ASPS Comments on 2014 Proposed Physician Fee Schedule and Hospital Outpatient and ASC Payment Systems
Included in the recent short-term fix of the Medicare sustainable growth rate was a provision to delay the implementation of ICD-10. The directive was a one sentence last-minute addition to the proposal and has led industry analysts to speculate that Congress did not fully understand the ramifications of the provision. For organizations that were installing new IT systems, training staff and preparing for the transition, the delay was not only a surprise, but an unwelcome one. Any ICD-10 conversion work already performed on systems will now need to be undone, and ICD-9 versions will need to be re-installed, retested and reintegrated. For organizations that were advocating for delayed implementation of ICD-10, the provision was welcomed whole heartedly. Industry surveys of healthcare executives routinely report ICD-10 preparation as the biggest IT challenge for organizations. Many smaller physician groups have yet to make necessary preparations for the conversion.This is the second delay for the adoption of the new coding schematic, and while a new start date of "no sooner than Oct. 1, 2015," has been identified, the postponement creates many unanswered questions about the timing of testing, training and level of ICD-10 education that is necessary for healthcare providers and payers. ASPS staff will continue to monitor the situation and provide updates as they become known.
A long standing Center for Medicare and Medicaid Services (CMS) policy that barred the release of information about the dollars paid to individual physicians was recently lifted, allowing the Agency to publicly share information on the number and types of services submitted to and paid by Medicare. The data includes information on every test and procedure billed to Medicare Part B by individual doctors in all 50 states during calendar year 2012. Only those providers who submitted 10 or less claims to the Medicare program are excluded from information contained in the database. The change comes after a years-long battle over the ability of the federal government to release physician specific payment information.
Historically, any release of the data was viewed as an invasion of privacy. Legal battles since the 1980s as well as a new focus in healthcare on increased transparency and fraud detection prompted the change. While many believe the data will offer new ways to look at just how much physicians earn under the Medicare program, others believe the information could include inaccuracies, resulting in unwarranted bias against some physicians.
CMS cautions that the file contains cost and utilization information only, and the volume of procedures presented may not be fully inclusive of all procedures performed by a provider. The Agency has not yet confirmed if it will be releasing data from previous years, but has indicated it will be releasing updated hospital data before the end of June.
Washington, DC health insurance providers must cover treatments for individuals with a diagnosis of gender dysphoria, according to a statement released by the Executive Office of Mayor Vincent C. Gray. The statement goes on to say that insurance providers must refer to the World Professional Association for Transgender Health Standards of Care as the recognized standard of medical care for transgender individuals.
“Today, the District takes a major step towards leveling the playing field for individuals diagnosed with gender dysphoria,” Mayor Gray said in the statement. “These residents should not have to pay exorbitant out-of-pocket expenses for medically necessary treatment when those without gender dysphoria do not.”
Five states already mandate insurance coverage for treatment of transgender individuals — California, Colorado, Oregon, Vermont and, as of last month, Connecticut — according to GLAAD.
Now is a critical time to learn more about issues facing the specialty and to advance ASPS legislative priorities on Capitol Hill.
- Educate your Members of Congress on your medical specialty
- Interact with your Members of Congress on issues of importance to plastic surgeons, their practices and their patients
- Advocate for the advancement of patient care and access to specialty medicine
Dates for the Program:
- May 6-7, 2013: Southeast/Midwest Regions
- June 19, 2013: Northeast and West Regions. This program is in conjunction with the Dueling Perspectives in Aesthetic Plastic Surgery Symposium.
All are welcome. Registration is free.
Please RSVP and direct any questions or requests for additional information to Carrie Lamb at (202) 672-1519 or via email at email@example.com.
CMS has indicated they will not delay upgrade to the EHR incentive program, but will develop procedures to allow physicians to avoid penalties if their electronic health record (EHR) vendor is slow in supplying Stage-2 compliant software.
Specifically, for those physicians who earned an EHR incentive bonus for at least two years under Stage 1 Meaningful Use criteria, the current program requires the ability to demonstrate Stage 2 compliance in calendar year 2014. Recent reports indicate only a fraction of EHR programs that had been certified for Stage 1 Meaningful Use have obtained certification for Stage 2.
