Reps. Joyce and Schrier reintroduce Access to Claims Data Act
Reps. John Joyce, MD (R-PA), and Kim Schrier, MD (D-WA), have reintroduced the Access to Claims Data Act (H.R. 4331), bipartisan legislation to give clinician-led registries access to Medicare claims data for evaluating long-term patient outcomes. As the operator of five musculoskeletal registries, AAOS strongly supports this bill, which has also been introduced in previous congresses, and worked closely with the sponsors on its reintroduction. A statement from AAOS was included in the official press release and can be viewed via the link below. |
| CMS releases CY 2026 Physician Fee Schedule proposed rule
The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2026 Physician Fee Schedule (PFS) proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the PFS and other Medicare Part B issues. The CY 2026 qualifying Alternative Payment Model (APM) conversion factor (CF) represents a projected increase of $1.24 (3.83%), to a total of $33.59, and the nonqualifying APM conversion factor represents a projected increase of $1.17 (3.62%), to a total of $33.42. Although this is the first positive CF update in many years — thanks to a 2.5% boost from Congress — the CF is still historically low. CMS has also proposed several changes that will reduce payments for individual procedures performed in facility settings, while increasing payments for procedures performed in non-facility settings. AAOS is working to analyze the interactions between these proposals and how they will impact orthopaedic surgeons. Finally, the CMS Innovation Center proposed the Ambulatory Specialty Model, a mandatory model aiming to better care for patients with chronic conditions (i.e., congestive heart failure or lower back pain) and will include orthopaedic surgeons. |
| CMS releases additional payment system proposed rules
The Centers for Medicare & Medicaid Services (CMS) also released the calendar year (CY) 2026 Hospital Outpatient and Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System proposed rule earlier this week. The agency proposes that hospitals that meet their outpatient quality and electronic health record reporting requirements will receive a 2026 payment increase of 2.4%, an increase of approximately $8.1 billion. Likewise, ASCs will receive a 2.4% increase in payments, resulting in an additional $480 million over 2025. The rule proposes to phase out the inpatient-only list over the next three years, starting with the removal of 285 mostly musculoskeletal services in CY 2026, and to move 271 of those codes to the ASC Covered Procedures List. |
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