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Healthcare Policy News
2021 Medicare Outpatient and Ambulatory Surgical Center Payment Rule Finalized
On December 2, the Centers for Medicare & Medicaid Services (CMS) finalized 2021 policies that eliminate the Inpatient Only list over the next three years beginning with the removal of approximately 300 primarily musculoskeletal-related services beginning January 1. The procedures will now be eligible for Medicare reimbursement in both the hospital inpatient and outpatient settings as determined by the physician. In response to AAOS advocacy, CMS will “indefinitely exempt these procedures from site-of-service claim denials under Medicare Part A, eligibility for Beneficiary and Family-Centered Care-Quality Improvement Organization (BFCC-QIO) referrals to Recovery Audit Contractors (RACs) for noncompliance with the 2-midnight rule, and RAC reviews for ‘patient status’ (that is, site-of-service).” In another win, high Medicaid physician-owned hospitals can now expand. Additional changes include total hip arthroplasty being reimbursable at ambulatory surgical centers and CMS now requiring prior authorization for cervical fusion with disc removal and spinal neurostimulators. Read the AAOS summary of the final rule…
2021 Medicare Physician Fee Schedule Finalized
On December 1, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule. Despite year-long requests from the medical community to preserve the value of services in light of the COVID-19 public health crisis, CMS finalized changes that will result in an estimated 4% reduction to all orthopaedic surgical services. Moreover, the previously finalized updates to Evaluation and Management Office/Outpatient visit codes were not extended to global surgical codes, also negatively impacting surgeon reimbursement. The rule also finalized a 5.4% cut to the work relative value units for hip and knee arthroplasty in spite of years of advocacy and compelling evidence provided by AAOS and the American Association of Hip and Knee Surgeons that physicians invest significant time in value-based patient care. Positive changes include making permanent many of the telehealth provisions implemented during COVID-19, broadening the scope of practice for certain non-physician practitioners and making updates to the Quality Payment Program. Read the AAOS summary of the final rule…
Doc Caucus Urges Congress to Mitigate Impending Cuts and Avert a Health Crisis
In a letter to House leadership, members of the Doc Caucus urged their congressional colleagues to address the impending Medicare cuts before the end of the year “in an effort to avert another health care crisis.” They pointed to two bipartisan legislative solutions (H.R. 8702 and H.R. 8505) developed by physician members of Congress that would provide stability for health care professionals as they respond to the COVID-19 pandemic. The group asked House leadership to consider these bills, or alternative shorter-term solutions if necessary, that mitigate cuts but maintain payment increases for primary care and complex office-based care. “As Members of Congress who directly care for patients, we understand the consequences that the upcoming reimbursement cuts will have on patient care and patient access to care,” they wrote. Read the Doc Caucus letter to House leadership…
Hospital Capacity Further Expanded During COVID-19
The Centers for Medicare & Medicaid Services (CMS) recently announced that it is further relaxing regulations regarding hospital care in non-traditional settings to mitigate the impact of steep increases in COVID-19 hospitalizations. The new flexibilities, as part of the Acute Hospital Care at Home Program, are designed to provide care to patients at home so they can continue to be with family and caregivers without the restrictions of a traditional hospital setting during the pandemic. Alternatively, the program will support the care of patients diagnosed with non-COVID illness and reduce the burden placed on traditional hospitals during surges of the virus. CMS also clarified that Ambulatory Surgical Centers participating in the Hospitals Without Walls program are only required to offer 24-hour nursing care when there is at least one patient receiving care onsite. Learn more about the new program…
Sweeping Changes to Physician Self-Referral Law and Anti-Kickback Statute
On November 20, the Centers for Medicare & Medicaid Services (CMS) released finalized changes to the Physician Self-Referral (Stark) Law and the Department of Health and Human Services’ Office of the Inspector General concurrently released changes to the Anti-Kickback Statute. Updates to these decades-old rules will result in a restructuring of the regulatory landscape which has long hamstringed physicians attempting to shift to value-based care. In formalizing a new universe of value-based care definitions for providers to collaborate within, the agencies will mitigate many regulatory or legal disparities between the two rules which create new safe harbors for value-based arrangements and reward greater financial risk with greater regulatory flexibility. AAOS has long-advocated for such changes and applauds the agencies’ efforts to reduce burden for physicians. Read the CMS fact sheet… |