Additionally, CMS will consider granting hardship exemptions to physicians, who for reasons beyond their control cannot attain some of the Stage 2 performance thresholds this year. A hardship exemption could spare noncompliant physicians from a Medicare reimbursement cut of 2%.
Jake Johnson joined ASPS on February 18th and will be responsible for researching, monitoring, analyzing and influencing state legislation and regulatory proposals; working with coalitions on common state issues; and educating government officials as to the implications of various policy changes that impact the specialty of plastic surgery. Jake will also manage the regional advocacy programs and all aspects of grassroots advocacy.
Jake comes to ASPS from Deltek, Inc. where he was an Associate Research Analyst and conducted research on State and Local Government agencies. Jake has held positions at Stateside Associates, was the Legislative Assistant for an Illinois State Representative and a Legislative Intern for an Illinois State Senator. As part of an internship program, Jake was a U.S. Department of State Intern for the Management Section at the U.S. Embassy in Rome, Italy. He took part in developing and completing projects in accordance to Federal policies and the needs of the Embassy, pertaining to the sustainability and environmental goals of the State Department.
In the following weeks, to facilitate communications, Jake will be reaching out to State Societies to update their contact information. If you have updated contact information pertaining to your State or Regional Society, please contact Jake at JJohnson@plasticsurgery.org.
Arizona Senate Bill 1042, regarding Truth in Advertising, hastily moved through the Senate last week with board certification language that has been deemed rather weak by a variety of healthcare groups, including ASPS. The bill’s sponsor, Senator Nancy Barto, remains unwilling to amend the bill to include stronger board certification language. Since amendment of the bill was not an option for Senator Barto, American Medical Association (AMA) and other medical specialty societies were able to successfully get the measure held in the House committee, delaying any further action. ASPS will continue to work with the AMA on a strategy to introduce more substantive legislation in Arizona.
This legislative session, breast cancer patient education legislation has been a trend among state legislatures. ASPS has a proactive advocacy strategy to help ensure that these bills include comprehensive language pertaining to the education of breast reconstruction care options. In the following months, we will be working closely with the Council on State Affairs to implement our advocacy strategy.
On February 27, ASPS submitted written testimony in support of Kentucky House Bill 123, the Genea Breast Cancer Awareness Act. ASPS is currently monitoring breast cancer patient education bills in Alabama, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Iowa, Kentucky, New Jersey, South Carolina, Tennessee and the state of Washington.
On February 6, the Senate Finance and House Energy and Commerce and Ways and Means Committees released their joint, bipartisan, bicameral proposal to permanently repeal the flawed SGR. The new legislation made some significant changes to the three previous drafts passed through the respective committees in 2013. Most notably, the proposal includes a 0.5% positive update for five years as opposed to the zero percent updates for ten years that was in previous drafts.
The proposal also eliminates the tournament style approach to payment adjustments that was included in the Senate Finance/House Ways and Means proposals, which ASPS opposed. The approach that would have pit physicians against one another for payment adjustments is replaced by a composite score system with a threshold score that must be met for positive payment adjustments and which will be known to physicians prior to the payment year. If the threshold score is not met, physicians will receive negative payment adjustments. The proposal streamlines the current law reporting programs (PQRS, EHR Meaningful Use) and the Value Based Payment Modifier into one reporting program and maintains the fee for service option. There are additional positive payment adjustments available for those physicians receiving a larger percentage of their Medicare revenue from various alternative payment models.
There remain some troubling provisions in the legislation though, most notably a provision that requires the Secretary of the Department of Health and Human Services (HHS) to identify misvalued codes in the physician free schedule. The Secretary is to identify 0.5% of the entire physician fee schedule in misvalued codes to be redistributed within the fee schedule. The RUC has already been working on a misvalued codes initiative and this provision is duplicative of that work, as well as an attempt to take from specialty codes to give to primary care codes.
