This week, ASCRS and the surgical coalition led by the American College of Surgeons, began the communications portion of our multi-pronged strategy to advocate for increased values of post-operative E/M services included in 10- and 90-day global surgery codes to correspond with scheduled increases to standalone E/M services in 2021. ASCRS is contributing financially to the effort which will include media, social media, and paid advertising on this issue. In addition, the campaign will focus on educating policymakers and the public on the value of surgical services and surgeons. As we have reported previously, this communications effort is in conjunction with coalition efforts on Capitol Hill seeking a legislative fix, and a potential legal challenge in 2021 if CMS’ policy goes into effect. We will keep you updated.
CMS and ONC Finalize Health IT Interoperability Rules; Take Steps to Address Privacy and Data Security Concerns
This week, the U.S. Department of Health and Human Services (HHS) issued two final rules aimed at improving the interoperability of healthcare data. The two rules, issued by HHS agencies, CMS and the Office of the National Coordinator for Health IT (ONC), implement provisions of the 21st Century Cures Act aimed at improving patient access to personal healthcare data. In our comments on the proposed rules last year, ASCRS supported efforts to improve interoperability, but, similar to others in the medical community, expressed concern that the proposals did not go far enough in protecting patient data and that some of the data it proposed to make available, such as claims data, may not be useful to Medicare beneficiaries.
CMS Final Rule
The CMS final rule requires Medicare Advantage (MA) plans, Medicaid, and plans sold on the federal exchanges to make data on claims and treatment history electronically available to beneficiaries through open application program interfaces (APIs). Medicare Part B already makes this information available to beneficiaries. ASCRS supported this provision but noted that it will be difficult to meet CMS’ goal of empowering beneficiaries to make cost-effective treatment decisions solely by providing claims data, and not providing relevant quality data. In addition, CMS finalized an ASCRS-supported provision to require plans to make their provider directories available through APIs.
ONC Final Rule
The ONC rule focuses on Health IT vendors and products and requires certified EHR systems to make health information broadly available through APIs. The final rule also requires that EHR systems provide the ability to download a single patient’s entire electronic record, or for a physician or provider to download all patients’ records for purposes of changing EHR vendors. The final rule also lays out conditions for physicians and health IT vendors to restrict the health information they share and not be data-blocking. These include instances such as the immediate safety or privacy of the patient; if the request is technically infeasible or is requested in a format the provider cannot fulfill; or allowing providers to charge a reasonable fee for fulfilling data requests. In response to comments from ASCRS and other stakeholders, ONC added provisions in the final rule that would permit healthcare providers to notify patients if they believe a third-party application seeking data on the patient’s behalf is not following best practices for data security. In addition, the rule clarifies that if a patient’s data is compromised when using a third-party application, the provider is not liable.
The implementation date for these final rules varies depending on the provision. Generally, ONC requirements related to data-blocking will take effect six-months from the rule publication to take effect. While CMS has given payers until January 1, 2021 to implement API functionality, EHR certification changes, such as the patient record download capability, have up to 24 months following publication to be implemented.
In addition to the rules, CMS and ONC published factsheets.
In the wake of the Coronavirus (COVID-19) pandemic, the AMA, CDC, CMS, and WHO have released detailed guidance and actionable information on how to prepare your practice and protect your patients. Below is a list of resources providers should review to educate and prepare their practice for COVID-19.
- AMA - The AMA created, a COVID-19 Resource Center, that includes “A Physician’s Guide to COVID-19,” a quick-start guide, curated from CDC, JAMA and WHO resources, that will help prepare your practice, address patient concerns, and answer your most pressing questions.
- CDC – CDC is closely monitoring the COVID-19 outbreak. They have created multiple guidance documents for healthcare providers that may be accessed here.
- CMS – CMS continues to respond to the COVID-19 virus, by releasing guidance for healthcare providers, billing information, and more, that may be accessed on the CMS Current Emergencies web page.
- WHO – WHO is regularly releasing information and guidance regarding the current outbreak of COVID-19, WHO released, “The COVID-19 Risk Communication Package For Healthcare Facilities,” that details actions one may take to prevent the spread of COVID-19 in your practice.
We encourage ASCRS and ASOA members to stay informed about your local COVID-19 situation. Know where to turn for reliable, up-to-date information in your local community. Monitor the CDC COVID-19 website and your state and local health department for the latest information.
If you are a Merit-based Incentive Payment System (MIPS) eligible clinician who participated in the 2019 performance period of the Quality Payment Program (QPP) and plan to submit 2019 data, the deadline is March 31 – just two weeks away! Data may be submitted and updated any time until 8:00 p.m. ET on March 31, 2020.
Please note, if you use the IRIS registry, you do not need to submit your data directly to CMS. However, IRIS and other third-party vendors may have earlier submission deadlines than CMS does.
Quality measures reported via Medicare Part B claims have been submitted throughout the 2019 performance period. You may review your preliminary feedback on Part B claims measure data by signing in to qpp.cms.gov. CMS will update this feedback at the end of the submission period with claims processed by your Medicare Administrative Contractor. Additionally, the data submission period through the CMS Web Interface for ACOs and pre-registered groups and virtual groups also closes on March 31, 2020 at 8:00 p.m. ET.
