SGR Repeal Passes U.S. Senate, Now on President’s Desk
The Senate followed the House of Representatives in passing comprehensive legislation to repeal Medicare’s Sustainable Growth Rate (SGR) formula and transition physicians to a new value-based payment system. This action comes on the heels of an overwhelming show of support in the House, where both Republicans and Democrats voted in favor of H.R. 2 on March 26. President Obama is expected to sign the bill immediately, which will avert a 21 percent Medicare payment cut from taking effect.
Highlights of the H.R. 2 legislation include:
- The SGR is permanently repealed, effective immediately; reversing the 21 percent SGR cut that went into effect on April 1.
- Positive payment updates of 0.5 percent are provided for four-and-a-half years, through 2019.
- Current quality incentive and payment programs are consolidated and streamlined into a new Merit-based Incentive Payment Program (MIPS), and the aggregate level of financial risk to practices from penalties has been mitigated in comparison to current law.
- Physicians in alternative payment models (APMs) receive a 5 percent bonus from 2019-2024.
- Strong incentives are created for physicians to participate in qualified Patient Centered Medical Homes (PCMHs), an innovative model of care that has been shown to improve outcomes, patient experience, and reduced costs. Physicians in qualified PCMHs will get the highest possible score for the practice improvement category in the new MIPS program. PCMHs that have demonstrated to HHS the capability to improve quality without increasing costs, or lower costs without harming quality, can also qualify as an APM without having to accept direct financial risk.
- Technical support is provided for smaller practices, funded at $20 million per year from 2016 to 2020, to help them participate in APMs or the new MIPS program.
- Funding is provided for quality measure development, at $15 million per year from 2015 to 2019. Physicians retain their preeminent role in developing quality standards.
In addition, H.R. 2 provides continued funding of the National Health Services Corps, Community Health Centers, Teaching Health Centers, and the Children’s Health Insurance Program, programs that are especially important to ensuring patient access to primary care.
National Healthcare Decisions Day – Get Involved!
The New York Chapter ACP, along with other national, state and community organizations, is participating in a massive effort to highlight the importance of advance healthcare decision-making—an effort that has culminated in the formal designation of April 16 as National Healthcare Decisions Day (NHDD). Although several states have engaged in advance directives awareness events and numerous organizations have devoted substantial time and money to improving education about advance healthcare planning, only a small minority of Americans has executed an advance directive.
To find out more, you can access the NHDD website (nationalhealthcaredecisionsday.org), which contains information and tools for the public to talk about future healthcare decisions and execute written advance directives (healthcare power of attorney and living wills) in accordance with their applicable state laws.
For New York State, the Department of Health has a website of resources including the Medical Orders for Life-Sustaining Treatment (MOLST) form. The DOH has created an informational portal that contains a wealth of information on advanced care decisions, including legal requirements checklists, frequently asked questions, and guidance documents.
Be sure to help educate your patients on end of life decisions on this Recognition Day and every day!
PCMH Medicaid Incentive Payment Reduction Delayed
In order to allow providers additional time to achieve Patient Centered Medical Home (PCMH) recognition from the National Committee for Quality Assurance (NCQA) under the 2014 standards, New York State Medicaid is extending the implementation date of the Statewide PCMH Incentive Payment Program changes affecting payments to providers recognized under 2011 or 2014 standards to January 1, 2016.
This was announced in February 2015 Medicaid Update. This extension only applies to providers recognized under the 2011 standards and all incentive payments for PCMH-recognized providers under NCQA’s 2008 standards will still be discontinued as of April 1, 2015.
This revised policy is applicable to both Medicaid Managed Care (MMC) and Medicaid fee-for-service (FFS). The January 1, 2016 implementation date for these changes give primary care practices and providers a financial incentive to achieve level 2 or 3 NCQA PCMH recognition under the 2014 standards by the end of 2015.
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Governor Cuomo Has Signed E-Prescribing Delay Into Law!
