Rheumatology Practice Management October 2016 Vol 4 No 5 - CMS News

In This Article

CMS Recruits American College of Rheumatology Leader for MACRA Committee

The Centers for Medicare & Medicaid Services (CMS) has recruited Alex Limanni, MD, FACR, Chief of Rheumatology, Baylor Medical Center, Dallas, TX, to its Medicare Access and CHIP Reauthorization Act (MACRA) Episode-Based Resource Use Measures Clinical Committee, according to a recent press release by the American College of Rheumatology (ACR).

The ACR nominated Dr Limanni for this appointment based on his demonstrated expertise as current co-chair of the ACR’s Quality Measures Subcommittee. In his capacity as co-chair, Dr Limanni manages the creation and testing of ACR measures with the aims of improving patient care and helping rheumatology providers comply with reporting requirements.

As part of the MACRA committee, Dr Limanni will continue to strive for these goals by contributing to the creation of episode-based resource use measures that can be employed in the new CMS Merit-Based Incentive Payment System. This entails outlining episode triggers and windows for care episode and patient condition groups, in addition to offering feedback on the algorithm for episode grouping, and approaches to the development of measures.

“We are pleased to hear that Dr Limanni was chosen to aid CMS in what will surely be a very complex endeavor. He has made great contributions to the practice of rheumatology, and the committee will be well-served by his expertise in developing effective measures of quality patient care,” said Joan Von Feldt, MD, MSEd, President, ACR, Atlanta, GA, in the ACR press release.

In recent years, Dr Limanni has played a huge part in the approval of numerous ACR-endorsed clinical practice guidelines, and has obtained endorsement from the National Quality Forum for 3 gout measures and 4 rheumatoid arthritis measures. He has also overseen the creation and implementation of 4 rheumatology measures for practice improvement in the ACR RISE Registry.

In addition to his appointment with the CMS MACRA committee and leadership role with the ACR, Dr Limanni is a clinical rheumatologist and investigator at the Arthritis Centers of Texas, Dallas, and a clinical assistant professor in the Department of Internal Medicine at Texas A&M Health Science Center College of Medicine, Bryan.

American College of Rheumatology. American College of Rheumatology leadership appointed to MACRA committee. Published September 1, 2016. Accessed October 10, 2016.

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Rheumatology Community Urges Congressional Leaders to Stop Medicare Part B Demo Project

In mid-September, more than 100 rheumatologists and patient advocates from the ACR convened on Capitol Hill to urge congressional leaders to halt the proposed Medicare Part B Payment Demonstration Project, the ACR recently announced. This proposed Part B rule threatens to limit patient access to biologic therapies, which serve as lifelines for millions of patients in the United States who have rheumatic diseases (eg, rheumatoid arthritis, lupus). Biologics also help individuals manage pain, avoid long-term disability, and stay active in society and the workforce.

The Capitol Hill Day was the second day of the Advocates for Arthritis legislative fly-in, held September 12-13, 2016, in Washington, DC. The goal of this annual event is to provide support to the rheumatology community and improve policymakers’ understanding and awareness of rheumatic diseases, in addition to the significant healthcare challenges faced by Americans living with these chronic, painful, and incapacitating conditions.

According to the Centers for Disease Control and Prevention (CDC), more than 52.5 million people live with rheumatic diseases, which remain the leading cause of disability in the United States and contribute to more than $128 billion in US healthcare costs annually.

“The proposed Part B rule ignores the healthcare needs of millions of Medicare patients living with rheumatic diseases, for whom safe access to biologic therapies is not an option but a necessity. The health and safety of our Medicare patients is now in jeopardy due to proposed payment cuts that restrict their ability to access safe and affordable biologic therapy infusions,” stated William Harvey, MD, MSc, FACR, Chair, Government Affairs Committee, ACR, Atlanta, GA, in a press release by the organization.

As it stands, the Part B rule will make it financially challenging for many rheumatologists to provide biologic therapy infusions to their patients in the outpatient setting. Further cutbacks proposed by CMS will leave such patients with no choice but to receive therapies—if they can even access these biologics—in less safe or more costly settings, the ACR has cautioned.

In the event that the finalized Part B rule fails to sufficiently address the key concerns outlined by the rheumatology community, ACR advocates have urged leaders in Congress to obstruct implementation of the Part B Demonstration Project by limiting funds or passing legislations against its activation (eg, the recently proposed HR 5122).

In early 2016, the ACR penned a comment letter to CMS through which they expressed concerns regarding the shortage of less costly albeit clinically comparable biologic therapies for Medicare patients with rheumatic diseases. The ACR also highlighted the safety and health hazards of switching a patient from a biologic therapy that works well for him or her, and the fact that most rheumatology providers are based in small or rural practices and cannot negotiate bulk discounts with pharmaceutical companies. Because of this, the current Medicare payment structure does not include costs for obtaining, storing, administering, and monitoring complex biologic therapy infusions in the outpatient setting, according to the ACR.

During their meetings with congressional leaders, ACR advocates also asked lawmakers to consider co-sponsoring the Medicare Access to Rehabilitation Services Act (HR 775, S. 539), which would revoke the Medicare cap on outpatient physical therapy, speech language pathology, and occupational therapy services. ACR advocates also asked members of Congress to support increased funding for arthritis research at the National Institutes of Health, Department of Defense, and CDC.

American College of Rheumatology. Rheumatology community to Congress: Stop Medicare Part B Demonstration Project to preserve patient access to lifesaving care. Published September 13, 2016. Accessed October 10, 2016.

