RheumWATCH Archives


Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.


SGR Repealed, Proposed MU Changes, Open Payments Data

SGR, No More!

Congress has finally acted. After 17 patches in 12 years, Congress passed a permanent repeal to the flawed SGR formula. The House passed the bipartisan legislation in late March, and the Senate recessed for two weeks without taking up the bill. CMS noted a two-week claim hold period, and the Senate returned for their vote just in time. On April 14, SGR repeal was finally passed, 92-8.

Passing legislation to repeal the SGR is an enormous accomplishment. The SGR battle in Congress is over, and physicians will no longer worry about the annual risk of debilitating cuts to their practices. This is an important victory for our patients as well, who will enjoy better access to care as a result of the improved and more predictable payment model.

With the President’s signature, the sustainable growth rate was immediately and permanently repealed. From now until 2019, the status quo of PQRS, MU, and VBM is maintained and there will be annual positive payment updates of 0.5%. From 2019 onward, the Merit-based Incentive Payment System (MIPS) will be in place. PQRS, MU, and VBM will be consolidated and streamlined into one program, and all physicians can earn a bonus of up to 10% for exceptional performance. Read a comparison of the current situation with the new payment system under H.R. 2, as well as a document containing myths and facts about the new payments system.

We are pleased to be finally moving forward from the long-time flawed payment model. The new law, however, is not perfect either. The ACR will begin work immediately on both implementation and improvement of the new Medicare payment policies.

Sunshine Act: Open Payments Review and Dispute Period Open Now

Take advantage of the opportunity to review and dispute payment data reported about you. As part of the CMS Open Payments program, you can review and dispute payments attributed to you now through May 20. Disputes that are initiated by May 20 will be flagged in the public release on June 30.

Drug and medical device makers are required to report certain payments made to physicians on an annual basis. After this review and dispute period officially ends on May 20, you can continue to register and initiate disputes, but resolutions will not be publicly displayed until the next reporting cycle.

To review data, register in both the CMS Enterprise Portal and the Open Payments system . This is the second reporting cycle for Open Payments, and it covers payments made in 2014. Last year, CMS published information about 4.45 million payments valued at $3.7 billion for the last five months of 2013.

Physicians and teaching hospitals who registered last year do not need to register again in the CMS Enterprise Portal or the Open Payments system. Go to the CMS Enterprise Portal, log in using your user ID and password, and navigate to the Open Payments system home page.

The CMS Enterprise Portal locks accounts if there is no activity for 60 days or more, and deactivates accounts if there is no activity for 180 days or more. To unlock an account, go to the CMS Enterprise Portal, enter your user ID, and correctly answer all challenge questions; you’ll then be prompted to enter a new password. To reinstate an account, contact the Open Payments Help Desk at openpayments@cms.hhs.gov.

Spotlight on State Society Activities

South Texas Association of Rheumatologists

The South Texas Association of Rheumatologists, in partnership with the Central Texas Rheumatology Society, hosted the 2015 Texas Rheumatology Roundup on March 27–28 in Austin. Over 150 rheumatology professionals attended. Program Directors Rodolfo Molina, MD, and Brian Sayers, MD, developed a program that included sessions on critical research and treatment issues, as well as a session featuring a member of the Texas General Assembly and updates from ACR Government Affairs staff on state and federal issues.

The research and treatment sessions focused on issues such as Associated Vasculitis: Changing the Standard of Care, and Periodontitis in Rheumatology: Arthritis Risk and Progression.

For more information about activities at the state level, please visit the ACR Affiliate Society Council page. To connect with ACR advocacy staff, or to share your state society efforts and be included in future RheumWATCH editions, contact stanner@rheumatology.org.

Message from you Government Affairs Chair: April 23

Will HarveyAdvocates,

This month, CMS released an important new proposed rule regarding Meaningful Use. This 210-page document has its roots in advocacy by the ACR and others, and will have significant (many positive) implications for us. The first thing I want to point out is that it is a proposed rule, with a 90-day comment period before it becomes final. Anyone, including the ACR, can and should comment if problems are found. So here is some background.

