CMS Releases Final 2017 Physician Fee Schedule and Hospital Outpatient Rules The Centers for Medicare and Medicaid Services (CMS) released the final 2017 Physician Fee Schedule (PFS) on Nov. 2. This followed the 2017 Hospital Outpatient Prospective Payment System (OPPS) rule released on Nov. 1. These rules solidify Medicare payment and quality provisions for physicians and hospitals in 2017. Under the PFS rule, physicians will see a 0.18 percent conversion factor payment decrease on Jan. 1, 2017. CMS estimates that the physician rule will maintain payment to cardiologists at roughly the same level from 2016 to 2017. This estimate is based on the entirety of payments to cardiologists and can vary widely depending on the mix of services provided in a practice. Under the OPPS rule, hospitals will see a 1.7 percent payment increase next year. Of note in the PFS rule, CMS finalized additional details for both implementation of the appropriate use criteria requirement for advanced imaging services (i.e., SPECT MPI, CT and MR) which will begin no earlier than Jan. 1, 2018, and a 2017 program to collect data on services provided within a surgical global period. The OPPS rule finalized implementation of the 90-day Electronic Health Record Incentive Program reporting period for 2016 for all eligible professionals, eligible hospitals and critical access hospitals. The reporting period can be any continuous 90-day period between Jan. 1, 2016, and Dec. 31, 2016. The ACC was instrumental in getting a bipartisan, bicameral bill introduced to raise the profile of this issue and signal the need for CMS to take action. Many other topics are addressed in this rulemaking cycle. Stay tuned to ACC.org and the ACC Advocate newsletter for additional information. Looking Ahead: What’s in Store For the New Medicare Payment System in 2017 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the broken Sustainable Growth Rate formula and ushered in a new Medicare payment system, the Quality Payment Program (QPP), that rewards clinicians for the value of care delivered versus the volume of services. MACRA also streamlines the current Medicare quality reporting programs: the Physician Quality Reporting System (PQRS), the Value Modifier and the Electronic Health Record (EHR) Incentive Program into a single program. Regardless of whether a clinician participates in the Merit- Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM), the two pathways under the QPP, clinicians will be measured on four core components: quality, meaningful use of certified EHRs, clinical practice improvement activities (CPIA) and resource use. The Centers for Medicare and Medicaid Services (CMS) on Oct. 14 released the final rule for the QPP that solidifies policies for MIPS and Advanced APM participation starting with the 2017 performance year (2019 payment year). Through its advocacy efforts, the College has worked with CMS and other health care organizations since day one to help shape the new Medicare payment system and ensure cardiovascular professionals can succeed in the new program. It is clear that CMS listened to the ACC and other health care stakeholders as key recommendations were included in the final rule to provide increased flexibility in year one of the program. Program flexibility highlights include: • The “Pick Your Pace” program will allow clinicians and groups to avoid a penalty under the MIPS program by simply reporting at least one measure. Clinicians and groups that strive to report data across all MIPS categories for at least 90 days, or ideally, the full 2017 calendar year, will be eligible for bonuses. • By increasing the low-volume dollar threshold from $10,000 to $30,000, CMS estimates 32 percent of clinicians will be exempt from QPP requirements in the first year of the program. • $100 million for technical assistance through contracts with regional organizations will be available to small practices of 15 or fewer MIPS eligible clinicians, rural areas, health professional shortage areas and Indian Health Services clinics, with priority given to rural areas, medically underserved areas and practices with low MIPS scores. Additionally, the Advancing Care Information (ACI) category of MIPS (formerly the EHR Incentive Program) requirements have been reduced from 11 required measures to five measures for full credit. CMS has also reduced the number of CPIAs that clinicians need to participate in to receive full credit in that category. CMS has lowered the scoring weight for the Resource Use (cost) MIPS category to 0 percent for the first year of the program, recognizing that many of the procedure- and condition-based episode groups used to measure performance in this category have not yet been tested for use at the clinician level. As a result, the 2017 performance year MIPS weight for the Quality category will be increased to 60 percent. As for Advanced APMs, this pathway is being expanded to include more clinicians by recognizing more APMs as Advanced, including simplifying the definition of the financial risk that an APM must assume in order to qualify. Merit-Based Incentive Payment System Highlights Quality The primary goal of the QPP is to reward clinicians for quality patient outcomes, rather than paying for the volume of services provided. Under MIPS, clinicians will be assessed based on performance against quality measures developed by the ACC, the American Heart Association and other stakeholders. Most of these measures will be familiar to clinicians as measures currently reported under PQRS. The structure of the MIPS Quality component and the process of reporting quality measures remains similar to PQRS in many ways, meaning that clinicians who are currently successfully reporting to PQRS should easily transition to reporting under the MIPS Quality component. In 2017, MIPS eligible clinicians or groups attempting full participation will be required to report at least six measures during a continuous 90-day performance period, including at least one outcome measure. Unlike PQRS which was only based on reporting measures, points will be awarded based on performance against prior year benchmarks for each