The House GOP Doctors Caucus held a meeting Friday, February 28, 2014 to discuss the most recent SGR proposal before Congress. In a letter to Senate and House leadership, the Caucus stated that, the House GOP Doctors Caucus has agreed to the policies contained within this compromise proposal.” According to Caucus, “approval of a final package would be subject to an evaluation of the totality of the legislation including of-sets.”
ASPS has not taken a position on the legislation, opting instead to take a cautious approach especially in light of the fact that the proposal does not include mechanisms by which to pay for the SGR repeal.
The National Quality Forum (NQF) Annual Conference and Membership Meeting was held in Washington, DC on February 13th and 14th. The event was titled “Making Sense of Quality Data for Patients, Providers, and Payers” and was attended for ASPS by William Wooden, MD and Carrie Lamb. Sessions and speakers focused on core issues including what and how much information should be shared with patients, the role of the patient-caregiver-physician relationship and how government quality data can be useful to patients. Breakout sessions were also held during which attendees discussed the new National Quality Partners initiative and the six National Quality Strategy priority areas.
As you know, on January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) released its Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs. The proposed rule would make some significant changes to the Medicare Part D program, including requiring physicians to be enrolled in Medicare in order to prescribe Part D drugs, removing the protected class status for some drugs and potential suspension from the Medicare program for physicians deemed as having abusive prescribing practices.
On February 26, the House Energy and Commerce Committee Health Subcommittee held a hearing titled “Messing with Success: How CMS’ Attack on the Part D Program Will Increase Costs and Reduce Choices for Seniors.”The hearing was called due to major concerns with the proposed rule from many Members of Congress, especially Republicans and from some of the physicians in Congress. Some Members have expressed outright opposition to the proposed rule and are calling for the rule to be rescinded.
ASPS signed-on to letters expressing concern with the CMS proposed rule with both the Alliance for Specialty Medicine and the Health Leadership Council, which has over 250 signatories. The Biotechnology Industry Organization (BIO), the Pharmaceutical Research and Manufacturers of America (PhRMA) and the AMA are also submitting comments to CMS.
This month, Representatives John Conyers (D-MI-13) and Dan Benishek, MD (R-MI-1) introduced the Quality Health Care Coalition Act of 2014 which provides limited antitrust protections for physicians in negotiations with private insurance companies. The legislation will give health care providers the ability to negotiate contract terms on an equal level with insurers, including terms that affect the quality of patient care. In introducing the bill, the sponsors and supporters noted that the immunity insurers have from antitrust laws has led to increasing concentration in the insurance market, which leaves consumers with fewer options. This legislation will work to increase choices and ensure physicians remain on a level playing field in insurance negotiations. ASPS will continue to monitor the legislation’s progress and will keep you informed as we learn more.
On February 27, Representatives Andy Barr (R-KY-6) and Ami Bera, MD (D-CA-7) introduced legislation for the development and dissemination of clinical practice guidelines that could provide limited ‘safe harbor’ protections for physicians. H.R. 4106 would also establish the right of removal to federal court, any malpractice actions involving and federal payer like Medicare. Members of the Health Coalition on Liability and Access, of which ASPS is a member, have been working closely with Representatives Barr and Bera on drafting the language. ASPS will continue to monitor the legislation’s progress and will keep you informed as we learn more.
The Improving Trauma Care Act of 2013 (H.R. 3548) passed through the House Energy and Commerce Health Subcommittee on February 27. The legislation will expand the definition of ‘trauma’ in the Public Health Service Act for the purposes of certain care programs to include injury from extrinsic agents, including thermal, electrical, chemical, or radioactive agents. Currently, the definition of trauma includes only injury from mechanical force. One of the lead sponsors is Representative Michael Burgess, MD (R-TX-26) and this bill is supported by many physician organizations including the American College of Surgeons.
This month, Senator McKoon of the 29 District in Georgia introduced legislation (SB 173) to address physician profiling, a potentially new state/federal issue for. This issue has recently been brought to our attention by ASPS members and medical specialty associations. It seems that several insurance companies are dropping providers from their networks with very little transparency about the reasons why these decisions are made. SB 173 would establish a physician profiling program to address these and other “profiling” mechanisms used by insurance companies. Please note, this activity is being conducted in the private marketplace, similar to what was done in years past with Medicare Advantage.
