What Physicians Need to Know About the New Federal Budget Agreement

After weeks of political posturing and following the second government shutdown of the year, Congress passed, and President Trump signed into law, The Bipartisan Budget Act of 2018 last Friday morning.

The sweeping budget agreement made front-page news headlines for ending the overnight government shutdown and increasing federal budget spending caps for 2018 and 2019. But beyond those headlines, the law also includes several important healthcare policy changes and reforms. For physicians, here are a few important facts to know about the new law:

• This is as much a healthcare law as it is a budget agreement. The final legislative package approved by Congress was 652 pages long and 377 of those pages were healthcare-focused. In a midterm election year with many other competing legislative priorities still on Congress’ to-do list, this law will likely be the most important healthcare bill passed in 2018.
• Nearly every healthcare provision in this law is bipartisan.Most, but not all, of the 377 healthcare-focused pages in this law were crafted by the House and Senate healthcare committees on a bipartisan basis over the past year. As such, you can be sure that most of the provisions in this law will last well beyond the next government funding crisis or election cycle.
• It includes a 0.25% cut to physicians’ 2019 Medicare fee-for-service (FFS) reimbursements. Further challenging physicians’ baseline Medicare FFS margins, the law reduces the reimbursement update physicians will receive under Medicare’s Physician Fee Schedule in 2019 from 0.50 percent to 0.25 percent.
• The new law could extend certain “transition year” policies for MACRA’s Merit-based Incentive Payment System (MIPS) for three more years. As part of the original MACRA law, CMS was allowed to implement “transition” policies for MIPS during the first two years of the program, 2017 and 2018. In this new law, Congress has provided CMS the discretion to continue certain MIPS “transition” policies- including those related to the cost category and the overall scoring benchmark- through 2021. Congress also removed a provision of the HITECH Act requiring CMS to make the Meaningful Use EHR Incentive Program more difficult over time, which could result in further changes to the MIPS Advancing Care Information category.
• It provides a two-year extension of community health center funding and four additional years of CHIP funding. In what is no doubt welcome news for community health centers (CHCs), this law includes an extension of mandatory funding for CHCs through September 2019 at increased funding levels for both 2018 and 2019. The law also includes an additional four years of funding for the Children’s Health Insurance Program (CHIP), which received a six-year funding extension last month and is now fully funded through FY 2027.