It’s been almost one year since the health care community celebrated the permanent repeal of the Sustainable Growth Rate (SGR) and shifted its focus to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation that establishes a framework for rewarding clinicians for value over volume, streamlines quality reporting programs into one system and reauthorizes two years of funding for the Children’s Health Insurance Program (CHIP). While MACRA holds significant promise for the future of health care delivery, there is still an abundance of unknowns that have caused anxiety for health care professionals. As the journey continues, the ACC is dedicated to helping its members piece together the MACRA puzzle. Get the Facts: What Does MACRA Do? • Repeals the SGR formula used for determining Medicare payments to clinicians. The SGR does not exist. • Reauthorizes funding for CHIP for two years through Fiscal Year (FY) 2017. • Extends funding for direct and indirect graduate medical education payments to teaching health centers through FY 2017. • Establishes a period of positive payment increases by providing an annual 0.5 percent payment increase for clinicians through Dec. 31, 2018, to support a predictable transition from fee-for-service to qualitybased payment. • Promotes the transition to quality-based payment by implementing two payment pathways for clinicians beginning in 2019: the new Merit-Based Incentive Payment System (MIPS) or participation in eligible Alternative Payment Models (APM). • Supports participation in APMs by providing annual payment increases of 0.75 percent to those participating in an eligible APM in 2026 and beyond, and 0. 25 annual payment increases to all other clinicians. • Declares a national objective to achieve widespread exchange of health information through interoperable certified electronic health record technology nationwide by Dec. 31, 2018. • Includes a provision that will protect clinicians by preventing quality program standards and measures (such as Physician Quality Reporting System/MIPS) from being used as a standard or duty of care in medical liability cases. Resources to Navigate MACRA The ACC has numerous resources to help navigate MACRA. Visit ACC.org/MACRA to access: • Issue briefs on MACRA, MIPS and APMs • Articles from ACC publications including the Journal of the American College of Cardiology and Cardiology magazine • ACC Advocacy action including comment letters • Webinars on MACRA developments and payment models STATE ADVOCACY: Recent Wins and Future Opportunities 2015 State Successes In 2015, ACC chapters dealt with a broad range of issues and met personally with lawmakers early in the legislative process to educate them of the effect of proposals on patients. The 2015 successes can also be attributed to a focused effort on stakeholder collaborations, including partnerships with state and specialty medical societies, and patient advocacy groups such as the Sports Safety Coalition. ACC member participation in groups such as the National Conference of State Legislators and the National Lieutenant Governors Association also provided an excellent platform to not only discuss key issues, but showcase ACC's patient-focused efforts. Some highlights of 2015 successes include: SUDDEN CARDIAC ARREST Legislation was defeated in Texas and North Carolina that would have required all scholastic athletes to take electrocardiogram tests as a condition of participation. PULSE OXIMETRY SCREENING Four states have not acted on pulse oximetry legislation, including Vermont, Kansas, Wyoming and Idaho. The ACC Northern New England Chapter supports a Department of Health proposed rule to mandate this screening to detect congenital heart disease. MEDICAL MALPRACTICE Several states have defeated ill-advised proposals to scrap the current state litigation system and replace it with a workers compensation model that would create new regulatory and quasi-judicial "expert panels" with authority to determine which claims are valid and the amounts patients should be compensated. INSURANCE COVERAGE ACC's Ohio and Pennsylvania Chapters are working closely with medical societies to reform prior authorization in order to ensure that clinical judgment guides coverage regulations. TEAM-BASED CARE Legislation was defeated in North Carolina that would have required cardiovascular interventional technicians to meet the requirements of radiological technologists in order to work in cath labs. MEDICAL MALPRACTICE In Illinois, legislation was defeated that would have lifted the exception that prohibits peer review deliberations from being admitted into evidence in medical malpractice lawsuits. Key Issues For 2016 Several challenging issues in 2016 will open doors for state advocacy efforts. Most state legislatures started their sessions in early January and lawmakers have been busy drafting proposals to address spiraling pharmaceutical costs, increasing access to care in rural areas, establishing clear rules for telemedicine licensure services, updating emergency care policies and addressing insurers' prior authorization policies. Some issues of note for this year include: POPULATION HEALTH In response to ACC's increased population health initiatives, the ACC State Advocacy team has further developed its resources for state chapters to get involved. Key 2016 population health issues include: • Sale of Tobacco Products: Currently, six states permit the sale of e-cigarettes to minors. Several other states treat e-cigarettes as tobacco products in their smoke-free laws. ACC State Advocacy objectives include enacting smoke-free laws, increasing cigarette taxes and increasing funding for smoking cessation. • CPR: A majority of states require cardiopulmonary resuscitation as a high school graduation