ASCRS and the Surgical Community Advocate for Increased E/M Reimbursement in Global Surgery Codes and Elimination of the Add-On Code on Capitol Hill
This week, ASCRS, the American College of Surgeons, and the surgical coalition began our legislative campaign to increase the value of post-operative E/M services included in 10- and 90-day global codes and to eliminate the E/M add-on code with several visits to key members of Congress. We are building support by targeting members of key healthcare committees and those who signed on to letters to CMS last fall asking that the post-operative visits be increased along with standalone E/M codes effective 2021.
As we have reported, CMS did not make the change in the final rule, and our subsequent analysis indicated that the E/M add-on code and the increase to standalone codes will have a significant negative impact on surgical reimbursements, particularly ophthalmology, through a decrease to the conversion factor. Therefore, we have joined with the surgical community on a multi-pronged advocacy campaign. We are seeking legislative language to increase the post-operative E/M visits in the globals and eliminate the add-on code to be included in must-pass healthcare extenders legislation in May. In addition, we are researching a potential legal option if our legislative advocacy is not successful, and a potential public relations campaign focused on the value of surgery and preventing cuts to surgical reimbursement. We will keep you updated.
Register Now: ASCRS Webinar Dispelling the Myths About the Cataract Episode-Based Cost Measure - What’s Included and What’s Not
Join ASCRS on February 26 from 2:00 – 3:00 p.m. ET, for the webinar, “Dispelling the Myths About the Cataract Episode-Based Cost Measure: What’s Included and What’s Not.” In this webinar, ASCRS and ASOA director of government relations Nancey McCann will explain the cost measure: what’s in included, what’s not, and how it measures the cost of cataract surgery. Don’t miss this important session to help you succeed in the Cost category of MIPS.
To register, please visit here. Attendance at this webinar provides 1 COE credit. ASCRS and ASOA members receive complimentary registration for the webinar with the coupon code CATA0226.
If you are unable to attend this webinar, please still register and we will send you a link to the recording and slides after the session concludes.
For more information on the Cost category, visits the ASCRS ASOA MACRA Center and review the ASCRS 2020 Category Guide. If you have any questions regarding registration, please contact Jillian Winans regulatory affairs specialist at 703-591-2220 or firstname.lastname@example.org.
FY2021 Trump Budget Proposal Continues Administration Efforts to Move Away from Fee-for-Service and Increase Medicare Payment for Primary Care, Also Proposes to Reform Medical Liability and Medicare Opt-Out
This week, the Trump administration released its FY 2021 budget proposal. Each year, the administration releases a budget proposal to Congress to highlight its priorities for the coming fiscal year. These documents have no force of law and often include proposals that would require additional legislative action beyond annual spending levels, however, they serve as a key indicator of the administration’s legislative agenda. The 2021 Department of Health and Human Services section of the budget proposal continues and expands on ongoing key healthcare-related issues, such as the effort to move Medicare payments to value-based programs, increase payment for primary care services, and decrease the cost of prescription drugs. This year’s budget also introduces several new priorities such as medical liability reform, modifying the time frame for opting out of Medicare, and introducing a value-based purchasing program for ASCs. As mentioned above, most of these proposals would require additional legislative action to be put into effect.
Full details on the healthcare provisions of the budget are below:
• MIPS: Transition the MIPS program to a claims-based program modeled on the flawed MedPAC proposal that would eliminate physicians’ ability to choose the measures they report on and instead evaluate them on primary care-based population health measures. ASCRS and the Alliance of Specialty Medicine have continually opposed this proposal.
• APMs: Proposing that the thresholds for participation in Advanced Alternative Payment Models (APMs) should be eliminated and instead automatically award physicians participating in the models the 5% bonus.
• Accelerating drug and device approval and reimbursement: HHS is seeking to spur innovation in new drug and device development through a streamlined approach to approval and coverage.
