Monday Rx - February 12, 2018 February 12, 2018 Tag 911 Healthcare Provisions in the Budget Agreement Last week, President Trump signed a two-year bipartisan budget agreement that ended the brief government shutdown. It would increase both defense and domestic spending by ~$300 billion over two years and is loaded with healthcare provisions. Highlights 1. Spending Offsets Medicare Physician Payment Cut of 0.25% in 2019. CMA Opposed. The Act cuts Medicare physician payments by 0.25% in 2019 to extend other expiring programs within Medicare. The Medicare physician payment originally started out as a two-year cut: 0.5% in 2019 and a larger cut in 2020. The 2020 cut was projected to reduce the fee schedule base below 2015 payment levels. The cuts would be achieved by revaluing misvalued services and making cuts if certain spending targets were not realized. After intense pressure from organized medicine, the House removed the 2020 payment cut in their stopgap bill. The AMA negotiated a further reduction in the cut from 0.5% to 0.25% at the last minute in the Senate. While this is an improvement over the original proposal, CMA/LACMA are extremely frustrated that the cuts are even in the bill. This cut will reduce by half the 0.5% payment update guaranteed to doctors in the MACRA legislation. CMA warned Congress that physicians cannot meet the difficult MACRA quality and EHR reporting requirements without adequate resources. We told them that Congress was going back on their MACRA agreement to provide annual stable updates. See the CMA letter to the California Congressional Delegation. CMA leaders are in Washington, D.C. this week and will be asking Congress to restore the MACRA payment cuts from 2016 and 2019 and to fund payment increases going forward. All other Medicare providers received payment cuts to offset other spending, including Pharma who is funding the Medicare Part D donut hole for seniors. Medicare premiums for wealthier seniors will rise. Individuals earning more than $500,000 or families earning more than $750,000 will pay 85% of the cost of Part B and Part D premiums instead of 80%. The ACA Public Health and Prevention Fund was cut by ~ $2 billion over 10 years to offset other funding increases. CMA opposed. 2. Health Care Improvements There is some good news.The bill provides improvements that CMA has been advocating. Extensions and Repeals -Extends and stabilizes the expired Children's Health Insurance Program (CHIP) for ten years. -Extends the expired Teaching Health Center Primary Care GME program for two years and doubled the funding; CMA was instrumental in the House-passed funding increase. -Repeals the Medicare Independent Payment Advisory Board (IPAB) slated to make arbitrary Medicare program budget cuts without Congress' approval. MACRA Improvements (AMA-sponsored) -Removes the cost of Part B Drugs from the cost category calculations which will help physicians. -Removes the cost of Part B Drugs from the total physician billings so that more physicians will be exempt from MIPS. -Reduces the weight of the cost category to 10% for the next three years which will reduce its negative impact. -The threshold for success in the cost category will be set at either the mean or median-again helping to keep physicians out of the penalty zone. -Provides more authority to the Physician Focused Payment Model TAC to provide actual feedback to physicians developing and submitting new payment models. EHR Improvements -Removes the mandate that the standards become more strict over time. -Reduces the Advancing Care Information/Meaningful Use EHR requirements. -Provides $6 billion in funding for mental health and the opioid crisis (new state grants for prevention, treatment, and law enforcement). -Increases funding for NIH research and CDC. -Provides funding for the community health centers and the National Health Service Corps. -Expands Medicare telehealth services and access. -Repeals the Medicare outpatient therapy caps. -Allows Medicare Shared Savings ACOs to prospectively assign enrollees to the ACO. 3. Outstanding Issues DACA There is no deal on DACA or immigration. Those negotiations will continue. ACA Market Stabilization None of the bipartisan ACA market stabilization provisions were included. However, the Senate budget agreement sets up an omnibus spending bill for consideration in late March that leaders say could be used as a vehicle to stabilize the individual insurance markets. Senators Alexander (R-TN) –Murray (D-WA) continue their work to achieve a bipartisan market stabilization bill that would for two years fund the cost-sharing payments that help low-income families afford co-payments and deductibles and it would fund reinsurance to cover the high-cost, catastrophic cases in order to bring down premiums for everyone. There is also a bill in the House authored by Rep Costello (R-PA) that would provide funds for states to use for reinsurance programs that cover high-cost patients. The reinsurance idea is gaining momentum partly because individual market/ACA Exchange premium hikes are expected to be announced right before the 2018 midterm elections unless more can be done to bring them down. CMA supports Alexander-Murray. We also support the reinsurance provisions in the Costello bill but it also includes abortion restrictions that we do not support. The CMA physician leaders are in Washington, D.C. this week fighting to restore physician payment cuts and provide a framework for updates in the future, urging passage of the market stabilization reinsurance bills, finding a permanent solution for the "Dreamers" who include over 100 medical students, and to provide massive regulatory relief for physicians. We will also be fighting the new federal regulation that sets limits on the dosage and duration of opioid prescriptions. CMA will meet with the leaders in Congress and Seema Verma, the head of the Centers for Medicare and Medicaid Services. See CMA's "Top Ten Priorities for Regulatory Relief." Never underestimate your membership. LACMA and CMA are hard at work advocating on your behalf and only through your membership are we able to continue our efforts. Thank you to all those members who share their concerns and issues each week. I assure you that I am listening and taking action. Three Weeks Until the 2nd Annual Saving Private Practice ConsortiumI sincerely encourage you to join us on Saturday, March 3rd at the 2nd Annual Saving Private Practice Consortium so that we can hear from you, learn about your needs and the challenges you face, while also providing you with the opportunity to interact with 25 healthcare industry experts who can offer you one-on-one assistance in real time, all at no cost to you. This is real, tangible value that, in just one day, can more than make up for the cost of membership. Your office staff is also invited at no cost to you. You can see the event agenda, review the areas of help and register here or email sheila@lacmanet.org with your RSVP. I also encourage you to share information about the event with your colleagues and affiliated medical centers. See some highlights from last year's Consortium here: Time is Running Out-Renew Your Membership Membership renewals were due by December 31st, but there is still time before your membership is dropped! Renew NOW! Save the Date Los Angeles County Medical Association's Annual Installation of Officers June 21, 2018 Hotel Casa del Mar 1910 Ocean Way Santa Monica, CA 90405 R.S.V.P lisa@lacmanet.org CME Opportunity City of Hope Presents How the Experts Treat Hematologic Malignancies March 15-17 Mandarin Oriental Las Vegas, NV Download Information and Registration Form City of Hope designates this live activity for a maximum of 16.25 AMA PRA Category 1 Credits Thank you! Gustavo Friederichsen Chief Executive Officer Los Angeles County Medical Association "If it matters to our LACMA members, it matters to me."