, visit the QualityNet website and review the June 2013 webinar materials under the ASC tab. The next ASCQR webinar on July 24 will cover proposed changes to the program. Information about the upcoming webinar can also be found on the QualityNet website.

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GI Societies Respond to Call for Measures
On July 1, ASGE, along with the American Gastroenterological Association and the American College of Gastroenterology, responded to the Centers for Medicare and Medicaid Services’ call for measures for the 2015 PQRS reporting period. The societies submitted three measures for inclusion:  1) Screening Colonoscopy Adenoma Detection Rate (ADR); 2) Repeat Colonoscopy Due to Poor Bowel Preparation; and 3) Appropriate Age for Colorectal Cancer Screening. ASGE has argued that low PQRS participation rates by gastroenterologists are due, in part, to the lack of endoscopy-specific measures in PQRS.  ASGE has also emphasized that more endoscopy-specific measures are needed to adequately compare the quality of physicians who provide endoscopy services. Following the response by the GI societies to the call for measures, CMS released the 2014 proposed Physician Fee Schedule which proposes new PQRS measures for the 2014 performance year and beyond. Among the newly proposed measures is screening colonoscopy ADR.


CMS Releases 2011 PQRS and e-Rx Experience Reports
The Centers for Medicare and Medicaid Services has released the 2011 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program experience report. In 2011, 3,164 gastroenterologists participated in PQRS, of whom 2,370 earned an incentive payment. The report shows that gastroenterologists who reported individual measures through a registry mechanism had a higher success rate of (91 percent) compared to gastroenterologists who reported individual measures via claims (62 percent). The top five measures reported in 2011 by gastroenterologists were (in ranked order): 1) Health Information Technology (#124) [Retired for 2013 PQRS]; 2) Colorectal Cancer Screening (#113); 3) Documentation of current medication in the medical record (#130); 4) Screening for Tobacco Use/Cessation Intervention (#226); and 5) Colonoscopy Interval for Patients with History of Adenomatous Polyps (#185). For 2011, 3,627 gastroenterologists qualified for the eRx incentive payment compared to 1,359 in 2010.
 

FDA Modifies Position on Fecal Microbiota Transplantation
On June 17, the Food and Drug Administration (FDA) announced that it will exercise “enforcement discretion” regarding investigational new drug (IND) requirements for use of Fecal Microbiota Transplantation (FMT) to treat C. difficile infection not responding to standard therapies so long that patient informed consent is obtained. Previously, in an April communication to the GI society leaders, including ASGE Immediate Past President Tom Deas, MD, FASGE, the FDA said an IND would be required for treatment of C. difficile. The FDA stated that it relaxed its stance on IND requirements after physicians and scientists expressed concern that FMT is not appropriate for study under an IND and that applying IND requirements would make FMT unavailable. The FDA will exercise discretion on IND requirements while it develops appropriate policies for the study and use of FMT products under IND.  As a follow up to the FDA announcements, the ASGE joined a July 15 letter  to the FDA that included recommendations for screening and stool tests of potential stool donors.

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ASGE Discusses EHR Use in ASCs with ONC Director
On May 22, ASGE joined the Ambulatory Surgery Center Association (ASCA) at a meeting with Farzad Mostashari, MD, the National Coordinator for Health Information Technology at the Department of Health and Human Services.  At the meeting, ASGE and ASCA representatives shared the challenges physicians who practice in ambulatory surgery centers (ASC) face in complying with the electronic health record (EHR) meaningful use requirements. Also discussed was the need for meaningful use standards that are relevant to the types of care provided in ASCs. In a follow-up letter to Dr. Mostashari, ASCA explained why a voluntary EHR system certification for ASCs is needed.  ASGE has led the charge for changes to the EHR Incentive Program to reduce the burden on physicians who practice in ASC, including exempting patient encounters that occur at an ASC when determining whether the eligible professional qualifies as a meaningful EHR user.

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CMS Releases Updated Clinical Quality Measures
The Centers for Medicare and Medicaid Services (CMS) has posted updated 2015 Clinical Quality Measures (CQMs) for eligible professionals, as well as corresponding specifications, for electronic reporting. The CQMs will be used beginning 2014 for multiple quality reporting programs with the goal of aligning electronic health record (EHR) incentive programs.  CMS will accept all versions of the CQMs for meaningful use, beginning with those finalized in the December 4, 2012 CMS-Office of the National Coordinator (ONC) Interim Final Rule, until the next phase of the EHR Incentive Programs.  However, CMS is encouraging providers to begin implementing and using the updated 2014 CQMs since they include new codes, logic corrections, and clarifications.  

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Register Now for July 31 National Provider Call on PV-PQRS Registration System
On July 31 at 2:30 pm ET, the Centers for Medicare and Medicaid Services (CMS) will host a National Provider Call during which the Physician Value (PV) - Physician Quality Reporting System (PQRS) Registration System will be explained. The PV-PQRS Registration System is a new application to serve the Physician Value Modifier and PQRS programs. The PV-PQRS Registration system will allow: (1) physician group practices to select their CY 2013 PQRS Group Reporting Mechanism, and if the group has 100 or more eligible professionals, elect quality tiering to calculate their CY 2015 Value-based Payment Modifier; and (2) individual eligible professionals to select the CMS-calculated Administrative Claims reporting mechanism for CY 2013 in order to avoid the PQRS negative payment adjustment in CY 2015. A question and answer session will follow the presentation. The PV-PQRS Registration System will be open from July 15, 2013 to October 15, 2013. Registration is required to participate in the call.