Late last Friday, March 13, Governor Cuomo signed legislation S.2486(Hannon)/A.4274 (McDonald) into law to delay by one year the implementation of New York's e-prescribing requirements. While the mandate to electronically transmit all prescriptions, including controlled substances is delayed until March 27, 2016, we urge all members to continue to work with their vendors now to get their e-prescribing software up and running as soon as possible. Those who have already begun e-prescribing including controlled substances have reported great satisfaction and success. There are extensive resources for finding certified vendors and preparing your practice for implementing e-prescriptions available on the NYACP website.
The e-prescribing requirements were a part of the State's Internet System for Tracking Over Prescribing (I-STOP) laws, enacted in 2012. I-STOP requires all prescribers to 1) consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III and IV controlled substances and 2) electronically transmit all prescriptions. To do so, each prescriber must have an individual Health Commerce System Account (HCS) to gain access to the PMP registry at https://commerce.health.state.ny.us
In addition, I-STOP also made changes to some controlled substance schedules, created a Prescription Pain Medication Awareness program, and a method for safe disposal of unused prescription medications. For more details on all I-STOP related updates, continue to monitor the NYACP Resource Page.
The Chapter's Resident/Student Advocacy Internship - An Exciting Experience
This past month we were able to host our 25th advocacy intern, Brianne Navetta, MD, at the Chapter offices in Albany. Brianne is a third year internal medicine resident from the North Shore Long Island Jewish Health System who, while with us, took a keen interest in learning the basic structure of our political system and the process of New York State government. By attending legislative sessions and through individual legislative visits with our Chapter staff, Brianne now understands how her role as a physician can impact legislation.
On her rotation, she was able to advocate a variety of Chapter positions on legislation such as requiring meningococcal vaccine for adolescents, Medicaid reimbursement rates in New York State, funding for Doctors Across New York (DANY), the development of retail clinics, regulating urgent care and office based surgery centers, banning the sale of flavored tobacco and including electronic cigarettes within the Clean Indoor Air Act. She was truly able to understand how the government works while experiencing how organized medicine can work within our political system to improve the lives and health of patients.
Brianne, as she leaves her rotation in Albany, is fully aware of the tools and resources that will help with her own advocacy efforts in the future and has developed skills to effectively communicate her interests and those of her patients to elected leaders and appointed officials.
The two pictures feature Brianne with Senator Kemp Hannon of Long Island, Chair of the Senate Health Committee, and working with Linda Lambert, the Chapter Executive Director, to review one of the three sets of proposed budget bills!
NYACP Health and Public Policy Meeting and Annual Legislative Day
On Monday March 2, 2015 the Chapter’s Health and Public Policy Committee met to discuss multiple issues impacting the practice of internal medicine and patient care including: Tobacco Control, Collaborative Drug Therapy, Death with Dignity and Immunizations as well as to discuss reports on Geriatrics, Obesity, GME, Hospital Medicine, and other committee reports. Staff Members of Assemblyman Richard Gottfried, Chair of the Assembly Health Committee, were present for a portion of the meeting to discuss Medicaid Parity, Doctors Across New York (DANY), ACO Regulations, Single Payer Legislation, and Convenient Care and Retail Clinics.
On Tuesday March 3, 2015 eleven members of the Committee participated in the Chapter’s Annual Legislative Day. The aim of Legislative Day is to allow physicians to discuss medical issues impacting patient care with their own elected officials. The main topics discussed throughout the day included Medicaid Parity, DANY, ACO Regulations, and Tobacco Control. The group also met with Senator Kemp Hannon, Chair of the Senate Health Committee and several high ranking officials from the Governor’s Office and the NYS Department of Health. Legislators acknowledged the importance of physicians visiting with them as a valued resource on healthcare issues. As evidenced by our physician representatives experience and feedback of the value of spending their time Albany...You can make a difference!
NYS Meningococcal Vaccine Bill
On January 30th the Chapter met with other interested stakeholders to review a legislative proposal that would add meningococcal immunizations to the list of other required immunizations a child would receive before entering the 6th grade and a booster dose before entering 11th grade in New York State. The legislation has been introduced by Assemblywoman Aileen Gunther and a Senate bill is expected soon. Planned activities include two advocacy days on February 25 and on April 21 to raise awareness and promote support for the legislation, timed to align with recognition of World Meningitis Day on April 24, 2015.
