The bill also ensures physician societies will have a say in quality metrics. The ACR will continue expanding its quality initiatives and will work with Congress and CMS to ensure appropriate quality measures are available for rheumatologists to use in their practices.
Ending the SGR [means] we can now move forward without the burden of uncertainty about the future of physician payments.
Although the bill was not perfect, it was far better than the status quo. And the bill was much better than previous proposals, which would have called for double-digit cuts if a physician did not move to an APM, locked in 0% baseline updates for years and pitted physicians against each other in competition for bonuses. We had asked to tie updates to the Medical Economic Index and had argued for an update of at least 2% higher than the baseline for those providers who primarily provide evaluation and management (E&M) services. Although the ACR would have liked to have seen higher updates, payment “bumps” based on E&M care may be feasible in the future.
You can count on the ACR to help members prepare for the new payment and reporting system that will be coming in 2019. We will help members identify ways they may need to modify practices to ensure appropriate reimbursement and how you can best prepare to deliver value-based care.
ICD-10
The implementation of ICD-10 remains among the most challenging issues for our members. Many rheumatology practices have been unable to obtain the recommended credit lines for six months of expenses if claims are delayed or not paid correctly. There is also the burden of the additional administrative and financial costs of implementation.
The ACR was on the Hill talking about ICD-10 when it was last delayed. We now have indications from Congressional leaders of both parties that ICD-10 will move forward on Oct. 1, 2015. Therefore, the ACR is taking a lead role among medical societies to minimize its effects.
The ACR has drafted legislation that mitigates the impacts of ICD-10, which has met with positive support from Hill offices and other physician societies. The bill stipulates the following:
- CMS must conduct full end-to-end testing prior to implementation, available to all providers;
- CMS must certify to Congress that the system is fully functioning;
- An 18-month implementation period during which physicians are held harmless for errors in coding specificity; claims may not be rejected due to specificity; applies to all payers;
- Physicians cannot be charged under the False Claims Act due to coding specificity; and
- CMS must provide feedback to providers regarding incorrect codes that are submitted.
Giving Patients Access to Breakthrough Treatments
We have each witnessed dramatic improvements in patient care with the introduction of biologics and other novel therapies. Patients with chronic rheumatologic diseases need access to these effective therapies to enable daily functioning and pursuit of their livelihoods. But these innovative medications are very expensive, often costing more than $20,000 per year. When insurers demand excessive cost sharing for these medications, it leaves the average American without access to affordable beneficial treatment.
