STATLINE

Read the Latest Issue of STATLINE

In This Issue:

• CAP and Other Specialty Societies Ask CMS to Reduce 2018 MIPS Reporting Period
• Deadline Approaching to Participate in CMS Study on MIPS Reporting Problems
• Complete Board Certification Survey by May 11
• In Major Defeat for Health Insurance Payers, New Jersey Legislature Rejects State Formula for Out-of-Network Payment
• 2018 Practice Leader Survey Opens April 30
• Be Heard at Next Week’s 2018 Policy Meeting

The CAP, the American Medical Association, and other physician specialty societies, urged the Centers for Medicare & Medicaid Services (CMS) to reduce the 2018 Merit-based Incentive Payment System (MIPS) reporting period from a full calendar year to a minimum of 90 consecutive days. The groups advocated for the reduction in an April 16 letter to the CMS and cited the lack of timely and direct notification to physicians about MIPS eligibility to support the request.

Moreover, there will be a delay by the CMS in updating the Quality Payment Program interactive website with 2018 information. The website is not expected to be updated until this summer. The two delays combined make it extraordinarily difficult for clinicians to meet the full-year quality data reporting requirements for 218 MIPS reporting. The physician groups also demanded a reduced reporting period for future MIPS program years in order to reduce administrative burdens and ensure physicians have sufficient time to report after receiving performance feedback from the CMS.

To determine whether they are eligible for the MIPS program, physicians must actively consult the CMS' website. To check your MIPS participation status go to HTTPS://QPP.CMS.GOV/.

The CAP is committed to working with the CMS to reduce reporting burdens and will continue to advocate for timely notification by the CMS on program changes to ensure successful participation for pathologists.

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The CMS wants to learn more about reporting issues and burdens that practices have encountered with MIPS. As part of our MIPS advocacy for pathologists, the CAP continues to ask the CMS to reduce the administrative burden of MIPS reporting, and the CMS has responded by asking physicians directly for their feedback. The CMS is accepting applications for this study through April 30, 2018.

Currently the CMS is studying the Burdens Associated with Reporting Quality Measures in 2018, as outlined in the 2018 Quality Payment Program final regulation. The CMS study runs from April 2018 to March 2019, and was first reported in STATLINE on March 6.

In the study, the CMS would like to know and learn about:

• Clinical workflows and data collection methods using different submission systems when reporting on MIPS.
• Understand any challenges you have when you collect and report quality data.
• Recommend any changes that would lower your burden, improve quality data collection and reporting, and enhance clinical care.

The study runs from April 2018 to March 2019. In order to complete the study and earn full improvement activity credit, you’ll need to do the all of the following:

• Complete a 2017 MIPS participation survey in April/May 2018.
• Complete a 2018 MIPS planning survey in September/October 2018.
• If invited by the study team, you must join a virtual 90-minute focus group between November 2018 and February 2019.
• You must meet minimum requirements for the MIPS quality performance category by submitting data for at least three measures in the MIPS quality performance category, as required for 2018 MIPS participation. The data submitted must:
  • Include one outcome measure.
  • Be submitted to us by the March 31, 2019, final MIPS reporting deadline.
  • Be submitted through any method accepted under 2018 MIPS Quality Payment Program.

If you report as a group, your entire group will earn credit. If you report as individuals, only you will earn credit.

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“Vision for the Future” is an initiative of the American Board of Medical Specialties, professional medical organizations, hospitals and health systems, and other key stakeholders to assess the future structure and requirements for continuing board certification for physicians (formerly Maintenance of Certification or “MOC”). The CAP wants to ensure that the pathologist voice is heard. This is your opportunity to help shape the future of board certification by completing this brief survey by May 11: HTTPS://CAPATHOLO.GY/2QCP9EJ.

Your input is critical and will impact current and future pathologists. Thank you for your participation in designing the future of continuing board certification and the profession.

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Legislation has passed the New Jersey legislature to prohibit balance billing of patients by out-of-network (OON) physicians at in-network facilities, including out of network laboratory services ordered by in-network providers at facilities. The CAP has requested a conditional veto of the bill.

Currently, New Jersey regulations require that such patients at in-network facilities be held financially harmless by their health insurance payers for any charges exceeding applicable co-payments, co-insurance and deductibles. Similarly, the legislation expressly requires the payers to be financially responsible for such charges and if “the carrier and the professional cannot agree on a reimbursement rate for the services … the carrier, professional, or covered person, as applicable, may initiate binding arbitration,” to determine the appropriate payment to the health care provider. The bill does not establish an out-of-network payment methodology.

