Trump Administration Releases Proposed FY 2020 Budget: Blueprint for Congress

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    On Monday, as required by law, the Trump Administration released its proposed FY 2020 federal government budget.  The budget is a draft proposal, or “blueprint,” for Congress to consider as lawmakers debate and finalize appropriations for federal agencies and federal programs.  The proposals were met with little support by lawmakers of both parties.

    ACG will continue to monitor the budget and appropriations process, including the following notables:

    • A proposed to cut NIH’s budget by $4.5 billion.
    • The National Cancer Institute’s budget would also be cut by $897 million.
    • A proposal to cut the CDC’s budget by $1.27 billion overall (the program focusing on vaccines for children would receive a $586 million increase).
    • Medicaid overhaul. The Trump administration is seeking a change to “block grant funding” and tighten eligibility standards. The proposal eliminates Medicaid’s open-ended funding in favor of sending fixed grants to states or setting per-person caps. With Democrats in control of the House, there is little chance Congress would approve any major changes to the program’s funding.

    ACG will oppose any cuts impacting GI research and patient care.

    ACG will also be very active on Capitol Hill on some other notables in the proposed budget related to Medicare and GI practice management:

    • The Physician Self-Referral Law (commonly referred to as the Stark Law): According to the draft, “Stark has been identified by as a significant impediment to care coordination, participation in alternative payment models, and the establishment of novel financial arrangements that further the goals of a value-based system.” Effective CY 2021, the Trump administration proposes to establish a new exception to the physician self-referral law for arrangements that arise due to participation in advanced Alternative Payment Models.
    • Implement Value-Based Purchasing Program for Outpatient Hospitals and Ambulatory Surgical Centers: According to the draft, “Medicare currently has value-based purchasing programs in place for inpatient hospital services and several other settings, but not for outpatient hospital services and ambulatory surgical centers.” Beginning in CY 2021, the Trump administration requests CMS to implement a value-based purchasing program for hospital outpatient departments and ambulatory surgical centers.
    • Redesign Outpatient Hospital and Ambulatory Surgical Center Payment Systems to Make Risk-Adjusted Payments: According to the draft, “Medicare currently bases payments for services furnished at outpatient hospital and ambulatory surgical centers on the setting of care rather than patient acuity.” The Trump administration proposes to risk-adjust payments to these facilities based on the severity of patients’ diagnoses. These adjustments would be made in a budget neutral manner.
    • Encourage Participation in Advanced Alternative Payment Models: According to the draft, “Effective CY 2020, the 5% bonus for clinicians in advanced Alternative Payment Models would be paid based on physician fee schedule revenues received through Models in which they participate rather than all Medicare physician fee schedule payments.”   This would result in $280 million in savings over 10 years.
    • Improve Safety and Quality of Care by Publicly Reporting Medicare Survey and Certification Reports Conducted by Accreditation Organizations: According to the draft, “accreditation organizations currently do not make their survey reports and accompanying ‘Plans of Corrections’ publicly available.” HHS is also prohibited from disclosing accreditation surveys that are not home health agencies surveys or related to an enforcement action. The Trump administration proposes to provide CMS with the authority to publish surveys for all accredited facilities, including hospitals, hospices, ambulatory surgical centers, outpatient physical therapy and speech-language pathology services, and rural health clinics.
    • Simplify and Eliminate Reporting Burdens for Clinicians Participating in the Merit-based Incentive Payment System: According to the draft, “the Merit-based Incentive Payment System (MIPS) is burdensome and overly complex, consisting of physician and other clinical level measures that are often not meaningful to clinicians who report them and do not help improve patient care.” Effective CY 2022, the Trump administration proposes to alter the MIPS program “by adopting a uniform set of broader claims calculated measures and simplifying beneficiary surveys to assess performance at the group practice level instead of the individual clinician level during the performance period to reduce burden and provide meaningful and comparable results to clinicians and patients.” This proposal would be budget-neutral.

    Whitfield L. Knapple, MD, FACG

    Chair, ACG Legislative and Public Policy Council

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