Half a Million Clinicians Face 2% Medicare Penalty This Year -AND- Senate Health Bill Would Revamp Medicaid, Alter ACA Guarantees, Cut Premium Support

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Mon Jul 10 10:57:07 PDT 2017



June 20, 2017


Half a Million Clinicians Face 2% Medicare Penalty This Year 



 <http://www.medscape.com/viewarticle/881870> Medscape



By Robert Lowes


Roughly 500,000 clinicians - half of them physicians - will see their
fee-for-service Medicare payments trimmed by 2% this year because they
didn't meet the requirements of the Physician Quality Reporting System
(PQRS) in 2015, the government announced earlier this month.


For a substantial number of these clinicians, the impact of the revenue cut
will be minor. In a report on PQRS performance in 2015, the Centers for
Medicare & Medicaid Services (CMS) said that almost 230,000 clinicians being
penalized had $10,000 or less in Medicare allowed charges that year. A 2%
pay cut based on the same level of charges in 2017 will top out at $200.


However, another 64,200 clinicians subject to the 2% penalty this year had
Medicare charges in 2015 that exceeded $100,000. If they bill Medicare for
just as much in 2017, they will forfeit more than $2000.


PQRS, launched in 2007, is a pay-for-reporting program widely decried by
physicians as unduly complicating their professional lives. Through 2014,
Medicare awarded bonuses to clinicians who successfully informed CMS how
they did on various measures of clinical quality. In 2015, Medicare began to
penalize clinicians who didn't meet PQRS requirements, nicking them by 1.5%
if they unsuccessfully reported their performance in 2013 or if they didn't
report it all.


The last year for PQRS penalties is 2018, when physicians will suffer the
consequences for botched or skipped reporting in 2016. In 2019, a new
Medicare reimbursement scheme called the Quality Payment Program (QPP) will
apportion bonuses and penalties on the basis of performance in 2017. 


One track of the QPP - the Merit-based Incentive Payment System (MIPS) -
combines and modifies PQRS, the Medicare electronic health record incentive
program, and the value-based modifier program.


MIPS Will Be Easier Than PQRS, Feds Say


Almost 1.4 million clinicians were eligible to participate in PQRS in 2015,
either by reporting quality data individually or by belonging to a group
that did.


As in the past, most of the clinicians subject to a 2% PQRS penalty this
year simply hadn't submitted any quality data to Medicare. However, the
percentage of penalized clinicians who had blown off the program in a prior
performance year decreased, going from 98% in 2015 to roughly 79% in 2017.
That paralleled an increase in the percentage of eligible clinicians who
participated in PQRS - 69% in 2015 compared with 51% in 2013.


Physicians least likely to participate in PQRS were those having fewer than
25 Medicare patients. Only about 54% of MDs and DOs in this category
submitted quality data in 2015, compared to almost 49% for all clinicians.


Participation rates varied by medical specialty, with pathologists and
radiologists ranking the highest at 89% and 87%, respectively. The
specialities with the lowest participation rates were psychiatry (39%) and
general practice (42%).


There were wide disparities in participation in terms of geography, too. In
Wisconsin, physicians and other clinicians posted the highest rate at 82%.
In last place was Alaska at 48%. In general, states in the Southeast,
Midwest, and New England led the way.


CMS cautions that no one should predict the level of participation in MIPS
on the basis of PQRS trends. For one thing, the quality-reporting
requirements under MIPS will be less complicated. In addition, MIPS will
exempt clinicians if they have 100 or fewer Medicare patients or $30,000 or
less in Medicare allowed charges, thresholds that don't exist in PQRS.




June 22, 2017


Senate Health Bill Would Revamp Medicaid, Alter ACA Guarantees, Cut Premium



5eq_8yHFSrr804d3Ut0Y358j-_q3kBxN3SOE1Y-08&_hsmi=53499938> Kaiser Health News



By Julie Rovner


Republicans in the U.S. Senate on Thursday unveiled a bill that would
dramatically transform the nation's Medicaid program, make significant
changes to the federal health law's tax credits that help lower-income
people buy insurance and allow states to water down changes to some of the
law's coverage guarantees.


The bill also repeals the tax mechanism that funded the Affordable Care
Act's benefits, resulting in hundreds of billions of dollars in tax cuts for
the wealthy and health care industry.


Most senators got their first look at the bill as it was released Thursday
morning, and some immediately voiced concerns. It had been crafted in secret
over the past several weeks. Senate Majority Leader Mitch McConnell (R-Ky.)
is seeking a vote on the bill before Congress leaves next week for its
Fourth of July recess.


Four conservative Republicans - a number large enough to stop the bill from
passage - announced in the afternoon that they were withholding support.
"Currently, for a variety of reasons, we are not ready to vote for this
bill, but we are open to negotiation and obtaining more information before
it is brought to the floor," said the statement from Sens. Rand Paul
(R-Ky.), Ted Cruz (R-Texas), Ron Johnson (R-Wis.), and Mike Lee (R-Utah).
"There are provisions in this draft that represent an improvement to our
current health care system, but it does not appear this draft as written
will accomplish the most important promise that we made to Americans: to
repeal Obamacare and lower their health care costs."


Senators had promised that their ACA replacement would be very different
than the version that passed the House in May, but the bill instead follows
the House's lead in many ways.


At lightning speed and with a little over a week for wider review, the
Republicans' bill could influence health care and health insurance of every
American. Reversing course on some of the more popular provisions of the
Affordable Care Act, it threatens to leave tens of millions of lower-income
Americans without insurance and those with chronic or expensive medical
conditions once again financially vulnerable.


