On Friday, February 9, President Donald Trump signed into law the Bipartisan Budget Agreement of 2018, a bill that funds the government and also includes several ASA-supported provisions, including repeal of the Independent Payment Advisory Board (IPAB), and funding to address the ongoing opioid abuse epidemic.
ASA is very pleased that the Independent Payment Advisory Board (IPAB) has been repealed. ASA has been a strong opponent of IPAB, a board of 15 non-elected and unaccountable appointees with sweeping powers to mandate across-the-board or other targeted reductions in Medicare Part B payments. The board’s cuts would have disproportionately fallen on physicians, as some providers, including hospitals and hospice care, are exempt from IPAB cuts until 2020. Thus, along with the already unreasonably low Medicare payments for anesthesia services (“the 33 percent problem”), IPAB cuts could have disproportionately impacted physician anesthesiologists specifically.
ASA was a co-founder, along with the American Association of Neurological Surgeons, of the IPAB Repeal Coalition, which consisted of over twenty specialty physician organizations representing more than 350,000 physicians and their patients. The coalition has supported a number of legislative efforts to repeal IPAB. In November, a bill to repeal IPAB passed in the House of Representatives but had not been advanced in the Senate. ASA applauds Congress and the President for including the repeal of IPAB in this law.
Funding to address the ongoing opioid abuse epidemic is also included in the funding bill. ASA is pleased that $3 billion is included for Fiscal Year 2018 and $3 billion for Fiscal Year 2019 to address the substance abuse epidemic. Additionally, this agreement includes a $2 billion increase for the National Institutes of Health (NIH) over two years.
The package also includes important changes to the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP). The legislative changes, which are consistent with previous ASA advocacy efforts (here and here), will improve physician anesthesiologists’ opportunities to successfully participate in the QPP.
Among a series of technical corrections, the modifications include:
• Elimination of the physician administered Part B drug costs from the Merit Based Incentive Payment System (MIPS) eligibility calculations and payment adjustment application. Without this adjustment, physicians would be unfairly penalized for Part B drug costs – costs the physicians often do not control.
• Elimination of improvement scoring for the MIPS cost performance category for the third through fifth years of MIPS and granting of new flexibility to CMS to reweight the cost performance category. These changes address ongoing challenges faced by CMS in accurately measuring physician performance in the MIPS cost category.
• New flexibility for CMS in setting the performance threshold for determining negative, neutral and positive payment adjustments. The flexibility will allow for a more realistic glidepath toward CMS setting a mean or median threshold in the sixth year of MIPS.
• Clarification of the role the Physician Focused Payment Model Technical Advisory Committee (PTAC) in providing feedback and guidance to stakeholders developing alternative payment models (APM).
Less favorably, ASA lobbyists, ASA’s grassroots and other medical organizations worked to oppose the extension of the ACA’s so-called “misvalued procedure” provision for 2019 and 2020. The provision directs CMS to identify savings by cutting payments for procedures deemed to be “misvalued.” The provision was dropped but language was included that reduces the annual MACRA-mandated .5% physician fee schedule update to a .25% update in 2019. According to the Congressional Budget Office (CBO), this change results in $1.9 billion less in Medicare payments over a decade.
The bill passed the Senate by a vote of 71-28. The bill passed the House of Representatives by a vote of 240-186.