News and noteworthy information for October 2017:



ISASS Signs on to Multi-Society Letter Urging Statutory Flexibility in Implementing MACRA

On October 2, ISASS and 118 state and specialty societies wrote to Congress urging the enactment of legislation to ensure that the Centers for Medicare and Medicaid Services (CMS) has the flexibility to continue a transitional approach to the implementation of the Quality Payment Program (QPP) required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  The letter was addressed to the Committee on Energy and Commerce and also went to chairs and ranking members of the House Ways and Means and Senate Finance committees.

MACRA was bipartisan legislation signed into law in April 2015 to permanently repeal the Sustainable Growth Rate (SGR), streamline physician quality reporting programs, and provide incentive payments for physician participation in alternative payment models. MACRA sunsets the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier, and the Medicare Electronic Health Record (EHR) Incentive Program and establishes an umbrella Quality Payment Program (QPP) with two new pathways for payment: 1. Merit-Based Incentive Payment System (MIPS) and 2. Advanced Alternative Payment Models (Advanced APMs).

At the insistence of medical societies and other stakeholders, CMS has taken a flexible approach to implementing the QPP. 2017 has been designated the “transition year” by allowing “pick your pace” reporting. In order to continue this flexible approach to implementation, Congress must make some statutory changes to MACRA including:

  1. allowing CMS to continue to weight the Cost category of MIPS to zero percent while episode-based cost measures are still under development. This means that physicians won’t be measured on the cost of patient care until appropriate measures are available to do so; and
  2. allowing CMS to continue to select a performance threshold lower than the mean or median while more physicians gain familiarity with the program. The performance threshold dictates whether penalties or incentive payments are made to physicians— physicians falling below the performance threshold are penalized and physicians falling above the performance threshold are awarded incentive payments. (The 2017 performance threshold is set at 3 points and CMS has proposed the 2018 performance threshold at 15 points.)

Click here to view the letter and here for more information on MACRA and QPP.


 MIPS Virtual Group Election Period Open

The election period is open to form a virtual group for the 2018 Merit-based Incentive Payment System (MIPS) performance period. As proposed in the 2018 Quality Payment Program (QPP) proposed rule, solo practitioners and groups can choose to participate in MIPS as a virtual group for the 2018 performance period through an election process through December 1, 2017.

What is a Virtual Group? A virtual group is a combination of two or more Taxpayer Identification Numbers (TINs) made up of:

For More Information:
MIPS webpage
Virtual Groups Toolkit: Information on the two-stage election process and agreements


CPT Editorial Panel Deletes CPT Code 76001 Effective 01/01/19

The CPT Editorial Panel met September 14-16 in Chicago. During the meeting, the Panel approved a code change application submitted by AMA staff to delete CPT code 76001 ((Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a non radiologic physician or other qualified health care professional (e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy) effective in the 2019 code set. Click here for a full summary of Panel actions from the September meeting.


CMS to Release 2018 Final Payment Rules

In the coming days, the Centers for Medicare and Medicaid Services (CMS) will release the final 2018 Physician Fee Schedule and the final 2018 Hospital Outpatient and ASC rules. These rules implement Medicare payment and policy changes for physician services and hospital outpatient departments and ASCs in 2018. Watch for communications from ISASS in the coming weeks with full analyses of the final rules. For a summary of the proposed 2018 Physician Fee Schedule, click here. For a summary of the proposed 2018 Hospital Outpatient and ASC rule, click here. ISASS’ comments to CMS on the proposed rules can be accessed here and here.


Hargan named Acting HHS Secretary

On October 10, President Trump named Eric Hargan as Acting Secretary of the US Department of Health and Human Services (HHS). Five days earlier, Hargan was sworn in as HHS Deputy Secretary of the Department after being confirmed by the Senate on a vote of 57-38. Hargan previously served on President Trump’s transition team and as HHS deputy general counsel, principal associate deputy secretary and acting deputy secretary under President George W. Bush. Most recently, Hargan worked as an attorney at the Greenberg Traurig law firm in Chicago and taught at Loyola University Chicago School of Law.

The mission of HHS is to enhance and protect the health and well-being of all Americans by providing for effective health and human services and fostering advances in medicine, public health, and social services. HHS has eleven operating divisions, including eight agencies in the U.S. Public Health Service and three human services agencies. The Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) fall under the HHS umbrella.


President Declares Opioid Epidemic a Public Health Emergency

On October 26, President Trump declared the nation’s opioid epidemic a public health emergency. This designation under federal law gives the Secretary of the U.S. Department of Health and Human Services (HHS) special authority to take appropriate actions to respond to the emergency such as shifting resources, making grants, expanding certain programs and services, and streamlining the hiring process to fill key positions needed to effectively respond to the epidemic. According to the President’s declaration, “drug overdoses are now the leading cause of injury death in the United States, outnumbering both traffic crashes and gun-related deaths,” with more than 300,000 Americans dying from overdoses involving opioids since 2000.

For more information about how to help reverse the nation’s opioid epidemic, visit the AMA’s website, End the Opioid Epidemic.



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