For more than five years, health insurance payers in New Jersey tried unsuccessfully to limit OON payment to in-network rates or a percentage of Medicare. If signed into law, New Jersey, by foregoing a state mandated payment formula for out of network payment, coupled with a ban on balance billing, will join other states with similar laws, including Arizona, Minnesota, Delaware, Florida, and Illinois. It is believed that the health insurance industry will be seeking a veto of the bill.

The bill passed the Assembly by a vote of 48-21 with three abstentions and the Senate by a vote of 21-13. The bill received the backing of the New Jersey Hospital Association. Both the CAP and New Jersey Society of Pathologists (NJSP) are joining the physician and medical society coalition in requesting a conditional veto of the bill in order to seek changes to the legislation. With a conditional veto, the New Jersey Governor can request certain changes in the legislation as a pre-condition for signing the bill into law. Specifically, both the NJSP and CAP object to provisions in the bill to expressly outlaw and sanction any physician waiving of charges for patients, based upon the patient’s economic circumstances.

CAP, NJSP Seek Conditional Veto

In a letter to New Jersey Governor Philip Dunton Murphy, the CAP and the NJSP argued that while the bill constructively builds upon protections for patients, it contains a provision that is clearly anti-patient and anti-consumer and designed to financially benefit the health insurance industry. “Specifically, the bill makes it an unlawful practice for physicians to waive charges for patients in economic distress,” said the CAP and NJSP.

“To construe any physician waiver of co-payments, co-insurance, or deductibles on any patient claim, regardless of the patient’s economic status, as a potentially fraudulent activity by the physician, is an irresponsible and harmful application of law to benevolent physicians and to patients,” the CAP and NJSP said.

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Do you wonder if your pathology practice has the same issues as other practices across the nation? If so, the CAP 2018 Practice Leader Survey (PLS), which opens on April 30, will collect information from practice leaders about practice demographics, patient case mix, staffing trends, impacts of mergers and acquisitions, and the impact from regulatory issues and an evolving healthcare marketplace.

Since 1994, the CAP has fielded a Practice Characteristics Survey and Practice Leader Survey to gather socioeconomic data about CAP members. Data from these surveys are critical to helping the CAP understand the services pathologists are providing, where they are providing those services, how long they have been in practice, their income, and retirement plans. These data, in turn, help CAP to understand which Advocacy issues are most important to our members and to help us provide data to support our positions with lawmakers and regulators.

The 2018 PLS is the second Advocacy survey targeting pathology practice leaders. Practice leaders will receive an email with the survey link the week of April 30. The link will also be sent to many practice managers and administrators, with a request that they bring the survey to the attention of their practice leader. CAP members should encourage their practice leader to take the survey, which only takes 20 minutes to complete. There will be one survey per practice. Those practices that complete the 2018 PLS will be eligible to win one of three $150 Amazon gift cards. The PLS is confidential. Anyone taking the survey will remain anonymous and results will only be shared in aggregate form.

All survey participants will be able to view an exclusive webinar that will review the findings later this year.

For questions about completing the survey, or if you want to make sure that your practice leader received the survey, please email PRACTICESURVEY@CAP.ORG.

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Can pathologists really make a difference in helping to drive change? Yes, and at next week’s annual 2018 Policy Meeting, CAP members will meet with House and Senate offices to discuss the issues important to pathologists and their patients.

CAP members can hear keynote speakers Judy Woodruff, Charlie Cook, and William Kristol provide a unique perspectives on the potential impact of the 2018 mid-term elections at the Policy Meeting, which is next week, April 30 – May 2, at the Washington Marriott in Washington, DC.

Ms. Woodruff is the anchor and Managing Editor of “PBS NewsHour,” and has covered politics and other news for more than four decades at CNN, NBC, and PBS. While Mr. Kristol is the editor-at-large of The Weekly Standard, is a regular on ABC’s “This Week” and on ABC’s special events and election coverage, and appears frequently on other leading political commentary shows. Moreover, Mr. Cook is editor and publisher of The Cook Political Report and a columnist for National Journal magazine. Mr. Cook founded The Cook Political Report in 1984 and became a columnist for Roll Call, the Capitol Hill newspaper.

The Policy Meeting is a benefit of CAP membership and there is no fee to register. View the full meeting agenda and register today.

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