Washington Watch Weekly - March 5, 2021

ASCRS Joins the AMA and Medical Community in a Letter to CMS Providing Recommendations for the Implementation of the MVP

This week, ASCRS joined the AMA and medical community in a letter to the Centers for Medicare & Medicaid Services (CMS) providing recommendations for the implementation of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), which will be a MIPS participation option, beginning in 2022, with the goal of easing the burden of MIPS reporting, aligning quality and cost measures, and focusing on quality improvement. In the letter, we focus on several issues that need to be addressed before it is proposed for the 2022 Quality Payment Program, including MVP design and prioritization, addressing the one-size-fits-all approach, scoring, guaranteeing the program is voluntary, and MIPS remains an option.

This follows our recent meeting with CMS, along with the American Academy of Ophthalmology (AAO) and the American Society of Retina Specialists (ASRS), to discuss a draft MVP on Eye Care that CMS developed. We provided feedback to CMS, indicating that the draft Eye Care MVP was too broad and many of the quality measures included are not relevant to all ophthalmologists, since ophthalmology consists of eight subspecialties with minimal overlap. We indicated that focusing on procedures or conditions that are relevant to specific subspecialists would be the only way to compare equitably. We reiterated our desire to continue the dialog with CMS so that we can provide input as future options for ophthalmic MVPs are considered.

Help to Stop Texas Optometrists from Gaining Surgical Privileges by Donating to the AAO’s Surgical Scope Fund

Texas optometrists introduced House Bill 2340 that would lower surgical safety and patient care standards by allowing optometrists to perform a wide range of surgical procedures, including advanced femtosecond laser procedures used for cataract removal. For instance, optometrists could perform femtosecond incisions for a cataract wound, femtosecond astigmatic cuts during cataract surgery and as a standalone procedure, and possibly anterior capsulotomy. However, the bill prohibits femtosecond fragmentation of the cataract, which is commonly performed along with femtosecond laser-assisted cataract.

If the bill is passed, the Texas Optometry Board will have the authority to regulate eye surgery, allowing over 4,000 optometrists to perform surgery outside the state Board of Medicine’s regulatory power.

ASCRS has already made a substantial contribution to the AAO’s Surgical Scope Fund, however, ASCRS members can also help by donating to the Surgical Scope Fund to oppose Texas efforts to grant surgical privileges to non-physician health care practitioners.

Senate to Debate American Rescue Plan (COVID Relief) Legislation Through the Weekend

The Senate is expected to spend the weekend debating the $1.9 trillion coronavirus relief plan that Democrats are prepared to pass without Republican votes. Senate Democrats added numerous health policy changes to the bill, including full coverage of COBRA health insurance premiums for workers who lost their jobs and adjusting the Medicare hospital wage index. The Republicans are also expected to offer amendments. After the American Rescue Plan Act of 2021 passes the Senate, the legislation will be sent back to the House for another vote on the new version. The administration’s goal is to sign the American Rescue Plan into law by March 14, which is when the current $300/week unemployment benefit bonus expires.

According to the Congressional Budget Office, final passage of the American Rescue Plan (COVID-19 relief package) would set in motion PAYGO statute reductions and trigger an additional 4% Medicare sequester. Currently, the moratorium on the 2% Medicare sequester is scheduled to expire on April 1. ASCRS and the medical community strongly oppose these arbitrary Medicare cuts and urge Congress to take immediate action to prevent the cuts that would be triggered with the passage of the American Rescue Plan and to pass H.R. 315, the “Medicare Sequester COVID Moratorium Act”—bipartisan legislation that would extend the current Medicare sequester moratorium for the duration of the public health emergency.

New AMA Report Indicates Ophthalmology Most Impacted Physician Specialty by COVID-19 Pandemic During the First Half of 2020

The AMA recently released a new report, “Changes in Medicare Physician Spending During the COVID-19 Pandemic,” that analyzed Medicare claims data exclusive to physician services from January to June 2020. The report found that ophthalmology was the most affected physician specialty impacted by the pandemic as Medicare spending for ophthalmic services dropped by 29% below pre-pandemic levels. Furthermore, Medicare spending in ambulatory surgical centers was down 90% in April due to regulations temporarily suspending elective procedures.

