BOS Washington Update - February 2016


Meaningful Use Exemption Information Posted

Last month, President Obama signed into law a provision which allows the Centers for Medicare and Medicaid Services (CMS) to consider hardship exceptions for categories of eligible professionals and hospitals in a new, more streamlined process.  The legislation requires that CMS provide a blanket hardship exemption from 2015 meaningful use (MU) penalties to all providers who request it.  CMS just released the details for applying for the hardship exemption ( AAOS advocated aggressively for the blanket exception. For additional information go to the AAOS Health Information Technology site (

Senate Releases Schedule for Consideration of Companion to 21st Century Cures

The Senate Health, Education, Labor and Pensions (HELP) Committee recently announced a critical step toward moving forward companion legislation to the House-passed 21st Century Cures bill.  The Senate will consider separate proposals in three markups rather than voting on a single piece of legislation.  One of the provisions that is expected to be included in the final bill is a draft proposal aimed at achieving interoperability and addressing information blocking.  It is also meant to spur the flow of patient records and improve the usability of Electronic Health Records (EHRs).  Specifically, it gives the Health and Human Services (HHS) Office of Inspector General the power to investigate and punish information blocking and requires a public-private collaborative to make recommendations on cutting red tape for physicians.

Possible Revisions to the Stark Law to be Considered

The Senate Finance and House Ways and Means committees are considering updating federal anti-kickback statutes, including the Stark Law, to make them better fit the move toward alternative payment models (APMs).  The Stark Law, which prevents doctors from referring patients to interest in which they have a financial relationship, contains an exception for in-office ancillary services (IOAS).  AAOS is strongly supportive of retaining this exception as it is essential to efficiently diagnose and treat musculoskeletal conditions by allowing orthopaedic surgeons to provide imaging and physical therapy services in their offices.

House Continues Efforts to Repeal Obamacare

On February 2 the House attempted unsuccessfully to override President Obama’s veto of the budget reconciliation act which repealed most of the Affordable Care Act (ACA).  Now, a bicameral legislative plan has been introduced that repeals the ACA and replaces it with “commonsense, patient-focused reforms that reduce health care costs and increase access to affordable high-quality care” according to the House Energy and Commerce Committee.  E&C Chairman Fred Upton (R-MI) is co-author of the Patient Choice Affordability, Responsibility and Empowerment (CARE) Act along with Senate Finance Chairman Orrin Hatch (-UR) and Senator Richard Burr (R-NC).  The bill includes patient-focused reforms, modernizes Medicaid, reduces defensive medicine, increases health care price transparency, reduces distortions in the tax code that drive up health care costs and empowers small businesses and individuals with purchasing power. 

Preview of the President’s 2017 Budget

President Obama’s 2017 budget to be released Tuesday February 9, will request $101 billion to address prescription opioid abuse and heroin use.  The issue has increasing potential for bipartisan agreement as many communities and Congressional districts across the country feel the impact of the escalating drug abuse epidemic.  Senate Majority Leader McConnell said the issue will be addressed “in the very near future.”

The President will also propose altering the controversial Cadillac tax on health benefits.  The plan will call for adjusting the 40 percent excise tax – which Congress recently decided to delay implementing for two years– to account for regional differences in health care costs across the country. 

FDA Announces Action Plan on Opioids

The FDA will give more weight to the public health risks of painkillers in approving new drugs, one of several steps the agency is making in response to growing concern over the opioid epidemic.

Senate Finance Committee’s Chronic Care Workgroup to Introduce Legislation

The Senate Finance Committee’s chronic care reforms should be introduced next month, according to sources.  Senator Johnny Isakson (R-GA) is leading the effort.   Supporters say this proposal should cut costs by reducing large institutional care for chronically ill seniors.

Telehealth Bill Introduced in the Senate

Senators Mark Warner  (D-VA) and Brian Schatz (D-HI)  introduced a telehealth bill this week.  There is a  House companion measure sponsored by Rep’s Peter Welch ( D-VT), Diane Black (R-TN) and Gregg Harper (R-MI).  The bill is strongly backed by the American Medical Association which argues that it could save $1.8 billion over a decade.  It would waive in certain cases a requirement set by federal law that to date has largely limited Medicare payments for telehealth services to cases where people live in rural areas and thus may have great difficulty in reaching medical offices.  A possible vehicle for this bill may be a separate Senate Finance Committee proposal to improve the care of people suffering from chronic conditions such as diabetes referenced above. 

Military to Allow Home Telemedicine Visits

Patients in the Military Health System can now receive telemedicine services at any location.  This policy change allows enrollees to get primary care in person, through secure messaging, by phone, behavioral health and pharmacy consults, through nurse advice lines, and via telemedicine visits with providers from military treatment centers.

NEJM on Doctors Working Longer Shifts

A study in the New England Journal of Medicine (NEJM) suggests that patients didn’t suffer additional harm when surgeons-in-training were allowed to work longer shifts.  This research suggests some concerns about doctor safety have been overblown and could be hurting surgeon training.

CMS Proposes Changes to ACO Rules

CMS has proposed new rules in an attempt to make participation in accountable care organizations (ACOS) more attractive to providers.  The proposed rule would update the way that CMS calculates the financial targets for ACOS.  It would also adjust financial targets, or the savings an ACO must meet to receive a portion of those savings, based on the health status of the organization’s patient population.

Federal Health Spending Speeds On

The Congressional Budget Office (CBO) estimates that payments for Medicare, Medicaid and other major health programs will nearly double to $2 trillion by fiscal 2026.  The aging of the baby boom generation is an important driver, with Medicare enrollment expected to swell by about 20 million people over the next decade to 75 million.  As the baby boomers age, their medical bills are expected to add significantly to the nation’s fiscal health burdens.  Even the near-term picture for Medicare finances concerns policy advisors and lawmakers alike.  Without changes to current law, CBO says federal spending on all major health care programs will reach $1.1 trillion this year, or 6.2 percent of gross domestic product (GDP), and by 2026, it will increase to $2 trillion or 7.4 percent of GDP.  In 2015, spending on health care exceeded the cost of Social Security for the first time.

Cigna Sanctioned by CMS

CMS recently sanctioned Cigna by suspending its enrollment and marketing efforts to recruit new patients for its Medicare Advantage health and Part D drug plans.  Its current Medicare operations are not affected by this action.  According to CMS, Cigna Corp.’s mishandling of coverage disputes through its Medicare plans posed a “serious threat” to its customers, who were denied access to health services and medicines due to “widespread and systemic failures” on the insurer’s part.