• Increase reimbursement to primary care at the expense of surgical care: As part of an ongoing effort to boost primary care payment, the administration proposes to create a risk-adjusted monthly payment to providers who are eligible to bill for E/M and who provide ongoing primary care. A 5% annual reduction to the valuations of all non-primary care services and procedures will be used to pay for the primary care payments.
• Reform Medicare practitioner opt-out: Currently, most physicians and some non-physician practitioners who do not wish to participate in the Medicare program may opt out of Medicare for two years. This proposal would provide broader flexibility under the Medicare opt out rules. New flexibilities would include expanding opt out provisions to a broader range of physicians and non-physician practitioners (e.g., occupational therapists, chiropractors) and reducing the standard opt out period to one year, with exceptions for shorter periods based on the Secretary’s discretion.
• ACOs: Broadening the scope of primary care providers that attribute patients to ACOs to nurse practitioners, physician assistants and clinical nurse specialists. In addition, the administration proposes to allow ACOs to target beneficiary incentives toward those that receive preventative primary care services, such as flu shots.
• Telemedicine: Expanding Medicare coverage for telemedicine services for providers participating in Advanced APMs.
• Stark/Self-referral law reform: This proposal establishes a new process for physicians to self-report inadvertent, technical non-compliance violations of the law and excludes physician-owned distributors from the indirect compensation exception, if physician owners generate more than 40% of the physician-owned distributor’s business
Specifically, the budget proposal includes the following medical liability reforms:
• Capping awards for noneconomic damages at $250,000 indexed to inflation;
• Providing safe harbors for providers based on clinical standards;
• Authorizing the Secretary to provide guidance to states to create expert panels and administrative healthcare tribunals;
• Allowing evidence of a claimant’s income from other sources such as workers’ compensation and auto insurance to be introduced at trial;
• Providing for a 3-year statute of limitations;
• Allowing courts to modify attorney fee arrangements;
• Establishing a fair-share rule to replace the current rule of joint and several liability;
• Excluding provider expressions of regret or apology from evidence; and
• Requiring courts to honor a request by either party to pay damages in periodic payments for any award equaling or exceeding $50,000.
Ambulatory Surgery Centers
• Value-Based Purchasing: Implement a value-based purchasing program for ASCs and HOPDs similar to the current inpatient program. The proposal would link 2% of payments to quality and outcome measures.
• Risk-Adjusted Payments: To promote site-neutrality, the administration proposes to create risk-adjusted payments for ASCs and HOPDs that are based on the severity of the patient’s diagnoses, in a budget neutral manner.
• Health Savings Accounts (HSAs): The administration proposes to allow Medicare beneficiaries in high-deductible health plans to contribute to HSAs, creates a one-time opportunity to roll-over funds from a private HSA. Medicare-eligible individuals who have an employer-sponsored, high-deductible health plan could contribute to their HSAs, although Medicare would not cover any of the deductible.
• Allow beneficiaries to opt-out of Part A: This proposal gives beneficiaries flexibility to opt out of Part A, without any impact to their Social Security benefits, allowing them to choose their own health insurance coverage.
As noted above, several of these proposals would require legislative action and are not likely to be enacted by the beginning of FY 2021 on October 1, 2020.
House Ways and Means and Education and Labor Committees Pass Different Versions of Surprise Billing Legislation; Three Committees Must Now Negotiate Consensus Legislation
This week, both the House Ways & Means and Education and Labor Committees completed markups and passed bi-partisan legislation out of committee aimed at preventing surprise medical billing. The Ways and Means Committee takes an approach, more favored by healthcare provider groups that would create an independent dispute resolution (IDR) program for any surprise bill. Whereas the Ed & Labor version mirrors the approach of legislation previously passed out of the Energy and Commerce and Senate HELP committees that would set a benchmark rate based on median in-network levels and only trigger arbitration when the bill reaches threshold of at least $750, which is favored by insurers. The deadline for a consensus bill is steadily approaching, and with any final surprise billing legislation, Congress will be looking to use the savings to pay for the renewal of the Medicare and Medicaid programs set to expire on May 22, 2020, known as the “extenders.”