ACP Services PAC Working For You: Key Advocacy Wins 2015

Repeal of Medicare’s Physician Payment System – The flawed formula used to pay physicians under Medicare, known as the Sustainable Growth Rate (SGR), was eliminated and replaced with a value-based system that focuses on quality of care. The Medicare Access and CHIP Reauthorization Act (H.R. 2) was signed into law on April 16, 2015 preventing a 21 percent cut from taking effect. This change put an end to the annual congressional battles over Medicare physician reimbursement.

Electronic Health Records – Enacted at the end of 2015 as part of the Patient Access and Medicare Protection Act (S. 2425), Congress gave the Centers for Medicare and Medicaid Services the authority to streamline the process for granting hardship exemptions so that doctors who treat Medicare and Medicaid patients would not be penalized for being unable to meet the reporting deadline on "meaningful use" of electronic records because the government published the rule too late. For 2015 alone, doctors can affirm their meaningful use of electronic records for any 90-day period.

Funding for the Agency for Health Research and Quality (AHRQ) – Despite attempts by the House of Representatives to terminate AHRQ in FY 2016, the agency survived and will continue to operate as a result of receiving funding, albeit at reduced levels, in the final FY2016 Omnibus Appropriations bill that was enacted at the end of 2015. This agency is responsible for improving the quality, safety, efficiency and effectiveness of care.

Funding for the National Health Service Corps (NHSC) – Included as part of the Medicare Access and CHIP Reauthorization Act, (H.R. 2), vital funding for the NHSC was secured. This Act extended the NHSC’s mandatory funding for two more fiscal years (FY2016, FY2017) at $310 million. Funding for the Corps was set to expire on Oct. 1, 2015. The Corps provides scholarship and loan forgiveness to primary care physicians and certain other clinicians in exchange for service in an under-served area.

Reform of “Facility Fees” – As part of the Bipartisan Budget Act of 2015, reforms were made ensuring that all new hospital acquisitions of private physician practices would only be eligible for Medicare payments equal to those for the same care services provided in the freestanding, community based setting. This represents a positive step forward in addressing unfair payment disparities for identical clinical services provided in different healthcare settings, which are shown to increase costs and encourage market consolidations that limit patient access.

Advance Care Planning – The Centers for Medicare and Medicare Services (CMS) is establishing separate payment and a payment rate for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners. The Medicare statute currently provides coverage for advance care planning under the “Welcome to Medicare” visit available to all Medicare beneficiaries, but they may not need these services when they first enroll. Establishing separate payment for advance care planning codes to recognize additional clinician time to conduct these conversations provides beneficiaries and clinicians greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families.

Payment for Chronic Care Management – Effective Jan. 1, 2015, and for the first time ever, Medicare pays you and your staff for the non-face-to-face work involved with chronic care management (CCM).