Washington Connection, Jan. 10, 2017
Written by: MGMA Government Affairs

Medical Group Policy Issues to Watch in 2018

Following a flurry of regulatory and legislative activity in 2017, which MGMA anticipated, we foresee no slowdown of action on key issues important to medical group practices in the coming year. As your voice in Washington, MGMA will continue calling on the Trump Administration and Congress to work in a bipartisan manner to pursue legislative and regulatory policies that will enable practices to thrive in their mission to furnish high-quality, cost-effective patient care. 

Expanding Item - View More 1. New HHS Secretary: Prioritize much-needed regulatory relief 

On his tenth day in office, President Trump signed an executive order calling for repeal of two existing regulations for each new rule. Similarly, MGMA is encouraged by the Centers for Medicare & Medicaid Services’  (CMS’) “Patients over Paperwork” Initiative to remove regulatory roadblocks to delivering high-quality care. However to date group practices have yet to feel significant relief as a result of these actions.

With the confirmation of a new secretary of the Department of Health and Human Services (HHS) likely in early 2018, the next twelve months will shed light on how and when the Department will accomplish its regulatory relief aims. MGMA will continue championing burden reduction through the standardization and streamlining of federal rules. For the latest, visit mgma.com/regrelief. 

Expanding Item - View More 2. Mixed signals from Congress on 2018 agenda

Congress will begin the new year addressing a laundry list of healthcare items from 2017, but leadership appears torn on an agenda for the remainder of 2018. While Republican House leaders consider healthcare entitlement reform and full Affordable Care Act (ACA) repeal top priorities, Senate Majority Leader Mitch McConnell indicated he would like to move onto other issues. President Trump recently distanced himself from tackling full ACA repeal and while he says he will not cut entitlement funding directly, he has left the door open for program reforms. 

Expanding Item - View More 3. Amid criticism, MIPS ups the ante in year two

Over 70% of the 750 practices who participated in a 2017 MGMA study were very or extremely concerned about MIPS’ lack of clinical relevance to patient care. The Medicare Payment Advisory Council has raised similar red flags and may recommend Congress repeal MIPS. MGMA contends the current MIPS program is incompatible with CMS’ “Patients over Paperwork” initiative. 

Despite this criticism, CMS mandated full-year quality data reporting, a four-fold increase from 2017. Stating this level of burden would disproportionately harm small practices, CMS estimates exempting even more clinicians under the higher low-volume threshold this year, over 500,000 by their estimates. MGMA is urging both the administration and Congress to reduce burden and improve the clinical relevance of MIPS. For more information, visit mgma.com/MACRA.

Expanding Item - View More 4. Administration slow with new APMs but expect the pace to pick up in 2018

To date, the current administration has launched just one new alternative payment model (APM), the Bundled Payments for Care Improvement (BPCI) Advanced model, which was announced Jan. 9. The model features bundled payments for 32 inpatient and outpatient clinical episodes and will qualify as an Advanced APM for the 2018 performance year. Notably, the Centers for Medicare and Medicaid Innovation (CMMI), tasked with developing new APMs, has been without a director since September and recently sought stakeholder feedback on a new direction. HHS Secretary nominee Alex Azar testified that CMMI is very important in driving Medicare transformation and signaled his openness to mandatory APMs, which contrasts the agency's earlier decision to cancel two mandatory models. Stay tuned for the potential release of several long-anticipated new APMs, including a Medicare Advantage demonstration project and more specialty models. 

Expanding Item - View More 5. ACA exchanges stable for now, but recent changes leave future uncertain

Despite an average premium hike of 34% for silver plans, 2018 exchange enrollment figures remained unexpectedly high. Still unclear is how the Affordable Care Act (ACA) individual insurance mandate repeal, expansion of association health plans and short-term coverage options will impact markets. While the changes may offer more consumer choice and flexibility, they could drive healthier customers from the exchanges and lead to increased premiums and weakened insurer interest. Many in Congress are calling for market stabilization measures such as reinsurance funding to mitigate the impact, but conservatives are not sold. With congressional gridlock likely to increase ahead of midterm elections, expect further changes to play out primarily at the state and regulatory levels. Of course, the fate of the ACA could change substantially if Democrats gain the majority in Congress in November. 

