CMS Goes to Washington

Advancing the physician wish list during historic health care reform debates

AS LAWMAKERS consider legislation to repeal and replace the Affordable Care Act, your Chicago Medical Society is using this historic opportunity to promote a physician agenda of reforms.

While in Washington, DC, on Feb. 28 through March 2, CMS leadership made the case that health care reform also needs to provide relief for physicians coping with historic levels of bureaucracy and burnout.

Comprehensive reform should address the regulatory and financial burdens that threaten medical practice and ultimately compromise patient care, the CMS team stressed.

These latest discussions with the Illinois Congressional Delegation reinforce CMS’ year-round advocacy on behalf of members practicing in the Chicago area. The talks took place only days before the release of the GOP plan, known as the American Health Care Act. While CMS has not taken a position on the bill, provisions are being studied through our committee structure.

Prior to leaving for Washington, CMS President Clarence W. Brown, Jr., MD, amassed more than 100 real-life examples from physician-members to use in discussions with lawmakers. The purpose of the narratives was to demonstrate how legislative decisions ultimately affect medical practice and patient care. “I am very pleased at the outpouring of responses to my request for specific examples of the frustrating barriers and unintended consequences of laws and policies,” he said. “Thank you to all who contributed.”

Working both sides of the aisle, CMS met with U.S. Sens. Richard Durbin and Tammy Duckworth of Illinois, and with Sen. Bill Cassidy of Louisiana. Among U.S. House members, CMS renewed ties with Reps. Danny K. Davis; Bill Foster; Luis V. Gutierrez; Adam D. Kinzinger; Peter Roskam; and Jan Schakowsky.

Here are some of the urgent priorities CMS brought to the attention of lawmakers:

HEALTH PLAN NETWORK ADEQUACY
The Chicago Medical Society leadership proudly noted that our organization set forth legislation provisions for the “Network Adequacy and Transparency Act.” This Illinois bill protects patients in the following ways:

• • Enacts standards for the minimum ratio of healthcare providers to plan beneficiaries, including specialists, in the network.
• Enacts maximum travel and distance times for insureds based on minutes or miles for each county.
• Ensures that network directories are accurate and kept up-to-date so that patients can make informed decisions about their insurance plan and health providers.
• Requires insurers to notify patients in advance when their healthcare provider is no longer in a network and allows patients to change plans if this occurs.
• Allows continuity of care for patients with serious health conditions or who are pregnant, permitting such patients to stay with their healthcare professional if the network changes.
• Requires periodic audits of health plan networks to verify compliance with network adequacy standards.
• Requires insurers to obtain approval for all services they offer through a health plan network.

PRIOR AUTHORIZATION REIMBURSEMENT
Another point of pride for the Chicago Medical Society—initiating state and national legislation that would enable physicians to bill insurance companies and pharmacy benefit managers for the time spent on each prior authorization. CMS recently authored a resolution requesting the AMA to consider the creation of a new CPT billing code that would allow physicians to bill for each pre-authorization form.

MEDICARE PHYSICIAN PAYMENT
The Chicago Medical Society was instrumental in achieving refinements to The Medicare Access and CHIP Reauthorization Act’s (MACRA) Quality Payment Program for physician services.

A new “pick your pace” transition policy allows physicians to avoid penalties in 2019 by simply reporting one quality measure for one patient at some point during the year. Originally, there was an aggressive start date of Jan. 1, 2017, for the first performance measurement period.

The Merit-based Incentive Payment System (MIPS) design is simpler than the separate performance measurement programs that were in effect previously. Other improvements:

• The MIPS performance threshold, especially for 2017, was reduced when compared to the previous measurement systems.
• The low-volume threshold that will exempt physicians from MIPS was adjusted, from the proposed maximum of $10,000 in Medicare Part B-allowed charges and 100 patients annually to $30,000 in annual allowed charges or 100 patients.
• Reporting requirements were reduced for small practices. The improved low-volume threshold will have a disproportionately positive impact on small practices.
• Physicians will have more opportunities for participation in advanced alternative payment models through improved risk bearing requirements.  More medical home certification entities will now be recognized. Further regulation details related to MACRA are forthcoming.