measure. Quality measure reporting will count toward 60 percent of a clinician’s or group’s MIPS composite performance score for the 2017 performance year/2019 payment year. Advancing Care Information Under MIPS, the requirement to meaningfully use certified EHR technology is referred to as ACI, which replaces the Medicare EHR Incentive Program for clinicians. The ACI component of MIPS expands program eligibility beyond physicians to clinical nurse specialists, physician assistants and certified registered nurse anesthesiologists in 2017 and 2018. Additional groups will be added in 2019. All MIPS eligible clinicians can participate as individuals or as members of a group. In 2017, clinicians have several options to report the ACI base score for 50 points on 5 measures in this transition year: • Use 2014 edition certified technology and report on the 2017 ACI Transition objectives and measures • Use a combination of 2014 and 2015 edition certified technology and report on a combination of the 2017 ACI Transition objectives and measures, and ACI objectives and measures (if their technology permits) • Use 2015 edition certified technology and report on the ACI objectives and measures In addition to the base score, clinicians can earn performance score credit on nine additional objectives and measures. Clinicians have the opportunity to earn bonus points through participation in public health and clinical data registries, as well as through selected CPIAs. Clinicians must also cooperate with the government’s health IT surveillance activities and certify that they are not engaged in information blocking. ACI will count toward 25 percent of a clinician’s MIPS composite score for the 2017 performance year/2019 payment year. Clinical Practice Improvement Activities As part of CPIA, the one new component of MIPS, clinicians can select the activities they participate in. To receive full credit, clinicians or groups must participate in four medium-weighted activities or two high-weighted activities. 90-day participation is required in each activity. Activities in this category include participation in the Million Hearts Cardiovascular Risk Reduction Model, participation in Maintenance of Certification Part IV, or use of a patient safety tool. Several activities are also linked to the use of a Qualified Clinical Data Registry such as ACC’s PINNACLE Registry, Diabetes Collaborative Registry and CathPCI Registry to support patient care and quality improvement. Clinicians or groups can report participation in activities through attestation or by reporting through a mechanism such as a registry, EHR or third party. CPIA will count toward 15 percent of a clinician’s or group’s MIPS composite score for the 2017 performance year/2019 payment year. Clinicians or groups who are part of an APM but fall under the MIPS pathway may be eligible to have their APM involvement count toward their CPIA requirements. Resource Use Under MIPS, clinicians or groups will be assessed based on their use of resources, or cost of care, provided to patients based on certain conditions, treatments or clinical episodes. The Resource Use category continues elements of the current Value-Based Payment Modifier. Reference scores will be calculated for two measures from the current Value-Based Payment Modifier: total costs per capita for all attributed beneficiaries and the Medicare Spending per Beneficiary measure, with adjustments. In addition, clinicians and groups will receive information on their performance in 10 clinical episode based measures including Aortic/Mitral Valve Surgery and Coronary Artery Bypass Graft. Resource Use data will be pulled from Medicare claims data and require no reporting by clinicians or groups. Resource Use will not count toward a clinician’s or group’s MIPS composite score for the 2017 performance year/2019 payment year, but clinicians and groups will receive data on their Resource Use performance in 2017. Test the Quality Payment Program • Report a minimum amount of data in at least one of the categories (for example, one quality measure, one CPIA, or all five required ACI measures) • Avoid a negative payment adjustment in 2019 Participate For Part of the Calendar Year • Submit MIPS data across all categories for at least 90 days, which could begin anytime between Jan. 1 and Oct. 2, 2017 • Potential for a small positive payment adjustment in 2019 Participate For the Full Calendar Year • Submit data across all MIPS categories covering the full year reporting period, starting Jan. 1, 2017 • Potential for a modest positive payment adjustment Participate in an Advanced Alternative Payment Model • Participate in an recognized Advanced APM and meet the patient or payment threshold in 2017 • 5 percent incentive payment on Medicare Part B payments in 2019 How This All Adds Up Performance on the MIPS components in 2017 will be used to determine whether a clinician or group receives an upward or downward payment adjustment of up to +/-4 percent on their Medicare Part B payments in 2019. The MIPS “Pick Your Pace” program finalized by CMS allows participants to avoid the 2019 penalty by reporting at least one measure in any of the categories, while rewarding those who report for at least 90 days or ideally, a full calendar year. ACC Legislative Conference: Advancing Cardiovascular Care on Capitol Hill History was the centerpiece of ACC’s 2016 Legislative Conference, which took place Sept. 11 – 13. Not only was the conference set in the heart of Washington, DC, where history is around every corner, but this year marked the 25th anniversary of the event. Over the last quarter of a century, the College has brought together thousands of cardiovascular professionals to advocate for policies that support patients, providers and practices. The 2016 conference kicked off with a special ACC Political Action Committee (ACCPAC)-sponsored reception and dinner with historian Michael Beschloss, who shared keen insights and fascinating anecdotes on the American presidency. A full day of educational sessions addressed topics ranging from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to best practices for state advocacy