By Dr. Lawrence Kim
Chair, DHPA Health Policy Committee
Since 2014, we’ve worked together to make DHPA a strong advocate on behalf of independent GI practices, promoting and protecting the high quality, cost-efficient and convenient care on which millions of our patients depend.
Our tireless efforts on behalf of our members, and all independent GI practices nationwide, have demonstrated how much we can achieve when we stand united. In the past three years, we’ve held more than 300 meetings with Congressional offices, and are now recognized by policymakers as a trusted resource on health policy issues that affect our member practices and the patients we serve.
In September, 53 DHPA Board Members participated in 100 meetings on Capitol Hill (including many meetings with the Senator or Representative) to educate lawmakers about the care that our practices provide to millions of Americans. Our Board Members focused on modernizing the Stark Law and supporting the Removing Barriers to Colorectal Cancer Screening Act. In addition to meetings on Capitol Hill, DHPA Board Members participated in political events for U.S. Representative Brett Guthrie (R-KY), and U.S. Representative Ron Kind (D-WI) – both of whom sit on committees with jurisdiction over the health policy issues that matter most to our patients and our practices.
Our direct engagement with policymakers is integral to our efforts to modernize the Stark Law. DHPA led a diverse coalition of 24 physician organizations – representing more than 500,000 physicians – in developing and negotiating the policy details of the bipartisan Medicare Care Coordination Improvement Act of 2017 (H.R. 4206, S. 2051). This bipartisan legislation is designed to eliminate barriers to care coordination created by the Stark Law, which was enacted nearly 30 years ago when fee-for-service medicine predominated.
These barriers were recognized years ago when Congress authorized the U.S. Department of Health and Human Services (HHS) to waive the self-referral and anti-kickback prohibitions for accountable care organizations (ACOs) in the Affordable Care Act. H.R. 4206 and S. 2051 would provide HHS the same authority to waive restrictions in the Stark Law that currently inhibit independent physician practices from developing and operating APMs.
The legislation would allow physician practices to incentivize practitioners to provide high-quality care while APMs are under development and in operation by repealing the so-called “value or volume” standard in the law. Modernizing the Stark Law is critical to ensuring that independent practices like ours can participate in, and succeed under, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). We will be in touch with you in early 2018 to seek your assistance in contacting your particular Members of Congress and Senators to cosponsor and advance this legislation.
Through our State Health Policy Action Fund, we supported DHPA member practices in Maryland in legislative efforts to reform that State’s self-referral law, resulting in Maryland becoming the first State in the country to modernize a self-referral law following passage of MACRA. DHPA also supported member practices in New Jersey in similar legislative efforts that led to enactment of a law modernizing New Jersey’s self-referral law (the “Codey Act”) to protect referrals made in furtherance of Advanced Payment Models.
In a meaningful victory for our patients, CMS announced in October that it had abandoned a proposed rule that would have jeopardized our patients’ access to drugs, such as Remicade, that we administer in our offices under Medicare Part B. DHPA, our allies and patient advocates loudly opposed the proposed rule, advocating against it for more than a year. In April 2016, more than 600 individuals in our DHPA member practices contacted their Representatives and Senators to request that they voice opposition to the proposed rule with CMS. Almost 200 Members of Congress received more than 1,900 emails from DHPA member practices urging them to ask CMS to withdraw the proposed rule.
Thanks in part to the outpouring of support from the independent GI community, more than 240 Members of Congress signed a bipartisan letter to CMS opposing the proposed rule. Those grassroots efforts complemented our submission of a formal comment letter to CMS focusing on the importance of CMS protecting patient access to critically important drugs administered to patients with Crohn’s disease and ulcerative colitis.
In 2017, DHPA filed comments on other critically important health policy issues impacting our member practices. In response to CMS’s CY 2018 Updates to the Quality Payment Program (“QPP”) Proposed Rule, we commented on the importance of CMS finalizing proposals with respect to the creation of “virtual groups” as a mechanism for encouraging specialty practices to participate in the MIPS. CMS finalized the proposal, which will enable groups of 10 or fewer physicians to come together in “virtual groups” for purposes of MIPS reporting. This option will be particularly important for the third of DHPA’s member practices with 10 or fewer physicians.
We also filed comments in response to the U.S. House Ways and Means Health Subcommittee’s Medicare Red Tape Relief Project, encouraging the committee to advance legislation that will modernize the Stark Law, and calling for greater authority for the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to design, develop and implement PFPMs.
We’ve accomplished a lot in a short time, but there is much more we can do together. At a time when our practices, along with patients, payers and policymakers, are more concerned than ever with the quality and cost effectiveness of care, it is critical that independent GI practices continue working together to advocate for healthcare policies that promote patient access to the high quality, cost-efficient care that we provide.
I encourage you to visit the advocacy page on our website for more information about all of our efforts on behalf of DHPA’s member practices. Thanks to your support, the voice of independent GI continues to grow in Washington, DC and in state capitals around the country.