Like the House measure, the Senate bill, which is being called a "discussion
draft," would not completely repeal the ACA but would roll back many of the
law's key provisions. Both bills would also - for the first time - cap
federal funding for the Medicaid program, which covers more than 70 million
low-income Americans. Since its inception in 1965, the federal government
has matched state spending for Medicaid. The new bill would shift much of
that burden back to states.


The bill would also reconfigure how Americans with slightly higher incomes
who don't qualify for Medicaid would get tax credits to help pay insurance
premiums and eliminate penalties for those who fail to obtain insurance and
employers who fail to provide it. It also would make it easier for states to
waive consumer protections in the ACA that require insurance companies to
charge the same premiums to sick and healthy people and to provide a
specific set of benefits.


"We agreed on the need to free Americans from Obamacare's mandates, and
policies contained in the discussion draft will repeal the individual
mandate so Americans are no longer forced to buy insurance they don't need
or can't afford; will repeal the employer mandate so Americans no longer see
their hours and take-home pay cut by employers because of it," McConnell
said on the floor of the Senate after releasing the bill. He also noted that
the bill would help "stabilize the insurance markets that are collapsing
under Obamacare as well."


As expected, Senate Minority Leader Chuck Schumer (D-N.Y.) assailed the
bill, saying it would "strip away health care benefits and protections from
Americans who need it most" through changes in Medicaid and the ACA's
essential health benefits. "Even though much of the early reporting says the
bill will keep certain protections for Americans with preexisting
conditions," he added, "the truth is it may well not guarantee them the
coverage they need. By allowing states to waive essential health benefits,
what the bill is saying to those Americans is: Insurance still has to cover
you, but it doesn't have to cover what you may actually need; it doesn't
have to cover all or even most of your costs."


The White House had no immediate comment, but President Donald Trump has
been pressuring Congress to pass a health bill quickly.


It is not clear that the bill will make it through the Senate, or that all
of it will even make it to the Senate floor. The Senate (like the House) is
operating under a special set of budget rules that allow it to pass this
measure with only a simple majority vote and block Democrats from dragging
out the debate by using a filibuster. But the "budget reconciliation"
process comes with strict rules, including the requirement that every
provision of the bill primarily impact the federal budget, either adding to
or subtracting from federal spending.


For example, the legislation as released includes a one-year ban on Medicaid
funding for Planned Parenthood. That is a key demand of anti-abortion groups
and some congressional conservatives, because Planned Parenthood performs
abortions with non-federal funding. But it is not yet clear that the Senate
parliamentarian will allow that provision to be included in the bill.


Also still in question is a provision of the Senate bill that would allow
states to waive insurance regulations in the Affordable Care Act. Many
budget experts say that runs afoul of Senate budget rules because the
federal funding impact is "merely incidental" to the policy.


Drafting the Senate bill has been a delicate dance for McConnell. With only
52 Republicans in the chamber and Democrats united in opposition to the
unraveling of the health law, McConnell can afford to lose only two votes
and still pass the bill with a tie-breaking vote from Vice President Mike


Sen. Tim Scott (R-S.C.) told reporters that he is "open to moving forward on
the bill" but expects negotiations will result in more changes. "We have a
lot of time now, seven days, to figure out what we like, what parts we plan
to keep. This is only draft legislation."


McConnell has been leading a small working group of senators - all men - but
even some of those have complained they were not able to take part in much
of the shaping of the measure, which seems to have been largely written by
McConnell's own staff.


So far, McConnell has been fielding complaints from the more moderate and
more conservative wings of his party. And the draft that has emerged appears
to try to placate both.


For example, as sought by moderates, the bill would phase down the Medicaid
expansion from 2020 to 2024, somewhat more slowly than the House bill does.
But it would still end eventually. The Senate bill also departs from the
House bill's flat tax credits to help pay for insurance, which would have
added thousands of dollars to the premiums of poorer and older people not
yet eligible for Medicare.


A Congressional Budget Office report estimating the Senate bill's impact on
individuals and the federal budget is expected early next week. The House
bill, according to the CBO, would result in 23 million fewer Americans
having health insurance over 10 years.


For conservatives, however, the Senate bill would clamp down even harder on
Medicaid in later years. The cap imposed by the House would grow more slowly
than Medicaid spending has, but the Senate's cap would grow even more slowly
than the House's. That would leave states with few options, other than
raising taxes, cutting eligibility, or cutting benefits in order to maintain
their programs.


Defenders of the health law were quick to react.


Sen. Ron Wyden (D-Ore.) complained about changes to coverage guarantees in
the ACA.


"I also want to make special note of the state waiver provision. Republicans
have twisted and abused a part of the Affordable Care Act I wrote to promote
state innovation, and they're using it to give insurance companies the power
to run roughshod over individuals," he said in a statement issued shortly
after the bill was released. "This amounts to hiding an attack on basic
health care guarantees behind state waivers, and I will fight it at every


"The heartless Senate health care repeal bill makes health care worse for
everyone - it raises costs, cuts coverage, weakens protections and cuts even
more from Medicaid than the mean House bill," said a statement from Protect
Our Care, an umbrella advocacy group opposing GOP changes to the health law.
"They wrote their plan in secret and are rushing forward with a vote next
week because they know how much harm their bill does to millions of people."


Tony Brooks, 42, from Philadelphia, was one was of the 60 or so people with
disabilities who crowded the hallway around McConnell's office to lobby the
senators to not cut Medicaid funding. Without Medicaid, Brooks, who uses a
wheelchair, said he wouldn't be able to afford his medication, his rent and
his medical care. Brooks got choked up when he talked about a friend who had
to stay in a nursing home until his death because insurance wouldn't cover
the care he needed to go home. Without Medicaid, Brooks said he was afraid
he would end up in a nursing home or shelter too.


"We are people with disabilities, we are human beings. Don't look at us as
garbage," Brooks said.




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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