Additionally, the report highlights the financial impact the COVID-19 pandemic has had on physicians. According to the survey results, 81% of physicians surveyed in July and August of 2020 said revenue was still lower than pre-pandemic.

GAO Report Finds Payment and Utilization Declines for Medicare Part B Cataract Drug When Pass-Through Payments Expire

This week, the Government Accountability Office (GAO) released a mandated report, "Medicare Part B: Payments and Use for Selected New, High-Cost Drugs," that analyzed the effect of Medicare's policy on payment and utilization for bundling high-cost drugs after their pass-through payments have expired. The report examines Medicare payment for seven drugs, including a cataract drug eligible for pass-through payments in 2017.

During 2017, if a hospital performed cataract surgery and used the pass-through drug for that procedure, CMS paid $1,824 for the ambulatory payment classification (APC) payment rate and $463 for the pass-through payment rate—a total of $2,287 for the procedure and drug combined. After the pass-through payments expired for the cataract drug in December 2017, the cost was bundled into the facility payment from January to September 2018. If a hospital used the same drug and performed cataract surgery during those nine months, CMS paid $1,921 for APC payment rate. Therefore, Medicare paid less for the drug and procedure after pass-through payments expired. The GAO's analysis of Medicare data showed that this was a trend, and higher payments were associated with six of seven selected drugs when they were eligible for pass-through payments versus when their payments were bundled.

Additionally, the GAO report found that hospitals' use of the cataract drug in an outpatient setting was associated with lower utilization when the pass-through payment expired, and the payment was bundled. Specifically, the report indicates that the cataract drug's use dropped by 89% when the pass-through payments expired.

ASCRS ASOA Release Quality Payment Program (QPP) 2021 Cataract Episode-Based Cost Measure Guide

On Friday, March 5, ASCRS ASOA released a new QPP resource, the 2021 Cataract Episode-Based Cost Measure Guide, for ophthalmic practices participating in the Merit-Based Incentive Payment System (MIPS). Please note, to be scored on the cataract episode measure, a surgeon will have at least ten attributed cases of uncomplicated cataract surgery (66984) on Medicare Part B patients during the 2021 performance year. Complex cataract surgery (66982) is not included in this measure.

For more resources on the QPP, please visit the ASCRS ASOA MACRA Center. If you have additional questions, please contact Jennifer Gallihugh, ASOA Senior Manager of Strategic Initiatives, at jgallihugh@asoa.org.

Senate Finance Committee Splits in Party-Line Vote on Becerra to Lead HHS

On Wednesday, the Senate Finance Committee did not advance Health and Human Services (HHS) Secretary nominee Xavier Becerra after a vote on the nomination resulted in a 14-14 tie. The split requires the nomination to go to the full Senate, where Senate Majority Leader Charles E. Schumer (D-NY) will decide whether to push for a vote. If there is a tie on the Senate floor, Becerra could be confirmed without Republican support if there is no opposition from Senate Democrats and Vice President Kamala Harris casts the deciding vote.

CMS Hosts Open Payments Webinar and Call

On Wednesday, March 10, the Centers for Medicare and Medicaid Services (CMS) will host a Question and Answer (Q&A) webinar on Open Payments from 2:00-2:30 p.m. ET. The webinar will open with a brief presentation on the Open Payments review, dispute, and correction periods, followed by a Q&A session. To participate, you will need to register for the webinar here.

Additionally, on Thursday, March 25, from 2:00-3:00 p.m. ET, CMS will host a call to provide an overview of the Open Payments program, including how to access your data, along with a Q&A session. To register for the call, visit here.

Please note that the Open Payments review and dispute period begins on April 1, 2021, and ends on May 15, 2021. For more information, please visit the ASCRS Open Payments and the CMS Open Payments web pages.

CMS Provides Automatic Relief from MIPS Penalties for the 2020 Performance Period; Reopens Application

On February 25, CMS announced that due to the COVID-19 pandemic and its impact on physician practices, it will hold physicians harmless from the up to 9% MIPS penalties. The Extreme and Uncontrollable Exception policy will be automatically applied to all MIPS eligible clinicians who do not submit any MIPS data for the 2020 performance period and avoid a 2022 payment penalty.