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CMS Announces New Initiative to Increase Clinician Engagement

The CMS announced a new initiative to improve the clinician experience with the Medicare program, according to a press release by the agency. The aim of this new, long-term initiative is to reshape the physician experience by reviewing regulations and policies to reduce administrative tasks and to seek additional input to improve clinician satisfaction. These efforts will be led by senior physicians within CMS who will report to the Office of the Administrator.

“Physicians and their care teams are the most vital resource a patient has. As we implement the Quality Payment Program under MACRA, we cannot do it without making a sustained, long-term commitment to take a holistic view on the demands on the physician and clinician workforce,” said Andy Slavitt, CMS Acting Administrator. “The new initiative will launch a nationwide effort to work with the clinician community to improve Medicare regulations, policies, and interaction points to address issues and to help get physicians back to the most important thing they do—taking care of patients.”

Mr Slavitt is appointing Shantanu Agrawal, MD, MPhil, to lead the development of this function and implementation, which will cover documentation requirements and existing physician interactions with CMS, among other aspects of provider experiences. To ensure CMS is hearing from physicians on the ground, each of the 10 CMS regional offices will oversee local meetings to obtain input from physician practices within the next 6 months and regular meetings thereafter. The information from these meetings will be included in a report, along with targeted recommendations to the CMS Administrator in 2017. Three of CMS’s regional Chief Medical Officers—Barbara J. Connors, DO, MPH, in Philadelphia, PA; Ashby Wolfe, MD, MPP, MPH, in San Francisco, CA; and Richard E. Wild, MD, JD, MBA, FACEP, in Atlanta, GA—have agreed to serve as regional champions of this initiative.

“CMS is turning a new page in assessing not only how to reward for quality, but also to reduce administrative hurdles,” said Dr Agrawal. “I look forward to hearing about what steps we can take to make the practice of medicine in Medicare more efficient and rewarding.”

The first action is the launch of an 18-month pilot program to minimize medical review for certain physicians while continuing to protect program integrity. Under this program, providers practicing within specified Advanced Alternative Payment Models (APMs) will be relieved of some scrutiny under certain medical review programs. After the results of the pilot are analyzed, CMS will consider expansion along various dimensions, including additional Advanced APMs, provider types, and specialties.

“Like all successful changes, we will begin with the basic steps and build over time,” said Dr Wolfe, Region IX Chief Medical Officer. “Most importantly, we are excited to build on the listening and engagement process we began this year by creating more opportunities for physicians to interact with CMS, especially through our regional offices.”

Centers for Medicare & Medicaid Services. CMS announces new initiative to increase clinician engagement. Published October 13, 2016. Accessed October 14, 2016.

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CMS Reveals New Flexible Options for Complying with MACRA Requirements

In response to the feedback received regarding the implementation of the Quality Payment Program (QPP), which are provisions of MACRA, CMS has announced that the program will allow physicians to choose how they participate in the first performance period beginning on January 1, 2017.

“We received feedback on our April proposal for implementing the QPP [Quality Payment Program], both in writing and as we talked to thousands of physicians and other clinicians across the country. Universally, the clinician community wants a system that begins and ends with what’s right for the patient,” said Andy Slavitt, Acting Administrator, CMS, in a blog post recently released by the agency.

According to the post, physicians and other clinicians responded to the QPP proposal with information about how technology can benefit patient care, and how too much reporting can distract from patient care; how to encourage medical homes and other new programs; as well as about the unique issues that physicians in small and rural nonhospital locations face.

Although these areas will be addressed when the final rule is released—either before or on November 1, 2016—Mr Slavitt stated that CMS wanted to share its plans regarding the timing of reporting for the program’s first year.

“In recognition of the wide diversity of physician practices, we intend for the QPP to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017. During 2017, eligible physicians and other clinicians will have multiple options for participation,” he explained.

Four options are described in the blog post as follows:

  • Option 1 - Test the program
    As long as some data are submitted to the program (including data from after January 1, 2017), participants will avoid receiving a negative payment adjustment. This option is reportedly designed to guarantee that the practice’s system is working, and that they are ready to participate more broadly in the coming 2 years
  • Option 2 - Participate for part of 2017
    With this option, participants may submit information for fewer days, and begin their performance period later than January 1, 2017, while still qualifying for a small positive payment adjustment.
  • Option 3 - Participate for all of 2017
    Participants whose practices are ready to begin the performance period on January 1, 2017, may submit QPP information for the full year. Mr Slavitt noted that CMS has “seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so.”
  • Option 4 - Participate in an Advanced Alternative Payment Model
    In lieu of quality data and other information, participants may join an Advanced Alternative Payment Model (APM, eg, Medicare Shared Savings Track 2 or Medicare Shared Savings Track 3) in 2017. Participants who receive enough Medicare payments, or who see enough Medicare patients throughout 2017 with the Advanced APM would qualify for a 5% incentive payment in 2019.
“Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019,” he stated in the blog post, adding that these options and other particulars will be described in detail in the final rule.

Regardless of which option a participant chooses for 2017, Mr Slavitt stated that CMS will have resources available to assist practices with finding out what needs to be done, and that all participant feedback will be instrumental in the future of this program.

“We appreciate the sincere and constructive participation in the feedback process to date and look forward to advancing step-by-step in that same spirit….Most importantly, we look forward to further engagement with physicians and other clinicians toward our shared goal of the highest quality of care and best outcomes for patients,” he concluded.

Centers for Medicare & Medicaid Services. Plans for the Quality Payment Program in 2017: Pick your pace. Published September 8, 2016. Accessed October 14, 2016.

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