Before Thanksgiving, the House of Representatives passed H.R. 1, the Tax Cuts and Jobs Act, by a vote of 227 to 205. The vote largely fell along party lines, with no Democrats voting for the bill. The House bill has several provisions of concern to the American Society of Nephrology (ASN), including one that could devastate the pipeline of future scientists.
“The already strained kidney science and care workforce—particularly PhD scientists—would be decimated by eliminating the deduction for graduate education and by PAYGO1 cuts to student aid administration program, jeopardizing any hope of future discoveries to cure kidney diseases. Every effort should be taken to encourage, not discourage, the next generation of scientists from pursuing their studies,” wrote ASN President Eleanor D. Lederer, MD, FASN, in a November 22, 2017 memorandum to House and Senate leaders.
Now that the Final Rule is released, what does it mean?
Trick or treating started a little early in Washington. When Medicare released the final rule regarding the Prospective Payment System and the Quality Incentive Program (QIP) on Friday, October 28, ASN found itself holding a mixed bag.
Home Dialysis Training Payment
Medicare nearly doubled the home dialysis training payment to $95.60. ASN believes patients with ESRD need greater access to home dialysis and any barriers to that access should be removed. However, the increase was made “budget neutral” meaning “you have to rob Peter to pay Paul” and no new money was added to the bundle, as ASN had recommended.
Legal update: Yesterday, the United States Court of Appeals for the Ninth Circuit, in San Francisco, CA, held an hour-long oral argument for plaintiffs—represented by the State of Washington—defendants—represented by the U.S. Department of Justice. A conference call is considered an unusual method for hearing oral arguments for Federal Appellate Courts. The Ninth Circuit is considered very influential, covering 20% of the American population. The ruling will almost certainly be followed by an appeal to the Supreme Court.
Participating clinicians should begin the application process now.
The Centers for Medicare and Medicaid Services (CMS) has announced that it is accepting the impact of COVID-19 as a condition for applying for an Extreme and Uncontrollable Circumstances exemption in the Merit-based Incentive Payment System (MIPS).
For the 2020 performance year (PY), Medicare will be using its Extreme and Uncontrollable Circumstances policy to allow clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories due to the current COVID-19 public health emergency. To provide additional support to clinicians, the agency is extending the extreme and uncontrollable circumstances application deadline for PY 2020 to Monday, February 1, 2021 at 8 p.m. ET.
Final rule applies new standards to organ procurement in the U.S.
The U.S. Department of Health and Human Services (HHS) today took action to increase donation rates and organ transplantation rates by applying new standards of accountability and transparency to the nation’s Organ Procurement Organizations (OPOs). HHS finalized the Organ Procurement Organizations Conditions for Coverage: Revisions to the Outcome Measure Requirements for Organ Procurement Organization rule that was proposed earlier this year by the Centers for Medicare and Medicaid Services (CMS).
Today, the Centers for Medicare and Medicaid Services (CMS) released finalized 2017 performance data for the Quality Payment Program (QPP) that will be used to determine clinician reimbursement adjustments for calendar year 2019 – the first year for adjusted payments under the new program. CMS announced the preliminary data earlier this year, and now it is claiming “significant success and participation in both the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) tracks” with the release of the finalized data.
In a joint letter to the Centers for Medicare and Medicaid Services Administrator (CMS) Seema Verma, ASN, the National Kidney Foundation (NKF), and the Renal Physicians Association (RPA) laud the Trump administration for its “ambitious agenda for kidney health” and identify five principles the organizations state will lead to “better patient outcomes that should be supported in the proposed ETC Model.”
The American Society of Nephrology (ASN) Department of Policy and Government Affairs team has received numerous questions from interested members on the proposed payment models arising from the Executive Order on Advancing American Kidney Health, the ESRD Treatment Choices (ETC) model and the and Kidney Care Choices (KCC) model. This Kidney News Online series aims to share these questions and answers with the broader ASN membership. Please also see parts 1 and 2 of this series for more background information.
After two months of ASN advocacy, led by the ASN Quality Committee, the Centers for Medicare and Medicaid Services (CMS) today, January 2, 2020, announced adjustments to the proposed Kidney Care Choices (KCC) Model’s basic design. The changes were originally called for by the ASN Quality Committee – just after the model’s unveiling – and were intended to correct a design flaw that made it impossible for many nephrology practices in multi-specialty practices to participate.
Status Tool for 2017 Qualifying APM Participant and MIPS APMs DataNow Available
If you participate in the Merit-based Incentive Payment System (MIPS), you should have reviewed your 2017 performance feedback by now. The 2017 MIPS performance feedback, reflecting activities in performance year one of the QPP (2017), indicates if you will receive a negative, neutral, or positive payment adjustment in 2019. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018. The following are examples of circumstances in which you may request a targeted review: