April 2016 - BOS Washington Update



Shoulder Coding Success

The Centers for Medicare and Medicaid Services (CMS) recently shared a letter with AAOS indicating that they will be remedying a shoulder coding issue that has been a key priority of AAOS, AOSSM, AANA and ASES.  AAOS President Gerald R. Williams, MD, along with Louis F. McIntyre, MD from AANA and William Shaffer, MD, AAOS Medical Director met with CMS officials in March to discuss the issue.  At the meeting, the participants asked CMS to eliminate National Correct Coding Initiative (NCCI) edits for certain code pairs, arguing that the shoulder is technically three anatomic synovial joints and two articulations.  The CMS policy had allowed the agency to deny payments when these procedures are performed or billed together.   As a result of the meeting, CMS is deleting the edits that caused the relevant CPT codes to be denied. Read more in Advocacy Now.


Congress – A Look Ahead

The House and Senate returned from spring recess to face a daunting list of high-priority issues and very little time to address them.  In the roughly 50 legislative days until Congress leaves mid-July for the political conventions and August recess, top priority items include passing as many FY 2017 spending bills as possible, defense authorization, emergency funding requests for combating Zika and opioid addiction, financial assistance for Puerto Rico, assistance for the Flint, MI water crisis and the Federal Aviation Authority authorization.  This is an especially heavy lift in an election year.


Legislation Introduced to Delay the Comprehensive Care for Joint Replacement Demo

House Budget Committee Chairman Tom Price, MD (R-GA) and Rep. David Scott (D-GA) introduced legislation that would delay the start of the mandatory CMS model to bundle payments for hip and knee surgeries until January 1, 2018. H.R. 4848, The Healthy Inpatient Procedures (HIP) Act, would ensure that physicians, hospitals, and post-acute care providers have adequate time to prepare for the onset of this complex payment system. While the program began April 1, 2016, legislative efforts continue. Read more in Advocacy Now.


Senate Health Innovation Proposal Moves Forward

The Senate Health, Education, Labor and Pensions (HELP) Committee wrapped up work on their medical innovation package with a third and final markup on April 6. The Committee passed five bipartisan bills, including two reform measures for the National Institutes of Health (NIH), a bill to advance precision medicine, a bill to enable the Food and Drug Administration to expedite an antibacterial drug’s approval if it is for an identifiable, limited patient population, and a proposal to ensure the inclusion of minorities in clinical research at the NIH as well as to make progress on reducing health disparities among women, minorities and certain age groups. The bills will be combined into a single package to be considered on the Senate floor. This proposal is a companion to the House’s 21st Century Cures initiative.


Rep. Burgess, MD (R-TX) to Speak at Hip Society Conference

Rep. Michael Burgess (R-TX) an OBGYN, will speak at the Hip Society’s annual conference in Bethesda, MD. Burgess is on the Health Subcommittee of the powerful Energy and Commerce Committee and was the architect of the legislation that replaced the SGR (MACRA).


SRS, POSNA Write USPSTF on Scoliosis Screening

AAOS joined SRS, POSNA and the American Academy of Pediatrics (AAP) in writing to the US Preventive Services Task Force on the importance of screening for early detection of scoliosis.  According to the letter, “current evidence for treatment of scoliosis in an early stage warrants increased attention by all health care personnel who evaluate at-risk children.” Additionally, AAOS, SRS, POSNA, AAP and others wrote the House and Senate appropriators to request $5.25 million in funding for FY 2017 for the Pediatric Device Consortia Grant Program.


Pre-Certification Alert

In January, leaders of the AAOS, AAHKS, Hip Society and Knee Society distributed a letter to members on new pre-certification procedures for total joint arthroplasty. The letter states, “We understand the goal of eliminating unnecessary health care costs, but these methods must be balanced with independent clinical judgment, patient preference, best levels of evidence and preservation of timely appropriate patient access to care… If our constructive engagement falls short of achieving the necessary results, we are prepared to bring additional pressure to bear and seek alliances with other affected stakeholders such as patients and employers.”  To share your concerns with the pre-certification process email precert@aaos.org or aahksstaff@aahks.org.


FDA Takes Further Steps to Curb Opioid Abuse

The Food and Drug Administration (FDA) recently announced that it will require black box warnings on immediate-release opioids to combat what the agency described as an epidemic of addiction.  Ninety percent of opioids prescribed are immediate-release, which are usually taken ever four to six hours.  The new FDA black box requirements will apply to drugs such as hydrocodone, oxycodone and other frequently prescribed immediate release painkillers.  The labels will include a variety of warnings about the risk of addiction, misuse, overdose and death.  In other related news, the FDA also announced new guidance to help drug manufacturers develop generic versions of opioid painkillers designed to prevent abuse.


EHRs Lead to Burnout

Electronic health records have not lived up to their promise of helping streamline patient care and instead have added hours and headaches to most physicians’ days, according to an article in Hospitalist News. Researchers are finding that many doctors don’t have enough time in their days to finish their documentation, so they spend their evenings and weekends finishing up.


Medicare Reforms Considered

The Health Subcommittee of the  House Ways and Means Committee recently held a hearing on how policymakers can reform the Medicare program to better serve America’s seniors.  There is general agreement that it is an outdated program needing structural reform if it will not run out of money by 2026. One of the witnesses from the Heritage Foundation recommended combining Parts A and B, retargeting the benefits to lower-income enrollees, increasing the eligibility age to 67 and encouraging competition through premium support. The House Budget Committee, Chaired by Tom Price, MD (R-GA) approved a budget framework that also calls for major reforms of Medicare which include premium support, combining Parts A and B, and means-testing of Medicare premiums.


AHA on Meaningful Use

The American Hospital Association would like CMS to be more flexible according to a letter to CMS.  The group wants the agency to do away with its “all-or-nothing” approach to meaningful use, where providers are punished equally whether they meet 9 or 99 percent of criteria. The AHA would like the new “passing” threshold to be 70 percent.


Hospital Consolidation Will Push Up Costs

The nationwide growth in hospital mergers will likely push up costs in many markets according to the Manhattan Institute. The assumption is that “large coordinating bodies are going to have an incentive to deliver more effectively” – but the empirical evidence doesn’t support that said senior fellow Paul Howard.


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