Capitol Hill Report: CMS Receptive to AAN Epilepsy, Headache Care Payment Models
October 10, 2016
AAN Leaders Meet with CMS on Neurology Alternative Payment Models
The AAN took a major step in advancing our neurology alternative payment models (APMs) last week, when Joel Kaufman, MD, FAAN, and Marc Raphaelson, MD, from the AAN's Payment Alternative Team, and AAN staff met with leadership from the Centers for Medicare & Medicaid Services (CMS). We were really encouraged by CMS' interest in our epilepsy and headache care payment models (and thank you to all the AAN members who responded to our request for comments and feedback). Agency staff asked many questions and provided us with steps to take so that our models could potentially be tested by CMS and qualify as Advanced APMs under MACRA. We will continue talking with CMS staff. This comes after we have received many comments from members and worked to incorporate improvements into the models. The AAN is on the leading edge of APM development and garnering national attention.
Dr. Kaufman, chair of the AAN's Payment Alternative Team, said, “The AAN is reaching out to insurers, other specialty societies, and now the Innovation Center. We are casting a wide net to get feedback on our models. These are working documents and will get stronger with broader input.” Dr. Kaufman described these models in an April 2016 AANnews® article. We committed to ensuring that our members have options under the new MACRA system, which allows professionals to pick between two options: the Merit-based Incentive Payment System (MIPS) pathway or participating in what CMS describes as an Advanced APM. We remain hopeful that our models will qualify under the APM track of MACRA and allow neurologists to negotiate new arrangements with payers.
Dr. Raphaelson emphasized, “The AAN is modelling several ways for neurologists to participate in new value-based payments. We want the neurologist to be free to provide best evidence-based care; CMS wants better outcomes even from specialists, and CMS also will require that we 'choose wisely' to limit costs. CMS intends to approve care and payment models that require the specialist and primary care physicians to more formally share responsibility for outcomes and costs-we may need new, cooperative clinical and financial relationships among specialist and primary care practices.”
CMS Releases Quality and Resource Use Reports
By Daniel Spirn, AAN Regulatory Counsel
To prepare for MACRA, we continue to encourage all members to review your Quality and Resource Use Reports (QRURs) and Physician Quality Reporting System (PQRS) feedback reports. With this in mind, it is important to note that CMS recently released its 2015 PQRS feedback reports. These reports provide the baseline information to determine if eligible professionals and group practices will be subjected to penalties.
CMS also released the 2015 Annual QRURs, which provide information on the quality and cost measures used to calculate the 2017 Value Modifier payment adjustment calculation. Details on how to access these reports can be found on the CMS website. The AAN also has helpful information on the PQRS program.
Please note that you are able to ask CMS to review any penalties. If you believe that a 2017 PQRS penalty is being applied in error, submit an informal review request by November 30, 2016, at 11:59 p.m. ET. CMS will investigate the merits of your informal review request and issue a decision within 90 days of receipt. To request an informal review, all requests must be submitted via a web-based tool on the Quality Reporting Communication Support Page.
For additional questions, contact the QualityNet Help Desk at (866) 288-8912. For questions about the content of the QRUR, contact the CMS Physician Value Help Desk at (888) 734-6563. They are available Monday through Friday from 8:00 a.m. to 8:00 p.m. ET.
Update on Zika, FAST Act, and New Medicare Part B Proposal
By Mike Amery, Esq., Senior Legislative Counsel, Federal Affairs
As expected, Congress adjourned last week after passing a continuing resolution funding government through December 9. The final funding bill included $1.1 billion to combat the Zika virus, which was a top priority of the AAN as the 114th Congress was coming to an end. The Academy would like to thank the many AAN members who responded to our advocacy action alert and contacted their senators and representatives to help push them to approve the Zika spending.
Congress will return after the November 8 elections in a “lame duck” session to ensure that the government remains open after December 9 and into 2017. There are a number of issues that Congress could take up in the lame duck session including consideration of the Furthering Access to Stroke Telemedicine (FAST) Act, HR 2799, which the AAN is pushing. The FAST Act now has 168 cosponsors and has gotten the attention of many members of Congress. The most recent endorsement was by Sen. Mark Warner (D-VA) who said as soon as we get a Congressional Budget Office score, he expects the bill will move. See below for more on the CBO score.
Another key issue Congress may deal with is a demonstration project proposed by CMS that seeks to cut costs by changing how physicians are reimbursed for the use of Medicare Part B drugs.
The AAN expects the CMS program to negatively impact AAN members and lead to access problems for patients with neurologic conditions. On Capitol Hill, we have been talking about the proposal with many members of Congress, as have patient advocacy organizations.
CMS has not published a final rule yet, but the proposal has created a truly interesting situation that might have constitutional implications. CMS bills the project as a “demonstration,” but it applies to all US physicians, except those in the state of Maryland. That is a pretty big demonstration project.
In Congress, hundreds of representatives and dozens of senators have weighed in by sending letters to CMS and legislation has been introduced by Rep. Larry Bucshon, MD, (R-IN) to prevent CMS from implementing the demonstration. The bill has 22 cosponsors.
Last week, the CBO issued a score of the bill, HR 5122. All bills considered by Congress must be first analyzed by the CBO to determine whether the legislation has fiscal implications, also known as a “score.” If the CBO determines that a new law will cost money, Congress is obligated to identify increased revenues to cover the cost or reduce spending elsewhere.
CBO has determined that the Bucshon legislation will cost $395 million. So, a government agency proposes a new regulation to reduce costs, Congress acts to stop the agency, and the CBO determines Congress must find money to cover the cost of stopping the agency's proposed savings. That is an interesting dilemma.