The American Society for Dermatologic Surgery Association and the Georgia Dermatological Society (ASDSA) are supporting the measure. ASPS has also been in touch the new Executive Director of Georgia Society of Plastic Surgeons, Hart Health Strategies (ASPS’s legislative and regulatory firm in Washington, DC) and Stateside Associates (ASPS’s new state legislation and regulation monitoring vendor) – all will be keeping an eye on this issue moving forward.
While there are a number of states with TIA legislation (see attached list), in Arizona, legislative action is already moving forward. On Wednesday, Senator Nancy Barto held a Health and Human Service Committee hearing on her bill. Unfortunately, the board certification language in this bill is rather weak, and Senator Barto does not seem willing to amend her bill (despite opposition from the American Academy of Facial Plastic and Reconstructive Surgery and the American Society for Dermatologic Surgery Association). ASPS and other medical specialty societies are working with the American Medical Association (AMA) on a strategy in the Arizona House to make the bill more substitutive. We have also been in touch with the CSA representative from Arizona, the Arizona Medical Association and the Arizona Plastic Surgery Society. More information will follow.
On January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) released its Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs. The proposed rule would make changes to Medicare Advantage and Part D plans, but could also impact your practice given it would 1) require prescribers of Part D drugs to enroll in Medicare and 2) allow Medicare to revoke Medicare enrollment of providers if they are deemed to have abusive prescribing practices or patterns.
A number of advocacy groups are drafting comments to CMS (due March 7, 2014), including, the Alliance for Specialty Medicine, the Biotechnology Industry Organization (BIO), the Pharmaceutical Research and Manufacturers of America (PhRMA) and the American Medical Association. ASPS Health Policy Staff is reviewing the proposal. More information will follow.
Check out the CMSS Physician Payment FAQs regarding the Sunshine Act.
Posted August 1, 2013 -- On February 1, 2013, the Centers for Medicare and Medicaid Services (CMS) released the final rule regarding Transparency Reports and Reporting of Physician Ownership or Investment Interests (also known as the "Sunshine Rule"). Among other things, this final rule requires applicable manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid or the Children's Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers of value provided to physicians or teaching hospitals ("covered recipients").Affordable Care Act's "Sunshine Rule" Increases Transparency in Health Care
Posted November 15, 2013 -- The end of the year serves as a reminder for physicians to prepare to report their quality measures to avoid the 2015 Physician Quality Reporting System (PQRS) adjustment. This adjustment of 1.5% will apply to covered professional services furnished by an eligible professional or group practice during 2015, but is based upon the reporting of quality measures during 2013. While the deadline for one option has already passed, two more opportunities exist to avoid the 2015 payment adjustment:
- Option 1: Meet the criteria for satisfactory reporting for the 2013 PQRS Incentive of 0.5%. These criteria vary depending on whether a physician is reporting measures or measures groups and how they report their measures.
- Option 2: Report at least one valid measure for one applicable patient via claims, participating registry or participating and qualified Electronic Health Record (EHR) vendor, or report at least one valid measures group via claims or participating registry. This second option is to avoid the 2015 payment adjustment only and has no incentive tied to it.
Physicians who do not currently have a mechanism for reporting quality measures should know that ASPS, jointly with CECity Registry developed a PQRS reporting tool for plastic surgeons, the PQRSwizard. The PQRSwizard is an easy to use online tool that helps physicians and other eligible professionals quickly and easily participate in PQRS by collecting, validating and submitting physician quality measures to CMS for payment. More information on the PQRSwizard and how to sign up can be found here.
Additional information about PQRS can be found on the CMS website.
