Promoting Integrated GI Care in the Independent Practice Setting Spring 2019
Dear Prospective Member Practice, In today s rapidly changing healthcare landscape, the ability to adapt is important. Recognizing new opportunities and threats is critical to ensuring that we can continue providing the highest quality care for our patients in our independent practices. DHPA s mission is to strengthen and promote our integrated, independent private practice model, which provides high quality care and value with a level of service and attention generally not attained in other practice models. DHPA s growth since forming in February 2014 has been remarkable. We started with 11 independent gastroenterology practices and 406 physicians. Today, DHPA stands at more than 1,800 physicians in 78 member practices from 36 states in every region of the country. We ve become a strong advocate on behalf of independent GI practices, promoting and protecting the high quality, cost-efficient and convenient care on which millions of patients depend. We've held more than 400 meetings with Congressional offices in the past four years, leading policymakers to recognize DHPA as a trusted resource on issues that affect our member practices and the millions of patients we serve. The following presentation provides information about our advocacy efforts and the ways in which we add value to our member practices. I highlight a few examples here. Stark Law Modernization Recognizing the need to modernize the federal physician self-referral law (commonly known as the Stark Law), DHPA led a diverse coalition of 24 physician organizations in developing the bipartisan Medicare Care Coordination Improvement Act of 2017 (H.R. 4206, S. 2051). The legislation seeks to eliminate barriers to care coordination created by the Stark Law, which was enacted 30 years ago when fee-for-service medicine predominated. Modernizing the Stark Law to allow physicians in independent medical practices to participate in value-based payment arrangements is critical to ensuring that we can participate in, and succeed under, MACRA. State Policy Initiatives 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 selfreferral law (the Codey Act ) to protect referrals made in furtherance of Advanced Payment Models. Regulatory Victories Several recommendations made in DHPA comment letters to CMS were included in the 2019 MPFS and OPPS final rules, including proposals aimed at reducing the regulatory burdens associated with E/M documentation and strengthening site-neutral payment policies aimed at eliminating incentives for hospitals to acquire physician practices. In previous years, our DHPA member practices engaged in a massive grassroots effort in support of Congress s repeal of the Sustainable Growth Rate formula and enactment of alternative payment policies that reward coordinated care. Our support was also instrumental in passage of the Electronic Health Fairness Act, which eliminates meaningful use penalties for physicians performing procedures at ambulatory surgery centers. 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 work together to advocate for healthcare policies that promote patient access to the high quality, cost-efficient care that we provide. Sincerely, Michael Weinstein, MD DHPA President and Chairman of the Board
DHPA governance & physician leadership EXECUTIVE COMMITTEE Michael Weinstein, MD President and Chairman of the Board Capital Digestive Care LLC Michael Dragutsky, MD Secretary Gastro One Paul Berggreen, MD Chair, Data Analytics Arizona Digestive Health Mehul Lalani, MD At-Large Member Regional GI James Weber, MD Vice President Texas Digestive Disease Consultants Fred Rosenberg, MD Immediate Past President Illinois Gastroenterology Group Latha Alaparthi, MD Chair, Communications Gastroenterology Center of Connecticut David Stokesberry, MD At-Large Member Digestive Disease Specialists David Ramsay, MD Treasurer Digestive Health Specialists, PA Naresh Gunaratnam, MD Chair, Health Policy Huron Gastroenterology Greg Munson, MD At-Large Member Northwest Gastroenterology Kevin Harlen Executive Director Capital Digestive Care, LLC BOARD OF DIRECTORS One physician leader from each DHPA member practice Board members have equal vote regardless of size of group Two in-person meetings per year Conference calls at least twice per year Brings together thought leaders in independent GI 3