requirement. Adding additional states is a high priority. • Physical Education: Major efforts are needed in fighting childhood obesity by requiring physical education in grades K – 12 and recess in grades K – 6. Three states meet this standard: Illinois, Missouri and Louisiana. Fourteen require either physical education or recess. Thirty-three states have no requirements. • Sudden Cardiac Arrest: The ACC State Advocacy team has developed resource materials for legislators and advocates that outline policies to prevent sudden cardiac arrest in scholastic athletes through training, education and on-site resources. EMERGENCY CARE The ACC Illinois Chapter is working with a coalition comprised of health department representatives, American Heart Association officials, emergency medical technicians (EMTs) and health system interests to update the state's ST-elevated myocardial infarction (STEMI) program. A key challenge will be to ensure EMT agencies have up-to-date information on hospital capabilities and are in constant contact with all stakeholders so that STEMI patients are transported to appropriate facilities. PHARMACEUTICAL COSTS Synchronization of refills, transparency and prior authorization will be a primary focus for ACC State Advocacy this year. The ACC has met with pharmaceutical stakeholders and payers to find common ground, and the next step is to position chapter leaders to deliver cardiology's message to lawmakers. In addition, medical societies nationwide have expressed newfound interest in this area and the ACC convenes with them regularly to evaluate proposals and share intelligence. Throughout 2016, ACC Chapters will continue to work closely with the ACC State Advocacy team to ensure members play a meaningful role in state policy discussions. This will involve preserving provider autonomy, offering policy solutions and serving as a resource to lawmakers. ACC ADVOCACY IS SHAPING THE FUTURE OF CARDIOLOGY Through its advocacy efforts, the ACC builds relationships with Congress, federal government agencies, state legislative and regulatory bodies, private insurers and other policy making groups to advance the College's mission of improving heart health. Watch this video to see how ACC members are ensuring cardiology's voice is heard at the local, state and national level. To learn how to make a difference, visit ACC.org/Advocacy or email AdvocacyLeg@acc.org. If You're Not at the Table, You're on the Menu A Rallying Cry For Fellows-in-Training In a recent Fellows in Training (FIT) and Early Career Page in the Journal of the American College of Cardiology, Sandeep Kumar Krishnan, MD, an FIT at Cedars-Sinai Medical Center in Los Angeles, CA, writes about the importance of ACC members in the U. S. being involved in advocacy, beginning in fellowship. “I feel privileged that our cardiovascular societies recognize the importance of advocacy and have worked over the past several decades to establish themselves as trusted and respected partners to Congress on health care issues,” Krishnan says. “During my most recent visit to the Hill as a representative of the ACC, I had the opportunity to interact with many U.S. representatives and senators – many of whom mentioned their high regard for the College. This is a reflection of the years of hard work and dedication that prior generations of cardiologists have poured into the ACC and ACC’s Political Action Committee.” According to Krishnan, it’s critical that FITs learn about the issues and find ways to get involved with advocacy efforts at the state, regional and national levels. “Our power as health care providers to help our patients is limited to the resources provided by the system in which we practice,” he said. “… We should do everything we can to ensure that we continue to improve the stature of our profession in the eyes of our patients and our legislators." In a response, former ACC President Ralph G. Brindis, MD, MPH, MACC, said he shares Krishnan’s “rallying call” for FITs to become involved in cardiovascular advocacy. “Professional cardiologists are best suited to share insights as to how services that affect cardiovascular disease can be improved to advance national health goals,” he writes. ”Given the evolving health care system, the need for supporting advances in scientific discovery, along with the needs of our patients, opportunities are ever-expanding for cardiovascular professionals to fulfill their advocacy responsibilities.” EHR Incentive Program Updates: It's Not as Hard to Claim Hardship According to the Centers for Medicare and Medicaid services (CMS), 209,000 eligible professionals will be subject to penalties in 2016 under the Medicare Electronic Health Record (EHR) Incentive Program for failing to demonstrate meaningful use. To avoid the penalties, eligible professionals must demonstrate meaningful use in either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program. Meanwhile, in response to feedback from the ACC and other stakeholders, CMS announced that a new, streamlined EHR Incentive Program hardship exception process is now in place starting with the 2017 payment adjustment. The changes, which stem from the Patient Access and Medicare Protection Act, aim to reduce the burden on eligible professionals, eligible hospitals and critical access hospitals. New hardship exception applications and instructions for the 2017 EHR payment adjustment are available on CMS’ website. To take advantage of the new process, eligible professionals must submit their applications by March 15. As part of the changes, groups of providers can now submit a single application to apply for a hardship exception. Eligible hospitals and critical access hospitals must submit applications by April 1.
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