How to Submit Your 2019 MIPS Data and For Additional Resources:
For questions or comments on data submission, please contact CMS QPP staff at 866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.
Ophthalmic Community Advocacy Prompts Noridian to Increase Reimbursement for Two Glaucoma Procedures
This week, Noridian announced it was increasing the reimbursement for two glaucoma procedures, 0449T (Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device) and 0191T (Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork: initial insertion). ASCRS and others in the ophthalmic community have advocated that Noridian increase its reimbursement for these two procedures. Effective March 23, 2020:
- 0191T: total facility RVUs are 8.81; non-facility: 9.40
- 0449T: total facility/non-facility RVUs are 21.66
Total RVUs may fluctuate based on geographic location. Physicians in Noridian jurisdictions should consult their individual fee schedules for their local RVUs.
ASCRS and Alliance of Specialty Medicine Support Excluding Intraocular and Biologic Products from Canadian Importation; Oppose Including PBMs in the Importation Process
This week, ASCRS joined members of the Alliance of Specialty Medicine in a letter to the FDA in response to its proposed rule, “Importation of Prescription Drugs,” that echoed ASCRS’ support for excluding intraocular and biologic products from importation from Canada to ensure patient safety and quality assurance of these drugs. Additionally, the letter repeats our opposition to allow pharmacy benefit managers to participate in the process of importing drugs from Canada.
As a reminder, last December the FDA released a proposed rule that would allow importation of certain prescription drugs shipped from Canada. Last month, ASCRS submitted separate comments on the proposed policy that may be read here.
This week, the United States Pharmacopeia (USP), an independent scientific organization that develops quality standards, announced its final decisions on appeals to revisions to General Chapters <795> Pharmaceutical Compounding – Nonsterile Preparation and <797> Pharmaceutical Compounding – Sterile Preparations, which were published on June 1, 2019. The Appeals Panel has granted the appeals to General Chapters <795> and <797> and is remanding the chapters to the Compounding Expert Committee (CMP EC) with the recommendation for further engagement on the issues raised concerning the beyond-use date provisions. This means, currently official chapters of <795> (last revised in 2014) and <797> (last revised in 2008) remain official.
As a reminder, the appealed chapter <797> would have required a sterile compounded product to be used within 4 hours after preparation.
The House Energy & Commerce Subcommittee on Health Unanimously Passed Three Bills to Strengthen Patient Protections for Medicare and Medicaid Beneficiaries
On Wednesday (March 11), the House Energy & Commerce Health Subcommittee held a markup for 13 bills aimed at strengthening Medicare and Medicaid, supporting FDA’s work in overseeing food, drug, device and cosmetic safety and improving outcomes for children. Notably, the subcommittee unanimously approved three bills that would strengthen patient protections for Medicare and Medicaid beneficiaries.
H.R. 2477, the “Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES),” introduced by Rep. Raul Ruiz (D-CA), would require HHS, the Social Security Administration and IRS to work together to notify those approaching Medicare eligibility age about enrollment rules. The bill would also help eliminate coverage gaps between a person’s initial enrollment period and the general enrollment period. A Senate companion has been introduced by Sens. Bob Casey (D-PA) and Todd Young (R-IN).
Non-Emergency Medical Transportation
H.R. 3935, the “Protecting Patient Transportation to Care Act,” introduced by Rep. Buddy Carter (R-GA), would require CMS to keep non-emergency transportation benefits in Medicaid.
Kidney Transplant Medication
H.R. 5534, the “Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act,” introduced by Rep. Ron Kind (D-WI), would ensure transplant recipients have lifelong access to immunosuppressive medications beyond the 36-month supply Medicare currently covers.
Click here for the full list of 13 bills considered during the markup.
On Thursday, March 19 from 2:00–3:00 p.m. ET, CMS will host a call on the Open Payments program. CMS will provide an overview of the Open Payments program, registration process, and will review critical deadlines for physicians and teaching hospitals to review and dispute data. A question and answer session will follow the presentation. Register for the call here.
As a reminder, the data on Open Payments is submitted by manufacturers and group purchasing organizations regarding payments made to physicians. Each year, Open Payments data is updated at least once to include information from disputes and other data corrections. The data is published to the Open Payments website for the public.
This year’s 2020 eyePAC Reception will be held at the New England Aquarium. Overlooking Boston Harbor, the Aquarium features more than 20,000 fish and aquatic animals representing 550 species from around the world. It truly is one of Boston’s most unique event venues!
On Friday evening, May 15, from 7-9:00 p.m., eyePAC donors and their guests will enjoy drinks and substantial hors d’oeuvres surrounded by penguins, sharks, sea turtles, moray eels, and thousands of exotic, colorful fish. You’ll have private access to all four levels of the aquarium’s stunning Main Exhibit Gallery. The four-story Giant Ocean Tank creates a fascinating centerpiece that will long be remembered by you and your guests!
To donate and register for the eyePAC Reception, use your member credentials to log onto www.ascrs.org. Then go to the official registration page. If you have any questions, please contact Chris Hughes, manager of PAC & Grassroots at 703-591-2220 or firstname.lastname@example.org. We hope to see you there so we can thank you for your support of eyePAC—the PAC for anterior segment specialists!