The 2017 Changes to Medicare Affect Every DCBy 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 with the yearly “doc fix.” Now instead we have a new mix of “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 indi-vidualized. There is no one simple solution for everyone.

This article will not be like a nav 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. For example (and this is by no means a complete list):

• What happened to Meaningful Use? to PQRS? to the Val-ue 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 every-

thing seems medical? • Is my EHR certified? For what 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 key question: Where can I go to get help to understand and then make my own decisions?

It is in addressing 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. Medi-care has created a new website dedicated to the new Quality Payment Program: www.QPP.cms.gov. The website offers

February 2017MCA In Touch

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detailed explanations of this big and complex law. It is not simple, but everything is straightforward and direct.

Within the QPP website are two further areas of help. First you can email questions to Medicare at QPP@cms.hhs.gov.

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 your question and the answer. I have used this. It works very well. The phone number is 1-866-288-8292.

In addition, the ACA provides information from a chiroprac-tic point of view. They have 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. The video helps you see the advantages for yourself and the profession to participate as you are able.

The video is free for ACA members, and $30 for non-mem-bers. I have watched it and recommend it for everyone. Non-members, it really is worth the price. You can view the video at https://www.acatoday.org/MACRA/MACRA-Video.

The changes to 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 – it’s bad for your posture and leaves you in a very vulnerable position.

Legislative UpdateBy 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 reimburse-ment, either directly or indirectly.

The first is the Patient Rights and Provider Non-Discrimina-tion bill (SF 749/HF 886), initially introduced late 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 Legislature, Sen. Scott Jensen, is the second author. The chief author in the House is Rep. Glen Gruenhagen, and Northwestern’s lobby-ist, Mr. Dave Kunz, has been successful in securing another 33 co-authors. (Senate bills have a limit of five authors.)

The non-discrimination bill is a pro-active effort to address a wide range of discriminatory health plan practices and poli-cies that are all too familiar to chiropractic doctors, including:

• Different – often substantially so – reimbursement rates for the same service 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 fac-tors and covered essential benefits

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 – is a bill that seeks to expand reimbursable services

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Medicare Changes continued from Page 1

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Introduction of HF886From Craig Couillard D.C., CMT, CCSP, ICCSP, CSCS, PES, CES, MCA Legislative Committee Chair

The Patient Rights and Provider Non-discrimination bill (HF 886) that the MCA is supporting has been introduced.

You can learn more about the bill at https://www.revisor.mn.gov/bills/bill.php?f=HF886&y=2017&ssn=0&b=house. This web page will give you access to the language of the bill and allow you to follow its progress. 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 on Thursday, March 9! Sign up at http://www.mnchiro.com/event/2017DayAtCapitol. MCA will provide the talking points at the event.

provided by chiropractic doctors to patients enrolled in Min-nesota’s public healthcare programs (i.e., Medical Assistance and MinnesotaCare).

Over the past few months, I have joined the MCA’s lead lob-byist, Mr. Kevin Goodno, in three very productive meetings with staff members from the Minnesota Department of Hu-man Services. They have assisted Mr. Goodno with revisions in the bill language that relate to evaluation and management services, as well as therapy services that are not currently a covered benefit. That work is finished, and the House version of the bill (HF 1357) has been introduced and will be first heard in the Health and Human Services Reform Committee.

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 contin-ue funding MinnesotaCare, but it includes a provision that would 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 intro-duced in the 2016 session, and again more recently, by Rep. Glen Gruenhagen that would allow medical, dental and chiro-

practic providers to deduct the value of charity care they pro-vide 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 Med-ical Assistance reimbursement for chiropractic services. In my remarks, I also mentioned the fact that many chiropractic doctors simply provide non-covered 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 pro-cess can be uncertain and is often messy. 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 ef-fective lobbying are essential for progress – and you generally have to be persistent!

That’s the inescapable reality, so take advantage of the oppor-tunity 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 web-site, or have contacted me directly, you are on the roster so watch your email for more information. If not, get on-board now!

Learn more and sign up for Day at the Capitol on the MCA website: http://www.mnchiro.com/event/2017DayAtCapitol.

Legislative Update continued from Page 3

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