Congress Adjourns Without Alleviating Cuts to Colonoscopy but Eases Meaningful Use Burdens

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    Congress closed out 2015 by passing the fiscal 2016 spending package, appropriating funds for the various federal agencies and programs. This “omnibus” package includes a variety of federal tax changes as well.   ACG is very disappointed that Congress decided to fast-track a separate package of Medicare related policy changes that did not include the SCREEN Act or any language preventing looming Medicare reimbursement cuts to colonoscopy from going into effect January 1, 2016. However, the package did include one of ACG’s top policy priorities: easing Meaningful Use practice burdens and costs.

    Medicare Policy Changes Delayed: Blanket Hardship Exemption for Modified Stage 2 Meaningful Use; ACG to continue the fight against cuts to colonoscopy

    Before adjourning for 2015, Congress decided to push a limited package of Medicare policy changes. Unfortunately, this means that unwarranted and unfair Medicare cuts to colonoscopy will likely occur beginning January 2016. ACG and an alliance of patient advocates will continue to urge Congress to include the SCREEN Act in any future Medicare package. ACG also urges you to ramp up your advocacy efforts and sign ACG’s Medicare Colonoscopy petition, and to persuade your colleagues and patients to sign it as well. Please note that these numbers reflect the totals of both the online signatures and paper petitions submitted to the ACG office. Tell Congress to pass the SCREEN Act via this pre-drafted email to your elected officials. The SCREEN Act can still be passed in 2016. ACG will continue this fight on behalf of our membership despite Congress’s unwillingness to prevent the cuts from occurring in the first place.

    The Medicare package did include a mandate for CMS to implement blanket hardship exemption for Meaningful Use Stage 2.   Reducing the burdens and costs associated with Meaningful Use continues to be a top priority for ACG. Congress passed a provision granting CMS the authority to expedite applications for exemptions for Meaningful Use Modified Stage 2 requirements for the 2015 calendar year. Eligible professionals must attest that they met the requirements for Meaningful Use Stage 2 for a period of 90 consecutive days during calendar year 2015 or face a penalty.  However, CMS did not even finalize these Modified Stage 2 requirements until October 2015. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.

    CMS has previously stated that it will grant hardship exemptions for 2015 if eligible providers are unable to attest due to the lateness of the rule, but only on a “case-by-case basis.” However, Congress now authorizes CMS to implement this hardship exemption in a more generous manner and efficient process.

    ACG Governors were on Capitol Hill in April 2015, educating Members of Congress about these practice management burdens and costs associated with meeting onerous Meaningful Use requirements. ACG has also endorsed and advocates for various legislation on Meaningful Use, including a bill to improve functionality and interoperability among electronic health record software (S. 2141), and legislation that excludes patient encounters at ambulatory surgical centers (ASCs) from counting towards Meaningful Use (S. 1347/HR 887), as well as the bill that was ultimately passed and provides for exemption for Modified Stage 2 Meaningful Use (HR 3940). ACG has also joined many other specialty societies in calling on Congress/HHS to improve or delay this onerous program altogether.

    Provisions in the Omnibus Package and Relevance to GI

    The omnibus package includes health care related issues such as a delay in the 2010 health reform law’s (ACA) medical device excise tax. This 2.3% medical device tax, which went into effect in 2013, would be delayed until 2016 and 2017. This may impact ACG members because any tax may simply be passed to the consumers of these medical devices, or facilities affiliated with ACG members.

    The omnibus spending bill also delays levies on high-cost employer health plans, widely known as the “Cadillac tax,” from its scheduled start in 2018 until 2020. This is relevant to ACG members as many employer organizations, businesses, and unions say the tax will hit a growing number of health insurance plans than only those with overly generous benefits. Thus, this may potentially trigger employers to scale back their health plans or pass on cost-sharing to health plan beneficiaries. In 2018, the threshold for the tax will be $10,200 for self-only coverage and $27,500 for family plans, with a 40% tax imposed on amounts over those limits in an effort to reign in on health care costs.   The legislation also suspends the ACA’s annual tax on insurers, which took effect in 2014, for one year in 2017.

    The health insurance tax delays contribute toward $57 billion in added deficit spending, estimated by the Congressional Budget Office. A separate estimate pegged a $3.9 billion cost for the delay of the medical device tax.

    Other highlights worth noting:

    • Reduces Medicare payment for the technical components for film x-ray (not digital) and computed radiography, as well as the hospital outpatient department facility fees for these services.
    • Reduces the professional component for multiple imaging services.
    • The Agency for Healthcare Research and Quality budget would be cut to $334 million from $363.7 million
    • The National Institutes for Health (NIH) budget would increase by $2 billion ($32 billion). This includes $100 million for research on antimicrobial resistance.
    • Centers for Disease Control (CDC) and Prevention budget would rise by $300 million to $7.2 billion. This includes $70 million to increase efforts to combat opioid prescription drug use.
    • Funding for the independent payment advisory board (IPAB) was cut by $15 billion, although the panel has never been established

    Congress included language requiring HHS to ignore the recent U.S. Preventive Services Task Force’s recommendation on breast cancer screening for 2 years.

    Brad Conway, ACG Vice President of Public Policy

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