LUGPA advocacy targets self-referral laws, USPSTF reform


In his health policy briefing, Deepak A. Kapoor, MD, discusses LUGPA’s comments to CMS regarding MACRA and the 2018 Medicare physician fee schedule.

Efforts to improve key proposed federal regulations and enact legislation modernizing physician self-referral laws (Stark Law) and to reform the U.S. Preventive Services Task Force (USPSTF) were outlined by LUGPA Health Policy Chair Deepak A. Kapoor, MD, during a health policy briefing at the LUGPA annual meeting in Chicago.

Dr. Kapoor outlined LUGPA’s efforts to influence the final rules involving the Quality Payment Program established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Medicare physician fee schedule for 2018, and the Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center Payment System.

Most “in flux,” Dr. Kapoor said, is the proposed MACRA regulation, noting that he has met with officials at the Centers for Medicare & Medicaid Services (CMS) regarding proposals supported by LUGPA to ease requirements in reporting for physicians who will be part of the Merit-based Incentive Payment System (MIPS). LUGPA has submitted comments containing several proposed revisions to the draft regulation, which is expected to be finalized soon, he said.

Read: LUGPA puts resources behind key policy initiatives, future leaders

Dr. Kapoor said many urologists will be disappointed in the bonuses for which they will be eligible by investing in “infrastructure” designed to improve efficiency. Those bonuses will be financed by penalties imposed on physicians who do not comply and a large percentage of providers are being exempted-thus reducing the funding available for the bonuses.

In its comments to CMS, LUGPA urged the agency to “create a more level playing field under the MIPS by halting the continued erosion of the pool of MIPS-eligible clinicians so that urologists and other physician specialists will be able to succeed under the program.”

Fee schedule

“We don’t expect a lot of major changes, but we have to keep an eye on the final rule,” said Dr. Kapoor.

In its comments to CMS, LUGPA asked the agency to “carry out Congress’ intent” of eliminating the Medicare payment incentive for hospitals to purchase physician offices and convert them into off-campus provider-based departments (PBDs).

Dr. Kapoor said LUGPA would like CMS to modify payment policy applicable to hospital off-campus PBDs that are permitted to receive payments for items and services under the Hospital Outpatient Payment System.

LUGPA also said CMS should ensure that specialists are allowed to care for patients through multiple accountable care organizations (ACOs), and it called for elimination of a proposed reimbursement cut for a technical component of prostate biopsy services.

Next: Stark Law modifications


Stark Law modifications

Dr. Kapoor explained that LUGPA is supporting the Medicare Care Coordination Improvement Act of 2017, which would provide CMS the regulatory authority to create exceptions under the Stark Law for alternative payment models (APMs) and remove barriers in current law to the development and operation of such arrangements.

He pointed out that physician practices are hampered from fully and successfully participating in APMs because of 30-year-old self-referral prohibitions that pose a barrier to care coordination.

“I’ve been working closely with the bill’s sponsors in both the House and Senate,” Dr. Kapoor said. “Stark was designed for fee-for-service, not value-based care. If I am assuming risk for performance of a service and not paid on a fee-for-service basis, there is no incentive for me because the law prohibits us from gainsharing arrangements when it comes to volume or value.”

Dr. Kapoor said Stark prohibitions “stifle care delivery innovation by inhibiting practices from incentivizing their physicians to deliver patient care more effectively and efficiently because they cannot use resources from designated health services, such as pathology, advanced imaging, radiation therapy, and physical therapy in rewarding or penalizing adherence to clinical guidelines and treatment pathways.”

Also see: Senate takes aim at pharmacy benefit managers’ role in rising drug costs

The legislation was introduced with bipartisan sponsorship in both the House and Senate in early October 2017. Dr. Kapoor said it is supported by more than 25 physician and other provider organizations representing more than 500,000 clinicians.

USPSTF reform

“We’ve been working hard on the legislation sponsored by Reps. Marsha Blackburn (R-TN) and Bobby Rush (D-IL) to reform the U.S. Preventive Services Task Force, which has issued restrictive recommendations on the PSA test for prostate screening, among other controversial clinical recommendations," Dr. Kapoor said.

He pointed out that support for the USPSTF Transparency and Accountability Act has been building in Congress since it was first introduced in 2015. The measure would require that a “balanced representation of primary and specialty care providers” and other key stakeholders be involved in the development and review of USPSTF recommendations.

“Hopefully, we’ll have some good news to report soon,” said Dr. Kapoor. “This bill is finally getting traction. We’re working on securing a sponsor in the Senate, and we should have that nailed down soon.”

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