Expanding Item - View More 6. Will the government finally improve EHRs and streamline claims transactions?

It has been 21 years since law authorized a standardized electronic claims attachment rule that would permit practices to send supporting documentation to payers electronically in support of a claim or prior authorization, thus decreasing reliance on fax and proprietary web portals. Action in 2018 is expected to address EHR interoperability and usability, two common complaints about the technology. Expect regulations prohibiting data blocking and additional pressure on providers and vendors to ensure patient data is shared effectively and securely. Implementation of the 21st Century Cures Act will continue with potential regulations aimed at creating a “trust framework” for the electronic sharing of patient data and promoting “user-centered design” of EHRs. 

Expanding Item - View More 7. Healthcare mergers get vertical

The healthcare industry is consolidating, and merger momentum is not expected to slow in 2018. CVS announced last year it will acquire Aetna for $69 billion. If approved by regulators, this would be the largest healthcare merger to date, potentially combining a drugstore, urgent-care clinic, pharmacy benefit manager, and health insurer under one roof. 

Recently, mega-mergers between health insurers (Anthem-Cigna and Aetna-Humana) were blocked on antitrust grounds due to concerns that consolidation would harm competition in key markets. Those were horizontal mergers, i.e. those between direct rivals operating in the same space, while the CVS-Aetna deal is vertical integration between companies operating at different levels of a supply chain, which has traditionally faced less regulatory scrutiny. If vertical integration becomes the trend, it raises the question: who else will follow suit? 

Expanding Item - View More 8. Cybersecurity threats expected to increase in 2018

According to recent studies, more than eight out of ten practices have been the victim of some form of cyberattack. Ransomware events (email attacks that hold patient data hostage) targeting the healthcare sector are expected to increase sharply in 2018. Implications for practices experiencing a cyberattack include reduced productivity, permanent loss of medical records, decreased confidence in systems, and potential government enforcement action. Practices should take steps to minimize their vulnerabilities and access MGMA's HIPAA Resource Center for member-benefit cybersecurity education and tools. 

Expanding Item - View More 9. Feds take aim at healthcare fraud

All signs point to federal officials continuing a tough stance on fraudulent billing practices in Medicare and Medicaid programs through 2018. Fraud and abuse are perennial concerns for the physician community, which faces oversight from several federal agencies, including HHS’ Office of Inspector General (OIG), CMS, HHS' Office for Civil Rights, and the Department of Justice (DOJ). In July 2017, OIG and DOJ participated in the largest ever healthcare fraud enforcement action, resulting in charges against over 400 defendants and OIG exclusion of nearly 300 providers. Attorney General Jeff Sessions said the takedown is “just [the] beginning.” In 2018, officials are expected to target opioid-related crimes with a newly created Opioid Fraud and Abuse Unit focusing on analyzing data to identify opioid-related healthcare fraud.

Expanding Item - View More 10. Medicare care management codes more manageable in 2018

As group practices look to increase efficiency and improve patient value, we anticipate a continued uptick in Medicare non-face-to-face care management and telehealth services in 2018. This market shift coincides with CMS’ relaxation of many of the overly stringent billing requirements for chronic care management (CCM) and added coverage for complex CCM services. CMS has also launched an educational campaign to increase awareness among Medicare beneficiaries of the benefits of CCM and its cost-sharing obligations. Beginning Jan. 1, Medicare will also cover remote patient monitoring, which is generally not considered telehealth by CMS and thus not subject to the same restrictions. 

Stay tuned to the Washington Connection for ongoing developments in all of these areas. 


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