Posted October 10, 2013 -- Beginning in 2014, all providers must report CQMs based on new requirements outlined in the Stage 2 final rule, regardless of what stage they are in. In preparation for this, the Centers for Medicare and Medicaid Services (CMS) has released a new resource, An Eligible Professional's Guide to Stage 2 of the EHR Incentive Programs, which provides a comprehensive overview of Stage 2 of the EHR Incentive Programs to eligible professionals (EPs). The guide outlines criteria for Stage 2 meaningful use, 2014 clinical quality measure reporting and 2014 EHR certification. Physicians can access a copy of this resource here. Additionally, more information on the EHR Incentive Programs can be found here. Questions can also be directed to Catherine French at firstname.lastname@example.org.
ASPS Comments on 2014 Proposed Physician Fee Schedule and Hospital Outpatient and ASC Payment Systems
Posted September 11, 2013 -- On September 6, the American Society of Plastic Surgeons (ASPS) provided comments on behalf of its members to the Centers for Medicare and Medicaid Services (CMS) on two proposed rules for 2014: Medicare physician fee schedule and the hospital outpatient prospective payment system and quality reporting programs. ASPS registered several concerns about:
- The increased number of measures that would be required for satisfactory reporting under the Medicare Physician Quality Reporting System (PQRS)
- The search functionality on the Medicare Physician Compare website
- The Agency's plans to cap payments to services performed in the non-facility setting when those payments are greater than what is paid when the same service is performed in either the hospital outpatient or ambulatory surgical center facility setting
- The CMS proposal to unconditionally package all drugs and biologicals that function as supplies or devices in a surgical procedure
You can read ASPS' comment letter to CMS on the CY 2014 physician fee schedule here and the comment letter on the hospital outpatient and ASC payment systems here. ASPS anticipates the final rules will be published in early November and will provide an update for members.
Posted September 11, 2013 -- On Aug. 16, Illinois Governor Pat Quinn signed legislation (H.B. 3175) that will help ensure breast cancer patients are informed of their reconstructive options. The new law, which was modeled after the ASPS federal bill, requires the Illinois Department of Health to develop and implement an education campaign to inform breast cancer patients, especially those in racial and ethnic minority groups, of the availability and coverage of breast reconstruction. ASPS supported the efforts of Rep. Kay Hatcher, the bill's sponsor, to pass this legislation.
Posted September 11, 2013 -- The Alabama Breast Cancer Patient Education Act of 2013 (S.B. 22), which was signed into law earlier this year by Governor Robert Bentley, became effective Aug. 1. The new law requires the Alabama Department of Public Health (ADPH) to develop standardized information for breast cancer patients about treatment and breast reconstruction options and insurance coverage availability for these treatments. Certain physicians are then required to disseminate the summary to breast cancer patients.
Use of app technology helps to bring greater transparency to payments and other financial interactions between doctors and health care industry.
Posted August 8, 2013 -- On July 17, CMS introduced two free mobile device applications (apps) to help physicians and health care industry users to track their payments and other financial transfers the industry will report under the Open Payments program (Physician Payments Sunshine Act). Created by a provision of the Affordable Care Act, Open Payments creates greater public transparency about the financial transactions between doctors, teaching hospitals, drug and device manufacturers, and other health care businesses.
CMS has made these apps available to facilitate accurate reporting of required information, which will be available to the public and will be published annually on the Open Payments website. To support the "Open Payments" program, CMS designed the mobile applications (one each for physicians and health care industry users) merging this proven and efficient format with real-time 24-hour tracking technology. The apps offer on-the-go convenience for users to track financial data. Both apps are compatible with the iOS (AppleTM) and Android platforms; they are available free through the iOS AppleTM Store and Google PlayTM Store.
Posted May 15, 2013 -- The American Recovery and Reinvestment Act (ARRA) of 2009 authorized The Centers for Medicare and Medicaid Services (CMS) to provide financial incentives to physicians that demonstrate Meaningful Use of certified electronic health record (EHR) technology. Physicians will need to engage in meaningful use of EHRs by 2015 to avoid 1% penalty in 2015, 2% penalty in 2016, and a 3% penalty in 2017; penalty could increase up to 5% by 2021.
This online interactive course demonstrates key items plastic surgeons should know about Meaningful Use - Stage 1. Additionally, 0.5 Patient Safety credit can be earned.