January 2016 BOS Washington Update

BOS Washington Update


Meaningful Use Stage 2 Hardship Exception

Last-minute legislation passed the House and Senate that provides a hardship exception for meaningful use (MU) penalties for 2015.  It was based on legislation introduced by Rep. Tom Price, H.R. 3940, the Meaningful Use Hardship Relief Act.  The Price legislation was incorporated in to S. 2425, the Patient Access and Medicare Protection Act.  The provision has been a top AAOS priority because although health information technology is a fundamental component of improving our nation’s health care system, fewer than 20% of physicians currently meet MU Stage 2 attestation and the significant ongoing burden of MU attestation creates additional, unnecessary barriers to the physician-patient relationship. CMS just reported that 200,000 docs will receive 2% cuts for failing to meet MU in 2014.  That’s roughly 2 in 5 that are eligible.

Omnibus Funds PRORP, Defunds IPAB

The bill to fund government operations for fiscal year 2016 also included a number of provisions AAOS supported.  It included $30 million for the Peer-reviewed orthopaedic research program (PRORP) which provides research funding for victims of extremity war injuries.  It also cut funding for the Independent Payment Advisory Board (IPAB) for two years.  An effort had been made to zero-out funding for the Agency for Healthcare Research and Quality (AHRQ).  AAOS fought to restore the funding and the final bill included a cut but the program was not eliminated.  Additionally, the bill delayed both the Cadillac tax and the device tax for two years.

Cigna Pre-certification for Total Joint Arthroplasty

On January 1, 2016, Cigna, using eviCore, implemented a pre-certification system for total joint arthroplasty patients.  Prior to the implementation of this new process, leadership from the AAOS and AAHKS met with representatives from Cigna and eviCore.  AAOS and AAHKS leadership shared concerns regarding the procedural and clinical aspects of this pre-certification process.  It was agreed to have a conference call after the pre-certification rollout to provide feedback on any problems encountered.  If you are having any problems with Cigna pre-certification approvals, please let Cigna and eviCore know and e-mail your concerns to precert@aaos.org.

Obama’s Final State of the Union Addresses Opioids, Health Research Funding

In his final State of the Union speech, President Obama touched on several issues he felt would have bipartisan support, including prescription drug abuse and heroin abuse.  Additionally he addressed cancer research.  Last summer, the House passed the 21st Century Cures bill which seeks to encourage innovation in medication by increasing funding for research and expediting the approval of new devices and drugs.  The Senate Health, Education, Labor and Pensions Committee is expected to release its version this spring.

Shoulder Code Edits

AAOS is working with Representative Tom Price to arrange a meeting with the Center for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt with AANA, ASES and AOSSM on the issue of Correct Coding Initiative (CCI) shoulder code edits.  Since 2013, CCI has bundled several Current Procedural Terminology (CPT) codes for shoulder surgery together and thereby denied payments when these procedures are performed or billed together.  To justify these edits, CMS has relied on a statement in their policy manual that defines the shoulder as a single anatomic structure.  The societies have made several previous efforts to convince CMS that the CCI edits were erroneous and get them to change the policy manual for January 1, 2016.  It was released in mid-November 2015 and did not result in any change to the policy or edits in question.

Open Payments Study

A recent study by researchers at the University of California, San Diego School of Medicine, analyzed the Open Payments database and compared payments among different specialties.  The highest proportion of physicians receiving payments was seen among cardiovascular and neurosurgical specialists.  Orthopaedic surgery and neurosurgery had the greatest mean value of general payments per physician.  Some specialties, such as cardiology and orthopaedics, likely received higher payments because of their dependence on devices used for procedures.  Additionally, physicians have become much more engaged in the development of new drugs and devices.  According to Jona Hattangadi-Gluth, chief of the central nervous system tumor service at UC San Diego Health, “Certain specialties, like surgery, may require more research and involvement in device development, resulting in higher royalty and license payments.  The study was published online by Mayo Clinic Proceedings.

CDC Guidelines for Prescribing Opioids for Chronic Pain

AAOS provided feedback on the Center for Disease Control and Prevention’s (CDC) draft guideline for Prescribing Opioids for Chronic pain.  The AAOS agreed with the CDC in recommending both non-pharmacologic and non-opioid pharmacologic treatment for various conditions, particularly for conditions such as osteoarthritis of the knee.  The AAOS also agreed with the CDC recommendation that physicians discuss with patients known risks and realistic benefits of opioid therapy; the recommendation to limit the use of extended-release/long acting opioids; and the physicians’ use of a Prescription Drug Monitoring Program (PDMP).

Regulatory Barrage

Obama is expected to push up to 4,000 regulations in a dash to push them through before the administration changes.  This is not unusual when an administration is winding down in a final attempt by the president to use executive power to promote an agenda or establish a legacy.  But GOP Senators are making plans to attack the regulatory process and make it harder to write new rules and require agencies to get Congressional approval for rulemaking.

Second Half of the 114th Congress Forecast

Since 2016 is an election year, it is unlikely that Congress will accomplish much.  Presidential politics gets in the way of bipartisan compromise.  But a few healthcare topics that may be considered include: Senate innovation health bill/21st Century Cures, insurance mergers and consolidation, equalizing payments across practice settings, drug abuse/opioids, GME, prescription drug costs, telemedicine, ASC issues (Medicare coverage for outpatient services).  There will likely be more messaging bills to repeal Obamacare and a republican alternative is in the works.