One of the ACR’s health policy goals is to work hard to reduce administrative burdens for rheumatologists and health professionals. We have long felt that Meaningful Use was a runaway train barreling down the tracks before the “Bridge of Interoperability” was completed. The major challenge, however, is that CMS, as is often the case, is reticent to pump the brakes on ANYTHING unless Congress tells them to. So the ACR joined a coalition that includes the AMA, CHIME (College of Health Information Management Executives), and a significant number of other groups whose goal was to lobby Congress to intervene.

We found our champion in Rep. Renee Ellmers (R-NC), who is a nurse and is married to a surgeon. She also, by the way, has introduced a bill to repeal the sequester cuts for infusion drug reimbursement. She introduced that on our behalf in the last Congress and in this one, introduced the Flex-IT Act, which has the goal of reducing 2015 to a shorter reporting window. But why take that step when there is so much wrong with MU as a whole?

Last year, CMS acknowledged that the train was in danger of running out of track when numerous sources, including AMA and CMS’s own data, suggested that a pitifully small number of providers were going to meet MU in 2014. A large barrier cited was that many had trouble installing or upgrading systems due to vendor issues. So they released a rule in late 2014 that provided additional hardship allowances. That was all well and good, except that it is difficult to go from a hardship in the last quarter of 2014 to full-year compliance starting Jan 1, 2015.

Additionally, the bulk of comments related to that 2014 rule were: 1) the patient engagement and electronic access measures depend on infrastructure that vendors have failed to provide; and 2) make 2015 a three-month reporting year instead of a full year so the people could pause and upgrade their systems and internal processes. CMS refused to do that in the 2014 rule, hence the bill.

Rep. Ellmers reintroduced Flex-IT in early 2015 and literally the same week, CMS announced it would rethink MU for 2015. Of course it was already scheduled to release Stage 3 rules (which it did a few weeks ago). In doing so, CMS indicated that there would be changes to some measures that are outdated or topped out, meaning that if everyone is always meeting them at a high rate, it doesn’t make sense to keep measuring—it has essentially become standard of care. But with the release of Stage 3, it became clear that there was a new gap between what they would want and where we are now.

So this 2015–2016 interim rule addresses that gap and several other concerns. Here is a very brief summary of the changes:

  • 2015 becomes a 90-day reporting year and everyone is eligible for penalties and incentives (yes, many people are still in the first four years of the MU program and are eligible for incentives), as they ordinarily would have been in a full year of reporting.
  • 2016 becomes a 90-day period for NEW providers and a full year for all others. This is in anticipation of 2017 being a full year for all per the Stage 3 rules.
  • Both providers and hospitals will report on calendar year data (hospitals had previously been on an Oct. 1 fiscal year calendar; this is the realignment they are talking about getting ready for Stage 3).
  • Several measures are removed, including, among others, vitals, smoking status, and family history.
  • For the patient electronic access measure, it changes the threshold from 5% to 1 patient per provider.
  • For the electronic messaging measure, it changes from a percentage threshold to a capability measure (yes/no).
  • Consolidates several public health reporting measures into a single measure.

Those last three points have in common that they required the highest amount of patient engagement and interoperability, which we all agree is a farce right now.

There is more, but those are the biggies. The result of this rule is that many more of our members will get MU incentive payments for 2015 and/or avoid penalties in 2016. Additionally, although the major goal of the Flex-IT coalition has been achieved (by the way, the AMA has been a major force here in helping us), we have agreed to keep the group together to continue advocacy around improving the MU program and making sure it is more realistic and that vendors are held to standards, not just providers.

I hope this gives some context and once more illustrates how the ACR’s effective advocacy, supported by staff and a number of committees, is working to benefit members. However, this is the next step, not the last one.

Since my Bruins knocked themselves out of the playoffs, the famous Gretzky quote seems appropriate: “Skate to where the puck will be, not where it is.” MU will be part of MIPS in 2019 as part of the SGR replacement. That's where the puck will be in 2019, so the preparation begins now. This was just a warm up. It starts with great coaching staff, and your ACR committees are guiding our actions. We also need money in the bank to recruit better players, so we’re depending on every ACR and ARHP member to donate and keep the RheumPAC donations coming. Fan support is important, too, and we will need more of our members to engage in these rivalries. Okay, enough—baseball, anyone?

Will Harvey, MD, MSc
Chair, ACR Government Affairs Committee

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