Governor Cuomo Presents State of the State and New York State Budget
On January 21st, Governor Andrew Cuomo presented his $141.6 Billion proposed state budget. In the health area, the Governor proposed to continue and advance new approaches to healthcare delivery to control spending growth and improve health results. Of interest to our members, healthcare transformation utilizing federal waiver monies, awarded through DSRIP grants, seeks to reduce avoidable hospital use by 25% over the next five years. In addition, the CMS $100 million grant to implement the State Health Innovation Plan over a four year period builds upon Medicaid reform efforts and extends them to achieve similar outcomes across the entire health care system, both public and private. The Chapter will be reviewing the entire 548 page budget booklet, looking for more specific detail on “increased payments to essential community providers”, “leveraging health homes”; some changes to “health insurance premiums for coverage both inside and outside of the Health Benefit exchange”; investments in caregiver supports, New York Connects, a statewide one stop access to free and objective assistance on accessing long term care services; discontinuing resident work hour audits (noting duplication of effort with federal oversight), discontinuation of the physician profile website and “ending the Aids Epidemic by 2020”.
Public hearings on the budget will be announced shortly, in anticipation of final budget action by March 31, 2015.
Join the Effort to Ensure Medicaid Fee Parity for Primary Care Physician Visits
Please take action today and urge Senators Schumer and Gillibrand to support the "Ensuring Access to Primary Care for Women & Children Act" (S. 2694). To ensure parity for Medicaid patients, this bill would continue payment of Medicaid fees at Medicare levels beyond 12/31/14.
It takes less than a minute! A sample message is provided for you to personalize. Be sure to add an opening and closing and we urge you to edit the suggested text to reflect your own practice situation.
The two-year Medicaid Primary Care Pay Parity program was enacted as part of the Affordable Care Act (ACA), and was effective Jan. 1, 2013 through Dec. 31, 2014.
Before this program went into effect, many New York State Primary Care Physician practices were unable to accept more Medicaid patients because Medicaid reimbursement rates in New York were much lower than Medicare and other payers, an astonishing 42% of Medicare, well below the actual cost of care. Please show your support of S. 2694 and tell your senators that Medicaid fee parity is important to the overall health of New York State!
Click the link below to log in and send your message:
CMS Launches Road to 10 Webcast Series
The Centers for Medicare & Medicaid Services (CMS) has released a new webcast introducing the "Road to 10" tool. Accessible through the "Road to 10" link on the CMS website, the webcast covers the history of the International Classification of Diseases (ICD) and the benefits of ICD-10. This is the first in the new "Road to 10" webcast series. Five more webcasts will follow-all aimed at helping small practices get ready for ICD-10 by the October 1, 2015, compliance date.
Also available now is a brief video introduction to the "Road to 10" tool. Developed in collaboration with physicians, the "Road to 10" tool offers:
- Clinical documentation tips
- Coding concepts
- Clinical scenarios
- Training calendar
Go to the CMS ICD-10 website to get started on the "Road to 10" today.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare.
"Doctors Across New York" - Vital Program for our Future
NYACP sponsored visits at the State Capital along with representatives from several other state healthcare organizations as part of the WAG (Physician Workforce Advisory Group) to inspire support for continued and expanded funding of DANY (Doctors Across New York). DANY award recipients were present to tell their real life story of how they settled into a community and began their medical career with the assistance with this vital state funded program. DANY was established to promote recruitment and retention of physicians providing care to underserved populations in New York. We met with State Senators and Assemblymen to discuss the benefits of a strong primary care foundation in the State and the dialogue was very productive. Legislators were actively engaged about the looming physician shortage, especially in primary care, the increase in insured patients due to the New York's Health Benefit Exchange and the need for a solid primary care workforce to keep New Yorkers healthy. In addition to DANY, the WAG also promoted the continued funding of the PCSC (Primary Care Service Corps) to support the growth of allied health providers to increase effective care teams.
The DANY program has allocated more than 34.2 million dollars to more than 100 award recipients. Continuation and expansion of this program is a priority legislative goal.
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