CMS is also reopening the hardship exception application for group practices, virtual groups, and alternative payment model entities who missed the previous 2020 deadline. The reopened application deadline is March 31, 2021. Groups and eligible clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus from the exceptional performance bonus pool or potentially be subject to a penalty.

The following is the information directly from CMS:

We are applying the MIPS automatic extreme and uncontrollable circumstances (EUC) policy to all MIPS eligible clinicians for the 2020 performance period. We are also reopening the MIPS EUC application for individual MIPS eligible clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31, 2021 at 8 p.m. ET. Please note that applications received between now and March 31, 2021 won’t override previously submitted data for individuals, groups and virtual groups.

This listserv will review what these flexibilities mean for:

Individual clinicians, groups, and virtual groups that haven’t submitted data;
Individual clinicians, groups, and virtual groups that have submitted data; and
APM Entities.

Individual clinicians, groups, and virtual groups that haven’t submitted data.

Individual MIPS eligible clinicians: You don’t need to take any additional action to qualify for the automatic EUC policy. You will be automatically identified and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) you submit data as an individual in 2 or more performance categories, or 2) your practice reports as a group, by submitting data for one or more performance category.
Groups: You don’t need to take any further action if you’re not able to submit data for the 2020 performance period. Group participation is optional, and your individual MIPS eligible clinicians qualify for the automatic EUC policy. They will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) they submit data in 2 or more performance categories as individuals, or 2) the practice reports as a group, by submitting data for one or more performance category.
Virtual Groups: If you’re unable to submit data for the 2020 performance period, you must submit an EUC application for all 4 performance categories by the deadline.

Individual clinicians, groups, and virtual groups that have submitted data.

Individual MIPS eligible clinicians that have submitted data for a single performance category (such as Medicare Part B Claims measures submitted throughout the 2020 performance period):
- You don’t need to take any additional action to be eligible for the automatic EUC policy.
- You’ll be automatically identified and have all 4 performance categories reweighted to 0% and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) you submit data for another performance category, or 2) your group submits data for one or more performance category.
Individual MIPS eligible clinicians that have submitted data as an individual for 2 or 3 performance categories:
- You’ll receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year based on the data you’ve submitted.
- You’ll only be scored in the performance categories for which data are submitted.
- You can’t submit an application to override previously submitted data.
Groups and virtual groups that have submitted data for a single performance category:
- If you’re not able to complete data submission for other performance categories, you can submit an application to request reweighting in all 4 performance categories.
- This includes small practices that were automatically scored as a group on Medicare Part B Claims measures submitted throughout the 2020 performance period.
- If you don’t submit an application, your group will be scored in all performance categories unless you are eligible for reweighting in one or more performance categories.
- If your application is approved and data isn’t submitted for another performance category, your MIPS eligible clinicians will receive a neutral payment adjustment for the 2022 MIPS payment year.
Groups and virtual groups that have submitted data for 2 or 3 performance categories:
- Your MIPS eligible clinicians will receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year.
- Your group will be scored in all performance categories unless you qualify for reweighting in one or more performance categories.
- You can’t submit an application to override previously submitted data.

APM Entities

APM Entities participating in MIPS APMs can submit an EUC application with some differences from the MIPS EUC policy for individuals, groups, and virtual groups:

APM Entities are required to request reweighting for all performance categories.
More than 75% of the MIPS eligible clinicians in the APM Entity must be eligible for reweighting in the Promoting Interoperability performance category.
Unlike applications for individuals, groups and virtual groups, an APM Entity’s approved application for performance category weighting will override previously submitted data.

Please note that if an APM Entity doesn’t report for the 2020 performance period (or doesn’t have an approved EUC application), their MIPS eligible clinicians will receive a negative payment adjustment in the 2022 payment year.

Additional Resources

For more information, please see the Quality Payment Program COVID-19 Response webpages of the QPP website. You can contact the Quality Payment program at 1-866-288-8292 (TRS: 711), Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

Washington Watch Weekly - March 5 2021