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Through our partnership with NRHI (Network for Regional Healthcare Improvement), we’re bringing you relevant policy updates to help you and your organization understand how changes in federal policy affect the delivery and consumption of health and healthcare in our region.

Lawmakers return to Washington.  Congress returned from a seven-week recess on September 6, and lawmakers are scheduled to leave again before the end of the month. The top priority for lawmakers is passing a Continuing Resolution (CR) to keep the government funded past the end of the fiscal year.  Senate Majority Leader Mitch McConnell (R-KY) moved this week to bring to the floor a package including a stopgap spending measure and Zika funding. The CR would run until December 9 and would be written at fiscal 2016 spending levels.

CMS to physicians: “Pick your pace” for first year of MACRA.  Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt announced in a blog post on September 8 that physicians will be allowed to “pick their pace” of participation for the first performance period under the Medicare Access and CHIP Reauthorization Act (MACRA). Physicians will have four options to avoid a negative payment adjustment:

  1. Test the Quality Payment Program. As long as physicians submit some data, including data from after January 1, 2017, they will avoid a negative payment adjustment
  2. Participate for part of the calendar year. Physicians may submit data for a reduced number of days, and may still qualify for a small positive payment adjustment
  3. Participate for the full calendar year. Practices may choose to submit Quality Payment Program information for a full calendar year, beginning on January 1, 2017, making them eligible for a “modest” positive payment adjustment.
  4. Participate in an Advanced Alternative Payment Model in 2017. The blog post seems to suggest that participation in an Advanced APM in 2017 is sufficient on its own to avoid a negative payment adjustment in 2019, but this won’t be clear until the final rule is released.

This announcement is short on details, which CMS says will be further fleshed out in the MACRA final rule, expected on or around November 1.  It is unusual for an agency to release details from a final rule so far in advance of its publication.  The timing of this “sneak peek” is interesting, given that CMS will very soon be notifying physicians of results from the Value-based Payment Modifier 2015 performance year – and these results could spell 2017 rate reductions for a large number of physician organizations that did not report quality data in 2015.

Final payment rules on this Administration’s docket.  With less than 4 months left under the current administration, there are a number of final rules pending that are likely to have far-reaching impact on various sectors of the health care industry.  Top among these, as mentioned above, is the final CY 2017 Physician Fee Schedule rule, along with final rules on MACRA, are expected to be released sometime on or before November 1.  Also expected to be released before year’s end are payment rules addressing: (1) the Part B Drug Payment Model, which will be a mandatory demonstration testing alternative ways to pay for Part B drugs; (2) the Hospital Outpatient Prospective Payment System, fixing rates for CY 2017 and implementing statutory cuts to new off-campus hospital outpatient departments; (3) Home Health, end-stage renal disease, and Durable Medical Equipment; and (4) DSH payments for qualifying hospitals; (5) supplemental payments to providers under Medicaid.  The Health Resources and Services Administration (HRSA), which administers the section 340B Drug Pricing Program, has also finalized controversial “mega-guidance” on the program, which is undergoing final review of the Office of Management and Budget.

House Ways and Means Health Subcommittee examines pay-for-performance systems in Medicare Part A. The House Ways and Means Committee Health Subcommittee on September 7 held a hearing titled, “Incentivizing Quality Outcomes in Medicare Part A.” The Subcommittee discussed pay-for-performance systems in the hospital inpatient setting and future payment reforms, including those in the post-acute care setting. Committee Chairman Kevin Brady (R-TX) and Subcommittee Chairman Pat Tiberi (R-OH) touted the Medicare Post-Acute Care Value-Based Purchasing Act (H.R. 3298) and indicated they will work to advance the bill in the near future.

CMS notifies hospitals of 2017 Results under Medicare EHR Incentive Program; small percentage of hospitals face penalties.  Eligible hospitals that were not meaningful EHR users during the 2015 reporting period and that are not granted a hardship exemption will be subject to a three-fourths reduction of the market basket update for FY 2017 IPPS rates.  CMS has reportedly sent letters to the hospitals that were eligible to participate in the meaningful use program but have failed to do so, notifying them of the penalty. The hospitals facing lower reimbursements represent a small percentage of those eligible to participate in the Medicare electronic health record program. The vast majority—98 percent—of the more than 4,800 hospitals eligible to participate in the meaningful use program, have done so successfully, according to the CMS.  CMS released additional details on FY 2017 penalties in a Fact Sheet posted on September 2.

Poll finds more patients say their doctor is entering medical data electronically. The latest Kaiser Health Tracking Poll released this month included questions on electronic health records (EHR) and health IT for the first time since 2009. The poll found that 80 percent of patients say their physicians are entering data electronically during their visit, compared with 46 percent in 2009. Fifty-two percent of respondents say it is “very important” that their health care provider uses EHRs, up from 42 percent in 2009. Many patients, especially African-Americans and Latinos, are concerned about the privacy of electronic health records.