programs and the political landscape to legislative issues on the horizon. During a break from the sessions, Laxmi S. Mehta, MD, FACC, was presented with the 2016 Excellence in Advocacy Award for Grassroots. This new award will be given annually to a cardiovascular professional who demonstrates leadership in advocacy, particularly by being a grassroots champion. Dee S. Mooty also received an Excellence in Advocacy Award for more than 20 years of work spearheading advocacy efforts as the Alabama Chapter executive. Armed with the information needed to take cardiology’s message to legislators, almost 450 cardiovascular professionals spent the final day of the conference on Capitol Hill advocating for health care policies that support health care providers and practices and provide patients with access to high quality care. Before meeting with legislators in their offices, ACC members gathered in the Cannon House Office Building for a special Congressional Breakfast during which Reps. Joe Heck, DO, (R-NV), Phil Roe, MD, (R-TN), Gene Green (D-TX), and Pete Sessions (R-TX) gave remarks on the health care landscape and the importance of active participation in advocacy efforts. During the breakfast, Rep. Ron Kind (D-WI) and Sen. Lamar Alexander (R-TN), chair of the Senate Committee on Health, Education, Labor and Pensions, were honored with ACC's 2016 President's Awards for Distinguished Public Service. While on Capitol Hill, more than 300 meetings took place between ACC members and their legislators. In addition to asking members of Congress to exercise careful oversight of MACRA implementation, ACC members urged Congress to cosponsor H.R. 3355/S. 488, a bill that would expand access to cardiac rehabilitation by allowing physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac, intensive cardiac and pulmonary rehabilitation programs; and support increased funding for the U.S. Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention to foster innovation and research. Save the date for the College’s 2017 Legislative Conference, which will take place Sept. 10 – 12. WATCH VIDEO ONLINE bit.ly/2dVI6y6 C. Michael Valentine, MD, FACC, vice president of the ACC, and Pascha Schafer, MD, FACC, an ACC Emerging Advocate, took a break during Legislative Conference to discuss what MACRA means for cardiovascular professionals during an interview on Facebook Live. Fellow in Training and Early Career Perspectives on ACC’s 2016 Legislative Conference “Through active engagement in advocacy, cardiologists can stay on the offense rather than the defense of the political process. After all, as was repeated numerous times at the conference, ‘if you don't have a seat at the table, you may be on the menu.’” Olivia Gilbert, MD, a member of ACC's Emerging Advocates Program “Whatever your thoughts on the utility of social media, I believe advocates are remiss to ignore the power of a strong voice on social media outlets today.” Sarosh P. Batlivala, MD, FACC “The legislative conference was a remarkable experience and incredibly insightful of how our legislative process works. It also served as a remarkable stepping stone to bring the dialogue of the conference back to the state I so proudly represent.” Charles Beale, MD, a Fellow in Training Representative for ACC's Rhode Island Chapter ACC Statement Stresses Importance of EHR Interoperability Participating in Integrating the Healthcare Enterprise (IHE) – a unique collaboration of health care professionals and industry focused on improving the way computer systems in health care share information – is crucial to achieving electronic health record (EHR) interoperability, according to an ACC health policy statement published Aug. 15 in the Journal of the American College of Cardiology, developed in conjunction with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society and Society for Cardiovascular Angiography and Interventions. “The lack of interoperability of health information technology (IT) prevents the field of health care from realizing the full potential of the Information Age that has revolutionized so many fields of human endeavor,” writes John R. Windle, MD, FACC, chair of the writing committee and a member of ACC’s Informatics and Health IT Task force, and co-authors. “Using internationally recognized standards, IHE provides a construct to create the technical frameworks to exchange health care data while maintaining the granular syntactic and semantic attributes needed to accommodate the needs of the diverse consumers of health care information,” they add. Given the complexity of achieving interoperability, the statement stresses the importance of stakeholders – including medical societies, government agencies and vendors – coming together to share best practices and work towards standardization. To that end, the College has worked with device vendors, medical societies and clinical facilities to develop 14 IHE profiles for cardiology that have been tested and validated. Moving forward, the writing committee hopes this health policy statement will help members of the C-suite and clinical leadership navigate interoperability and leverage IHE to connect various parts of the clinical workflow into a cohesive whole. AFIB FACTS: An estimated 2.7–6.1 million people in the United States have Afib. With the aging of the U.S. population, this number is expected to increase. Approximately 2% of people younger than age 65 have Afib, while about 9% of people aged 65 years or older have Afib. African Americans are less likely than those of European descent to have Afib. Because Afib cases increase with age and women generally live longer than men, more women than men experience Afib. SOLUTIONS FOR ATRIAL FIBRILLATION USING ACC’S QUALITY IMPROVEMENT FOR INSTITUTIONS REGISTRIES: • Afib Ablation Registry™ • PINNACLE Registry® CLINICAL TOOLS: • ASCVD Risk Estimator • Preventing Preventable Strokes Toolkit • Afib Toolkit • Afib Decision Aid for Anticoagulation Learn more about how our quality improvement solutions can support your clinical care and improve patient outcomes. Log into CVQuality.ACC.org today!
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