DHPA: Creating a voice for independent GI Even with existing strong relationships with the Tri-Societies (AGA, ACG, ASGE), independent GI practices need to proactively define and promote the ways in which they safeguard patient access to affordable, high-quality care. As our health care system shifts away from fee-for-service medicine, independent GI practices need to ensure that policymakers provide them with the clarity and flexibility to participate in Alternative Payment Models (APMs) and other value-based payment arrangements. DHPA seeks to complement the efforts of our existing national societies by focusing laser-like on issues vitally important to our single constituency independent GI practices and our patients. 4
DHPA formation (2014): Threats to integrated GI care GAO Reports on Self-Referral in the Office Setting: Advanced Imaging (Sept. 2012); Anatomic Pathology (June 2013); Intensity-Modulated Radiation Therapy (July 2013) Federal Legislation: The Protecting Integrity of Medicare Act of 2013 called for elimination of in-office ancillary services protection for advanced imaging, anatomic pathology, radiation therapy and physical therapy services President Obama s Budget: Claimed $6+ billion savings over 10 years if in-office ancillary services protection were eliminated for advanced imaging, anatomic pathology, and other services (CBO scores savings: $3.3 billion) CMS Payment Policy: Widening payment disparity between identical services furnished in physician office and outpatient hospital department settings State Attacks on Integrated GI Care: Attacks on in-office anatomic pathology, advanced imaging and anesthesia services 5
6 Rapid growth evidence of need
Strategic overview Promote high quality, cost-efficient and integrated care furnished in the independent GI practice setting TACTICS Federal and State legislative and regulatory advocacy Grassroots physician outreach and mobilization Leveraging member data and research Alliance development and thought leadership Earned and social media Online and digital engagement KEY MESSAGES Patients receive highest quality care in independent GI practice setting Independent GI practice model is more cost-efficient than the hospital setting The health care system needs independent medicine to succeed Independent GI physicians are job creators and caregivers in the community AUDIENCES INTERNAL COMMUNICATIONS Federal lawmakers State lawmakers Regulatory agencies Policy influencers Keep the physicians in our member practices informed and engaged 7
Best-in-class advisors Our strategic plan is supported by experienced practitioners of three key components of advocacy legal, lobbying, and communications Howard Rubin Partner Katten Muchin Rosenman Legal Counsel John McManus President The McManus Group Lead Republican Lobbyist Tracy Spicer Founding Partner Avenue Solutions Lead Democratic Lobbyist Andrew Sousa Partner Steadfast Communications Lead Comms Strategist 8
2014-2016 federal advocacy accomplishments LEGISLATIVE Policymaker Discussions: Held 230 meetings on Capitol Hill with lawmakers and staff Successfully opposed legislation to narrow inoffice ancillary services exception (IOASE) Supported Removing Barriers to Colorectal Cancer Act (H.R. 1220/S. 624), to waive Medicare cost sharing for screening colonoscopy Advocated to preserve site-of-service payment neutrality provision in the Bipartisan Budget Act of 2015 (BBA) Secured enactment of the Electronic Health Fairness Act, which eliminates meaningful use penalties imposed on physicians providing care in ambulatory surgery centers. Recognized by House and Senate leadership for our efforts urging repeal of Sustainable Growth Rate formula and passage of MACRA Grassroots activation of DHPA member practices was instrumental in 240 Members of Congress signing a letter to CMS urging withdrawal of Part B Drug Proposal that would have changed reimbursement for drugs administered in independent GI physician offices LEVERAGE DATA 2014: Commissioned Milliman study, which showed that physician ownership was not driving utilization of anatomic pathology services. The study was widely shared on Capitol Hill. Conducted internal study on ADR as Quality Metric using data from 27 member practices: ADR: 39.1% nearly double estimated 20% ADR benchmark STARK LAW MODERNIZATION 2016: Submitted comment letters to U.S. Senate Finance and U.S. House Ways and Means Committees, on ways to modernize physician self-referral law Joined 21 physician organizations on a separate letter to the U.S. Senate Finance and U.S. House Ways and Means Committees Submitted comments to CMS on proposed rule implementing the Merit-Based Incentive Payment System (MIPS) and incentives for Alternative Payment Models (APMs) REGULATORY MPFS CY2015: Supported revision to definition of colorectal cancer screening tests to