Doc Caucus Urges CMS to Revise Low-Volume Threshold

The House GOP Doctors Caucus has written to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting that the agency reduce the number of physicians excluded from the Merit-based Incentive Payment System (MIPS) as CMS works to set participation thresholds for 2019. The lawmakers express concerns that limited physician participation in MIPS restricts the possible upward payment adjustments for high performers in the program.

For the 2018 performance year, CMS raised the low-volume threshold to exclude doctors with no more than $90,000 in Part B charges or those who saw 200 Medicare beneficiaries or fewer. Approximately 60 percent of otherwise eligible providers were excluded from MIPS in 2018, largely based on the low-volume threshold.

The Doctors Caucus requests that CMS adjust the low-volume threshold for MIPS eligible clinicians in 2019 to fully realize the extent of payment adjustments envisioned in the law. Under statute, physicians in MIPS could be subject to payment adjustments of up to seven percent for the 2019 performance year. However, the smaller the number of clinicians that participate in the program, the smaller the potential range of program scores and the fewer incentives available. The letter points out that high performers are expected to receive an aggregate upward adjustment of 1.1 percent for 2019 based on their 2017 performance, despite the law allowing for adjustments of up to four percent. The lawmakers argue that MIPS needs to utilize the maximum incentives allowed in order for the program to reach its full potential. CMS is expected to include 2019 updates for the Quality Payment Program, which includes MIPS, in the upcoming Physician Fee Schedule rule.

House to Vote on Medical Device Tax Repeal This Month

The House of Representatives is planning to vote this month on legislation to repeal the Affordable Care Act’s (ACA) medical device tax. The 2.3 percent tax on medical device sales is scheduled to take effect in 2020. There is bipartisan support for repeal of the tax, which the Congressional Budget Office (CBO) estimates would reduce federal revenues by approximately $20 billion over the next decade. The legislation -- H.R.184 - Protect Medical Innovation Act of 2017-- is sponsored by Rep. Erik Paulsen (R-Minn.).

White House Halts Risk Adjustment Payments

The Trump administration has recently announced its decision to stop collecting and paying out money under the ACA’s risk adjustment program, which provides billions of dollars in annual payments to insurers covering a disproportionate share of patients with expensive medical needs. CMS states that a recent ruling by the federal trial court in New Mexico prevents the agency from making further collections or payments under the program until the litigation is resolved. The agency believes that the court ruling bars CMS from collecting or making payments under the current risk adjustment methodology, which uses a formula based on statewide average premiums. The insurance industry has decried CMS’ decision, arguing that it will cause significant market disruption that will lead to premium increases. CMS Administrator Seema Verma said that CMS has asked the court to reconsider its ruling.

E&C Health Names New Chief Counsel

House Energy and Commerce Committee Chairman Greg Walden (D-Ore.) announced that Josh Trent has been named Chief Counsel for the Health Subcommittee. Trent has been a member of the subcommittee’s staff for four years, most recently serving as Deputy Chief Counsel. Prior to joining the committee, he worked for Sen. Tom Coburn (R-Ok.). Trent will replace Paul Edattel, who left Energy and Commerce last month.

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