News from the AGA

AGA hosted productive Hill meeting advocating for GIs


 

Rep. Peter Roskam, Chair of the Subcommittee on Health of the Ways and Means Committee, invited AGA and the Alliance of Specialty Medicine to participate in a policy roundtable to learn more about the issues facing physicians and their patients. Chairman Roskam recently took over the chair of the Health Subcommittee, which has prime jurisdiction over Medicare Part B issues when Rep. Pat Tieberi, R-OH, retired. The roundtable focused on regulatory issues that impact physician practices and their ability to provide timely care to patients.

AGA and the Alliance of Specialty Medicine thanked Chairman Roskam and Congress for the technical corrections to the Quality Payment Program (QPP) that were included as part of the bipartisan budget agreement passed earlier this year that will significantly improve physicians’ ability to successfully participate in the Merit-based Incentive Payment System (MIPS) track. Because of the lack of opportunity for specialists like gastroenterologists to participate in advanced alternative payment models (APMs), most physicians will be participating in MIPS. Although Congress provided CMS with more flexibility in scoring for MIPS, we stressed to Chairman Roskam that MIPS reporting and scoring needs to be simplified to make it less administratively burdensome and costly for physicians. We also addressed the ongoing challenges regarding electronic health records (EHR) interoperability and the administrative and financial burdens it has on physician practices. This roundtable is part of one of AGA’s top advocacy issues, urging the Centers for Medicare & Medicaid Services (CMS), other payors, and Congress to provide relief to physicians.

AGA also raised the issue of alternative payment models and gastroenterology’s experience with developing bundles and episodes around common GI conditions. AGA stressed to Roskam the need for CMS to move forward piloting specialty payment models that have been approved by the Physician Technical Advisory Committee (PTAC) to test them in the Medicare population. The need for modernizing the Stark laws to enable physician practices to participate in alternative payment models was also discussed at the roundtable since the current Stark laws prohibit physician referral based on volume or value. AGA supports S. 2051/H.R. 4206, the Medicare Care Coordination Improvement Act, which would provide CMS with the regulatory authority to create exceptions under the Stark law for APMs and to remove barriers in the current law to the development and operation of such arrangements. The legislation would allow CMS to waive the Stark laws for physicians seeking to develop and operate APMs like what Congress allowed for accountable care organizations (ACOs). AGA believes this legislation is necessary for many of the innovative payment models developed by gastroenterologists to be implemented in the Medicare program.

Prior authorization

Prior authorization was also a major topic raised with Roskam and how it impacts all physicians regardless of where they practice. We emphasized how tremendously burdensome prior authorizations is to physicians and physician practices, and gave examples of how it often interrupts and/or delays delivery of patient care.

AGA and the alliance recommended that payors make prior authorization requirements and criteria transparent and easily accessible. We also recommended that CMS standardize and streamline prior authorization processes by Medicare Advantage and Part D plans. We also encouraged the committee to conduct oversight hearings to investigate prior authorization and utilization management practices by Medicare Advantage Organizations and Part D plans.

AGA and the alliance will continue to work with Roskam and the committees of jurisdiction to find solutions to lessen the regulatory burden on physicians that take time away from providing care to patients.

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