include anesthesia furnished with screening colonoscopies Secured Congressional letter objecting to RUCproposed cuts to reimbursement for lower endoscopic procedures (cuts were excluded from the Medicare Physician Fee Schedule Final Rule) MPFS CY2016: Submitted comments on proposed cuts to colonoscopy reimbursement Secured bipartisan champions: Sen. Cassidy (R- LA), Sen. Cardin (D-MD) and Rep. Lance (R-NJ) and 27 Senators and 94 Representatives on letter to CMS OPPS CY2016: Submitted comments supporting implementation of site neutrality provisions of the BBA. Final Rule strongly supported site neutrality. Submitted comments on proposed rule implementing the Merit-Based Incentive Payment System (MIPS) and incentives for Alternative Payment Models (APMs) 9
2017 federal advocacy accomplishments LEGISLATIVE/REGULATORY MEDICARE PART B DRUG STARK LAW MODERNIZATION Policymaker Discussions: Met with more than 115 congressional offices to discuss policy priorities: o Modernize the Stark Law to enable physicians to succeed under MACRA o Support Removing Barriers to Colorectal Cancer Screening Act Held fundraisers for six Members of Congress who are influential on important policies related to independent GI APM Proposals Project Sonar and Colonoscopy Bundle: DHPA supported two proposals submitted to the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which would provide opportunities for gastroenterologists to participate in Advanced APMs Policymaker Letters: DHPA joined 268 other leading physician organizations in sending a letter to the Secretary of HHS, Dr. Thomas E. Price, urging withdrawal of the Medicare Part B proposed rule. o Urged Secretary Price to reject a series of recommendations from the Medicare Payment Advisory Commission (MedPAC) that would have undercut the effectiveness of the current Medicare Part B Drug Program DHPA also joined nearly 200 physician, patient and other advocacy groups in signing a letter to MedPAC expressing concern about its recommendations to CMS CMS announced in October that it had withdrawn the proposed rule Medicare Care Coordination Improvement Act: DHPA worked with a diverse coalition of 24 physician organizations to support development of the Medicare Care Coordination Improvement Act of 2017 (H.R. 4206 and S. 2051) o Promotes care coordination and will enable physicians to participate more fully in value-based payment models incentivized by MACRA o Provides HHS the same authority to waive restrictions in the Stark Law and Anti-Kickback Statute with respect to APMs, as was provided to ACOs in the Affordable Care Act o Allows physician practices to incentivize practitioners to provide high quality care while alternative payment models are under development and in operation 10
2018 federal advocacy accomplishments LEGISLATIVE STARK LAW MODERNIZATION REGULATORY Policymaker Discussions: Met with more than 140 congressional offices to discuss DHPA policy priorities: o Modernize the Stark Law to enable physicians to succeed under MACRA o Reform step therapy protocols to let providers determine patient care o Remove barriers to colorectal cancer screening Held fundraisers for six Members of Congress who are committed to independent GI Organized grassroots action to block efforts by the hospital lobby to oppose CMS proposal to implement site neutral payment policies Signed onto a coalition letter to Congressional leaders asking them to urge CMS to reconsider a proposal to allow Medicare Advantage plans to implement step therapy for Part B drugs. Signed onto a coalition letter to Congressional leaders opposing a CMS Medicare Part B proposal that would affect half of all independent physicians and their patients. Medicare Care Coordination Improvement Act: Advocated for the Medicare Care Coordination Improvement Act of 2017 (H.R. 4206 and S. 2051) DHPA President Dr. Michael Weinstein testified before the U.S. House Energy & Commerce Health Subcommittee during a hearing examining barriers to expanding innovative value-based care in Medicare Organized grassroots action resulting in more than 150 letters being sent to Congressional offices by DHPA member physicians support modernization of the Stark law Policymaker Letters: Submitted comments to a CMS Request for Information (RFI) on modernizing the Stark law outlining ways to ensure that independent GI practices can participate in value-based financial arrangements. Submitted comments to an RFI from the HHS Office of Inspector General regarding the need to modernize the Anti-Kickback Statute to support value-based care models. Signed onto a coalition letter supporting CMS s proposed simplification of documentation requirements and opposing proposed payment changes regarding E/M coding in the MPFS Proposed Rule for CY2019 Submitted comments in response to the HHS RFI regarding the Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs Signed onto a coalition letter to HHS voicing concern about Medicare Part B proposals outlined in the Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs 11
