MCA In Touch February 2017
The 2017 Changes to Medicare Affects Every DC By Lyle Coleman, DC
2017 is a year of big transitions and Medicare is part of that trend. Gone is the yearly suspense as we used to wait for Congress to amend a significant reduction in everyone’s fee schedule, the yearly “doc fix”. Now instead we have a mix of new ‘alphabet soup” of acronyms to learn. Like MACRA – it is not a form of pasta, and MIPS – it is not a new neurological disorder. And a shuffling of programs that are familiar to most of us. Every DC will have decisions to make, answers to discern, and a new path to carve. Because each DC and each practice is unique, the decisions, answers, and pathways will be individualized. There is no one simple solution for everyone. This article will not be like a navigation screen with an illuminated path to blindly follow. Instead it will be a resource to help you blaze your own trail. You can’t get answers and make decisions until you know what the questions are. And with these changes there are plenty of questions.
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For example – and this is by no means a complete list: • What happened to Meaningful Use? • To PQRS? • To Value based modifier? • What is MACRA (a law)? • And MIPS (a new payment method)? • What on earth is a Low Volume Exclusion? • Does it apply to me? How? • If I am excluded from MIPS by low volume, am I out of Medicare? (No) • If I am not in MIPS, what are my choices and pathways forward? • What are my options within MIPS for 2017? • Which choice fits me the best? • How am I going to report, and what is a Registry? • Are there Registries that are for Chiropractic, since everything seems medical? • Is my EHR certified? For which year? • What are the unintended consequences of my decisions – for this year? For the future? For me and my practice? • And importantly, for the profession and the professions future? And the really key question: Where can I go to get help to understand and then make my own decisions? It is this last question that MCA can be of the most help to you. There are answers, there are resources, there is help available for your own specific situation and issues. First of all there is help right from the horses mouth, Medicare. There is a new website dedicated to this new Quality Payment Program. The address is: www.QPP.cms.gov. Here there are detailed explanations of this big and complex law. It is not simple, but everything is straightforward and
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Continued from Page 1: The 2017 Changes to Medicare Affects Every DC
direct. Within that website are two further areas of help. First you can email questions to Medicare. The address is: QPP@ cms.hhs.gov.
The video is free for ACA members, and $30 for nonmembers. I have watched it and recommend it for everyone. Non-members, it really is worth the price.
Secondly there is a dedicated phone help line just for the QPP program. Here experts give you verbal answers that are followed up by a confirming email containing the question and answer. I have used this. It works very well. The phone number is: 1-866-288-8292.
Check out the video here: MACRA and the Quality Payment Program: Implications and Opportunities for Chiropractic
Secondly there is information totally from a chiropractic point of view from the ACA. The ACA has produced a wonderful video that gives an overview of the MACRA law and details each of the components. There is enough information within the video for each DC to make an informed decision of what path is best for their individual practice for this year. Plus there is information about a chiropractic registry with chiropractic relevant measures to report. Also the video helps you see the advantages for yourself and the profession to participate, as you are able.
The changes for Medicare for 2017 do present challenges and difficulties. Within those challenges are opportunities for you as an individual DC and for the profession. You owe it to yourself and to the profession to take the time and effort to educate yourself and make an informed decision. Please avoid the temptation to simply follow the path of least resistance by sticking your head in the sand – bad for your posture and leaves you in a very vulnerable position. MCA supports and guides my decisions with a diverse and inspired leadership team, strong MCA membership and a unified vision for chiropractic for 2017!
By Dr. Chuck Sawyer, MCA Professional Officer for Legislative Affairs The 2017 session of the Minnesota Legislature is now in high gear and a few bills are beginning to move through the legislative process that the MCA is either closely following, or actively supporting. Now, building on our success a few years ago in passing Scope of Practice legislation, there are two specific bills that have the potential to influence reimbursement either directly, or indirectly. The first is the Patient Rights and Provider NonDiscrimination bill (SF 749/HF 886) initially introduced in the 2016 session. The Minnesota Fair Care Coalition is spearheading this legislative effort under the leadership of Dr. Michele Maiers, Executive Director of Research and Innovation at Northwestern Health Sciences University. In addition to MCA’s strong support and participation in the work of the coalition, other members of this advocacy group include the Minnesota Podiatric Medical Association, the Minnesota Optometric Association and the Acupuncture and Oriental Medicine Association of Minnesota. Dr. Jim Abeler is the chief bill author in the Senate, and one of two medical physicians in the Minnesota Legislator, Sen. Scott Jensen, is the second author. The chief author in
the House is Rep. Glen Gruenhagen, and Northwestern’s lobbyist, Mr. Dave Kunz, has been successful in securing another 33 co-authors (Senate bills have a limit of five). The non-discrimination bill is a pro-active effort to address a wide range of discriminatory health plan practices and policies that are all too familiar to chiropractic doctors, including: • Differing reimbursement rates for the same service– often substantial -- based on provider type. • Arbitrary caps placed on the number of treatments a patient may receive • Billable CPT code restrictions, even when the service is within our scope of practice • Limitations on the number of providers in health plan networks • Variations in co-payments, deductibles, conversion factors and covered essential benefits Continued on Page 5
Continued from Page 3: Legislative Update
