Feb. 9, 2018

NIH funding, meaningful use standards and biosimilars coverage under Medicare Part D are some of the areas with GI wins.

Congress passed, and the president signed, a major budget agreement to fund the government through September 2019. The agreement increases the current budget caps that have been in place since the Budget Control Act and provides an additional $300 billion in new funding for defense and non-defense discretionary spending for the next two years. The budget agreement was attached to a short-term continuing resolution that funds the government through March 23. Appropriators will now write the language that details the funding through Sept. 30, 2019.  

The agreement contains several provisions for which AGA has been advocating over this past year and in some cases, over several years.

NIH Funding     
The agreement includes $2 billion in additional funding for NIH. AGA and the entire research community have been advocating for increased NIH funding to expand research opportunities, keep our country competitive and improve health care in our nation.

The agreement also provides flexibility under the new Quality Payment Program (QPP) and the Merit-based Incentive Payment System (MIPS) that were created under the Medicare Access and CHIP Reauthorization Act (MACRA). The language addresses four areas of the QPP that AGA and all of organized medicine have been advocating for Congress to address, including:

  • Excluding Medicare Part B drug costs from MIPS payment adjustments.
  • Eliminating improvement scoring for the cost performance category for the second through fifth years of MIPS.
  • Allowing CMS to weight the cost performance category at less than 30 percent, but not less than 10 percent for the second through fifth years of MIPS.
  • Allowing CMS flexibility in setting the performance threshold for MIPS years two through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year.
  • Allowing the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback on alternative payment models regarding the extent to which they meet criteria and an explanation of the basis for the feedback.

These changes were a major victory for the physician community and will help better transition physicians in the QPP. Since most physicians will participate in MIPS, AGA has argued that these changes were essential to ensure that the program will work and allow for physicians to be successful in their participation.

Meaningful Use Standards
The package addresses electronic health record (EHR) standards and eases requirements for physicians. The language removes the mandate that meaningful use standards become more stringent over time, which is a major financial burden for physician practices. The language also gives physicians more time to submit and receive a hardship exemption from the current EHR standards that would apply to meaningful use and the QPP’s advancing care information performance category.  

IPAB Repeal
AGA and all of organized medicine have long opposed the Independent Payment Advisory Board (IPAB) that was created as part of the Affordable Care Act. IPAB is an unelected, unaccountable board whose sole purpose is to cut Medicare spending from providers should Medicare reach a certain threshold of spending. Since hospitals are exempt from their purview, physicians would be particularly vulnerable to cuts. However, repealing IPAB has had bipartisan support over the years, and we applaud Congress for listening to us and the medical community and taking action. 

Misvalued Codes
AGA and the physician community were also successful in removing a provision that would have extended the misvalued codes initiative for the next two years to reallocate savings from potentially overvalued codes. AGA, the Alliance of Specialty Medicine and the AMA opposed the original provision expanding the misvalued codes initiative and have argued that virtually all codes under the fee schedule, including gastroenterology, have been reevaluated and have already faced significant cuts. 

Geographic Practice Cost Index 
The budget agreement extends the work for the Geographic Practice Cost Index (GPCI) floor for two additional years, which avoids a decrease in Medicare reimbursement for physicians that practice in rural areas.  The work GPCI is a variable that Medicare uses to adjust the work component of physician payment based on where they live. A work GPCI floor of 1.0 protects physicians in low-cost, often rural areas, from being paid less for the work they do. 

Biosimilars Coverage Under Medicare Part D
The agreement also levels the playing field between biologics and biosimilars by adding biosimilars to the Medicare Coverage Gap Discount Program. Additionally, by providing the 50 percent discount equally, beneficiary out-of-pocket costs will be reduced and the Medicare program will save money as a result of covering the less expensive medication.  

National Health Service Corps
Funding for the National Health Service Corps is extended at the FY 2015 – 2017 annual level of $310 million for two additional years.

Teaching Health Center Graduate Medical Education
Funding for Teaching Health Center Graduate Medical Education is extended for two years at an annual level of $126.5 million, more than doubling the current annual funding for this program.

Additional Health Provisions

  • $6 billion to fund the fight against the opioid and mental health crises. 
  • $4 billion to rebuild and improve VA Hospitals and Clinics. 
  • $7 billion for Community Health Centers and reauthorizes the program for two years. 
  • Closing the Medicare Part D “donut hole” for seniors in 2019. 
  • Reauthorizes the Children’s Health Insurance Program (CHIP) for an additional four years.

AGA and the medical community have fought long and hard for these provisions and are happy to see them finally being implemented. We thank all of our members who have worked along with us to ensure that the voice of gastroenterology continues to be heard on Capitol Hill.