State-level engagement STATEHOUSE LANDSCAPE HEALTH POLICY ACTION FUND STATEHOUSE ACTIVITIES Must go 2-0 to protect integrated care because federal law does not preempt state law States can eliminate/restrict what otherwise is protected federally Easier to change the rules at the state level harming integrated medicine Protect against harmful legislation in one State serving as copycat for other States DHPA teaming with corporate member J&J to establish early warning detection system at state level Created to support DHPA member practice engagement on key state issues impacting patient access to high quality, integrated GI care Twice a year, DHPA s State Health Policy Committee solicits and reviews grant applications from member practices on key state issues for which member practices seek support Initial awards made in January 2017 to support DHPA member practice efforts to modernize state self-referral laws (Maryland and New Jersey) and to repeal/modify an onerous ASC tax (Connecticut) Additional awards made in Winter 2018 to support DHPA member practice efforts to eliminate CON restrictions on ASCs (Maryland); protect in-office pathology (Pennsylvania); repeal ASC tax (Connecticut) Supported California member practices in mobilizing independent medical practices in the State to oppose SB 1215, which would have eliminated in-office anatomic pathology, advanced imaging and other critical services o With DHPA support, the bill failed with only one affirmative vote Supported member practices in Maryland in legislative efforts to reform the State s self-referral law o In May 2017, Maryland became the first State to modernize a self-referral law following passage of MACRA Supported member practices in New Jersey in similar legislative efforts that resulted in enactment of a law modernizing the State s self-referral law (the Codey Act ) to protect referrals made in furtherance of APMs 12
DHPA priorities, goals & objectives: 2019 1. Reintroduce and champion the Medicare Care Coordination Improvement Act (S. 2051, H.R. 4206 in the 115th Congress), legislation to modernize the federal physician self-referral (Stark) law to enable physicians to participate more fully in value-based payment models incentivized by MACRA 2. Support member practices in the education of primary care physicians and patients regarding appropriate colorectal cancer screening options 3. Advocate for the Restoring the Patient s Voice Act (H.R. 2077 in the 115th Congress), bipartisan legislation to reform step therapy requirements and give providers increased autonomy in determining the care that is best for their patients 4. Advocate for the Removing Barriers to Colorectal Cancer Screening Act of 2019 (S. 668, H.R. 1570) 5. Educate Members of Congress on how independent GI practices provide a high quality, cost-efficient alternative to procedures in hospital outpatient departments 6. Support DHPA member practices on significant state health policy issues impacting patient access to high quality, cost-efficient and comprehensive care furnished in independent GI practices 13
Dues assessment and political fundraiser support MEMBERSHIP DUES Each member practices pays dues on a per physician basis (minimum contribution at the level of five physicians) Dues paid on corporate account of the practice (not by individual physicians) 2019 dues have been set at $650 per physician Travel-related expenses for semi-annual meetings covered by DHPA (travel for DHPA Board member to Washington DC in March 2019 and for Board member + 1 or more additional people (depending on size of practice) from each member practice for Fall 2019 Annual Membership Meeting) BOARD UNANIMOUSLY APPROVED SIX FUNDRAISERS PER YEAR Each DHPA member supports one fundraiser for a Member of Congress once every 18 months with request for voluntary contributions of $150 from each physician in the practice From 2015 through 2018, DHPA has held 20 fundraisers for U.S. Senators and U.S. Representatives who sit on committees with jurisdiction over health care issues, as well as for members of Congressional leadership 14
Contact: Kevin Harlen DHPA Executive Director Kevin.Harlen@capitaldigestivecare.com www.dhpassociation.org @DHPAnews