In essence, this legislation seeks to apply non-discrimination provisions to all insurance plans in Minnesota (including all commercial products, self-insured, third party administrators, workers compensation, state health care programs, and auto insurance carriers). While it is an ambitious initiative, we have a few allies from other similarly affected professions in the Minnesota Fair Care Coalition. A second legislative initiative that the MCA is pursuing on a parallel track – and you have likely read about in previous articles – involved a bill that seeks to expand reimbursable services provided by chiropractic doctors to patients enrolled in Minnesota’s public healthcare programs (i.e., Medical Assistance and MinnesotaCare). I have joined the MCA’s lead lobbyist, Mr. Kevin Goodno, in three very productive meetings over the past few months with staff members from the Minnesota Department of Human Services. They have been helpful in assisting Kevin in revising bill language that relates to evaluation and management services, as well as therapy services that are not currently a covered benefit. While that work continues, we anticipate being able to introduce bills in both the House and the Senate in the near future. In addition, there are other issues and legislation we are following including, most notably, a bill that would eliminate the repeal of the Health Care Provider Tax (HF 430/SF 694). Under this legislation, the 2% provider tax scheduled to sunset in 2019 would be maintained in order to continue funding MinnesotaCare, but increase the medical assistance payment rate for family physicians, pediatricians, physician
assistants and advanced practice registered nurses – but not chiropractic doctors who also provide primary care. Another bill (HF 156) worth mentioning is one first introduced in the 2016 session, and again more recently, by Rep. Glen Gruenhagen that would allow medical, dental and chiropractic providers to deduct the value of charity care they provide to patients enrolled in the Medical Assistance program. When it was initially heard in the Health and Human Services Reform committee, I testified in support of the bill because it presented an opportunity to address the issue of limited Medical Assistance reimbursement for chiropractic services. In my remarks, I also mentioned the fact that many chiropractic doctors simply provide noncovered services to patients and then absorb that cost without seeking out-of-pocket payment from the patient. As you have heard many times in the past, the legislative process can be uncertain, often messy and it is generally easier to stop a bill we don’t like from becoming law than to pass one we do support. Hard work, grass-roots advocacy and effective lobbying are essential for progress – and you generally have to be persistent! That’s the inescapable reality, so take advantage of the opportunity to pitch-in and help by attending the upcoming MCA Day at the Capitol event on the morning of Thursday, March 9th. If you have already registered through the MCA’s website, or have contacted me directly, you are on the roster so watch your email for more information. If not, get onboard now!
Introduction of HF886
From Craig Couillard D.C., CMT, CCSP, ICCSP, CSCS, PES, CES, MCA Legislative Committee Chair Patient Rights and Provider Non-discrimination bill (HF 886) that the MCA is supporting has been introduced. The following link will give you access to the language and where you can follow the bill. Learn more about the bill here. We need a large percentage of doctors to attend the Day at the Capitol to help lobby this important bill. This bill can be a game changer to how we are paid in the state of Minnesota. Please register to attend the Day at the Capitol Thursday March 9. Sign up on the MCA website. MCA will provide the talking points at the event.
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MCA: Unity. Strength. Vision. March 9-11, 2017 Register Now to join us at the Minneapolis Marriott Northwest Keynote Speaker Dr. Bill Moreau, Managing Director of the United States Olympic Committee (USOC) Sports Medicine Division Program Preview Thursday, March 9 2:00-3:00pm Professional Boundaries 3:00-6:00pm X-Ray 6:30-8:00pm MCA Board Meeting Friday, March 10 6:45-7:30am 7:30-9:10am 9:15-10:05am 10:35am-12:15pm 12:15-1:30pm 2:30-3:50pm 3:55-5:25pm 5:30-6:30pm 7:00-9:00pm
Exhibits and Continental Breakfast Featured Speaker – Dr. Robert Silverman Extremity Adjusting – Dr. Scott Mooring NCMIC: Risk Management – Dr. Perle Luncheon Meeting Veteran Care – Dr. Chad Paulson, Joan Olson, Nona Peterson Keynote Address – Dr. Bill Moreau Exhibitor Reception Awards Banquet
Saturday, March 11 6:45-7:30am Registration 7:00-7:30am Exhibits and Continental Breakfast 7:30am-12:15pm CPR Certification and Recertification 7:30-8:20am NCMIC: Ethics – Dr. Perle 8:20-9:10am NCMIC: Soft Tissue Dysfunction – Dr. Perle 9:50-10:40am Year Two Gallup-Palmer Survey – Dr. Mickey Burt 10:40-11:30am NCMIC: Rehabilitation – Dr. Perle 11:30am-12:15pm Exhibits 12:15-1:15pm Lunch and Annual Meeting 1:30-4:15pm NCMIC: Evidence Based Practice – Dr. Perle 4:15-5:15pm President’s Reception and Farewell
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Don’t Miss MCA Day at the Capitol!
March 9, 2017
Join us at the State Capitol to meet with lawmakers about the critical issues that affect you and your patients, including: •
The importance of the chiropractic profession in Minnesota’s health care workforce
Support for legislation expanding access for Medical Assistance and MinnesotaCare patients to the full scope of your clinical services
The discriminatory reimbursement practices and policies of Minnesota’s health insurers
Protecting the rights of injured patients in Minnesota’s no-fault automobile insurance system
Your voice at the Capitol is important — in fact, it’s vital for the success of your legislative agenda!
Visit www.mnchiro.com to register 7
Minnesota Chiropractic Association 1000 Westgate Drive, Suite 252 Saint Paul, MN 55114 www.mnchiro.com (651) 288-3428 Phone (651) 290-2266 Fax
Upcoming MCA Events Sat, 2/4 – Sun, 2/5/17 Thu, 2/16/17 Tue, 2/21/17 Tue, 2/21/17 Thu, 3/9/17 Thu, 3/9 – Sat, 3/11/17
Review for State of MN Limited X-Ray Operator Exam – Minneapolis, MN Metro East District Meeting – Saint Paul, MN Central District Meeting – Saint Cloud, MN Southeast District Meeting – Rochester, MN MCA Day at the Capitol – Saint Paul, MN MCA 2017 Annual Convention – Brooklyn Park, MN Visit www.mnchiro.com/events to learn more and register for these events.