(March 7, 2019): The Department of Veteran Affairs (VA) has issued proposed regulations implementing the mandates of the VA MISSION Act of 2018 that requires eligible veterans have access to walk-in clinics from qualifying non-VA entities or providers without prior authorization. UCA offered comments to the VA on its proposal to refer to the benefit as urgent care, versus walk-in care, essentially making care provided in urgent care facilities and retail clinics indistinguishable. UCA also took issue with the VA’s proposal to define episodic care as a single visit and disallowing preventive services (other than flu shots, and therapeutic vaccines that are furnished in the course of treatment of another condition). The UCA stressed the importance, as a best practice, of follow-up care in certain situation to a non-emergent acute care visit. UCA’s comments to the proposed rule can be read in full here.

(January 2, 2019): On December 3, the Administration released a report on improving choice and competition in the health care system that takes aim at state certificate of need (CON) laws. In the report, the Administration recommends that states should consider repeal of CON statutes or, at a minimum, significantly scale back the scope of their CON laws. For example, the report states that competitors of CON applicants should not be allowed to weigh in on these applications. The recommendation is supported by evidence highlighted in the report that CON laws have not resulted in cost savings, higher quality heath care, or greater access to care. Instead, the report notes that CON laws interfere with market forces, including by shielding health care providers from competition of new market entrants. Speculation is the Administration will use its 1332 state innovation waiver authority as a mechanism to encourage state deregulation, including repeal of CON laws. Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a state innovation waiver to pursue innovative strategies for providing their residents health insurance while retaining the basic protections of the ACA, although recent changes to the regulations that govern Section 1332 relax the waiver standards. Innovation waivers are important to states because the federal government can “pass through” the money that it would have spent on premium tax credits, cost-sharing reductions, and small employer tax credits to a state. While the federal government cannot force states to repeal or modify their CON laws, the report suggests that states pursuing a Section 1332 waiver may be received more favorably if they demonstrate efforts to deregulate.

(January 1, 2019): In December, the Centers for Medicare and Medicaid Services (CMS) announced that it is increasing effective immediately all currently assessed Clinical Laboratory Improvement Amendments (CLIA) fees by 20 percent to close the gap between current obligations and current collections. In the notice, CMS states it intends for the increase to be a one-time adjustment to address a projected $9.3 million shortfall to ensure the program can remain self-sustaining into Fiscal Year 2022. The Agency, however, will continue to review its obligations and collections and may make future adjustments as needed to avoid shortfalls. The fee increase applies to Certificate Fees (except fees for the issuance of a Certificate of Registration) and Compliance Fees for non-accredited labs. The increase also applies to Additional Fees that cover the cost of validation inspections for labs with a Certificate of Accreditation. CMS will accept public comment on the fee increase through March 1, 2019. Comments can be submitted through regulations.gov.

(November 14, 2018): On November 8, the Centers for Medicare and Medicaid Services released a snapshot of 2017 performance data for the Quality Payment Program. Not surprisingly nearly all (93 percent) will receive a positive payment adjustment in 2019. The first performance year of the Merit-based Incentive Payment System was 2017, which allowed clinicians to “pick their pace” in the program. The performance threshold was only three points. Comparatively, the performance threshold for the 2019 performance year will be 30 points.

(November 7, 2018): On November 1, the Centers for Medicare & Medicaid Services (CMS) finalized updates to payment policies and rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019. UCA Policy Consultant Camille Bonta, MHS, has provided a summary of components of the PFS rules that have the potential to significantly impact urgent care medicine. The full communication can be read here.

(September 11, 2018): On September 10, the Urgent Care Association (UCA), with input from your Health and Public Policy Committee, submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the CY 2019 Medicare Physician Fee Schedule Proposed Rule. The rule includes changes to Medicare payment policy and participation requirements for the Quality Payment Program (QPP) for 2019. Publication of a final rule is expected in early November.

(July 19, 2018): On July 12, the CY 2019 Medicare Physician Fee Schedule (PFS) proposed rule was released, which also includes proposed changes to the Quality Payment Program (QPP) for the 2019 performance year. CMS is proposing a new urgent care specialty measure set. The measure set, which includes 15 measures, was requested by the College of Urgent Care Medicine (CUCM) and Urgent Care Association (UCA). Eleven of 12 measures proposed by CUCM and UCA were accepted. The creation of a measure set will serve to help urgent care providers with the selection of measures when fulfilling the quality component of the Merit-Based Incentive Payment System (MIPS). The measure set also creates a distinction between family and emergency medicine. Among the most consequential proposals in the rule is the creation a single payment amount for office/outpatient Evaluation and Management (E/M) visit levels 2 through 5. The proposed payment changes are budget neutral which will result in a redistribution of dollars among primary and specialty care.

(June 28, 2018): The Urgent Care Association (UCA) appreciates the opportunity to lend its voice to this discussions as all Americans should have access to affordable and comprehensive health care coverage. The reality is, however, that health care affordability requires attacking the cost drivers in our system without compromising access or quality. One cost driver is health system failure to incentivize site appropriate health care and the inability of consumers to make informed decisions on where to access care because transparency is lacking. Please read the testimony further here.

(June 21, 2018): The Payer Relations Committee discussed this item on a recent call and how it connects them with the Health and Public Policy Committee. This can serve as a valuable resource to UCA members as this report seeks to shed light on this other work through an examination of state-level value-based payment initiatives underway across America. Overall, five states stand out for the breadth of their initiatives, their embrace of payment models that involve shared risk, and their willingness to test innovative strategies. Please read the full report here.

(April 6, 2018): In a letter to members of the Missouri General Assembly, UCAOA offered support of the pending legislation that would encourage, but not require, primary care providers and urgent care physicians to inquire of new patients whether they are registered with the bone marrow registry. In its letter of support, UCAOA emphasized the importance of giving health care providers flexibility to voluntarily support initiatives to increase the number of potential bone marrow donors. Send your thoughts, ideas and experiences to Nirja Shah at nshah@ucaoa.org.

(April 3, 2018): Sens. Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO) are seeking feedback from the health care and patient communities as they develop legislation to improve price transparency in the health care market. In response to the solicitation, UCAOA submitted comments that the lack of price and information transparency is a contributor to hospital emergency department overuse. The Association also highlighted that many consumers don’t know the difference on when to seek care at a free-standing emergency department versus an urgent care center and the associated costs — a distinction that is not apparent until after a patient receives a bill for care provided in a free-standing emergency department that includes a facility charge. The Health & Public Policy Committee is interested in better understanding state-level price transparency requirements from an urgent care center perspective. Send your thoughts, ideas and experiences to Nirja Shah at nshah@ucaoa.org.

(February 15, 2018): On February 9, the Urgent Care Association (UCA) in collaboration with the College of Urgent Care Medicine (CUCM) submitted a letter to the Centers for Medicare and Medicaid Services (CMS) in response to a call for recommendations for specialty quality measure sets for the 2019 performance year of the to the Merit-Based Incentive Payment System (MIPS). The specialty set recommended by the two societies includes 12 quality measures.