AAOS Supports Student Loan Forgiveness Bill; Opioid Guides Released; Overhaul for Medicare ACOs and CON laws

Many orthopaedic residents accrue considerable debt by the time they graduate from residency. According to studies published in Orthopaedics, student loan debt for graduating medical students continues to rise as medical school tuition increases each year. According to one of the studies, forty-eight percent of the orthopaedic residents surveyed (years 1 to 5) had medical educational debt significantly greater than $100,000. The authors concluded that debt affects orthopaedic residents financially and may also cause stress and hinder their medical training.

Medical Education Online reported that students with higher aggregate amounts of medical student loan debt were also more likely to delay getting married, and to say that they would not necessarily choose to become a physician again if given the choice. Increases in both aggregate and relative debt were associated with delaying getting married, having children, and buying a house. It also led to concerns about managing and paying back educational debt, and worrying that educational debt would influence one’s specialty choice.

On August 1, the Departments of Health and Human Services (HSS), Labor, and Treasury (known as the tri-agencies) issued a final rule to provide the option of short-term, limited duration health insurance plans on the individual market. The plans would provide health insurance coverage during a time gap when an individual is transitioning from one plan or coverage to another, such as in between jobs. This type of coverage is exempt from the definition of individual health insurance coverage under the Patient Protection and Affordable Care Act (ACA, 2010) and is not subject to the ACA provisions that apply to the individual market.

On August 9, the Centers for Medicare and Medicaid Services (CMS) proposed major updates for the Medicare Shared Savings Program Accountable Care Organizations (ACO), which were initially launched in 2012. The new and updated program, called “Pathways to Success,” would move from three-year to five-year participation agreements. Also, instead of the current three-track program, the rule proposes to offer two tracks beginning July 2019: the BASIC track and the ENHANCED track.

The BASIC track would allow ACOs in the Quality Payment Program to begin under a one-sided risk model, then gradually phase in higher levels of risk to qualify as an Advanced Alternative Payment Model. In this track, ACOs would be able to share up to 25 percent of savings after they meet minimum savings rates. Then they would be eligible for a 50 percent shared savings rate at the end of the initial two years. The ENHANCED track, based on the program’s existing Track 3, provides additional tools and flexibility for ACOs that take on the highest level of risk and potential reward.

On July 25, the Subcommittees on Government Operations and Information Technology, of the House Oversight and Government Reform Committee, held a joint hearing to review cybersecurity challenge areas highlighted in the Government Accountability Office’s (GAO) High Risk interim report. The goal was to examine how the Federal Chief Information Officer plans to coordinate a government-wide response to address these challenges.

Testimony presented by Comptroller General Gene Dodaro concluded that the U.S. federal government needs to do a better job with electronic health record data security and privacy. GAO identified four major cybersecurity challenges and 10 critical actions to address them. GAO continues to designate information security as a government-wide, high-risk area due to increasing cyber-based threats and the persistent nature of security vulnerabilities.

The American Medical Association’s (AMA) Opioid Task Force recently released a guide for physicians to help address the growing public health crisis. The guide includes six specific recommendations for action:

1.      Register for and use Prescription Drug Monitoring Programs (PDMPs) to inform clinical decision-making.

2.      Ensure that you have the necessary training and education on effective, evidence-based treatment.

3.      Urge all health insurance companies and other payers to remove administrative and other barriers to treatment for patients with pain and substance abuse disorders.

4.      Encourage physicians to confront the devastating effects of stigma faced by patients in pain and who have a substance abuse disorder.

5.      Prescribe naloxone to patients at risk for opioid overdose when clinically appropriate.

6.      Talk to patients about appropriate ways to dispose of expired, unwanted, and unused opioid medications.

In an August address to the American Legislative Exchange Council (ALEC), Health and Human Services Secretary Alex Azar called for state lawmakers to reform certificate-of-need (CON) laws.

“Regulations like certificates of need…can be a significant barrier to new competition and lower-cost market disruptors,” said Azar. “Fundamentally, when we wonder why American healthcare costs so much, why patients feel so disempowered, so often the answer is that government rules are standing in the way of necessary innovation. As we undertake our efforts to free up competition from the federal level, we hope all of you will examine what can be done in the states.”

Earlier this month, Board of Councilors (BOC) Chair Basil Besh, MD, and BOC representatives each sent a letter to AAOS members encouraging them to contribute to the AAOS Orthopaedic Political Action Committee (PAC). The letter outlined the importance of contributing to the PAC and explained how the hard work of AAOS’ government relations and PAC opens doors and allows our viewpoints to be heard.

The BOC also explained that AAOS achieved some major accomplishments for the House of Orthopaedics this year, and that many of its niche education campaigns directed at Congress and the Centers for Medicare and Medicaid Services (CMS) came to fruition. For example, AAOS worked to increase payment for total ankle replacements (TAR) so that reimbursement appropriately reflects the difficulty of the procedure. Additionally, after years of asking Congress and CMS to equalize payments across sites of service for the same procedure—which has led to increased hospital acquisition of physician practices—CMS listened. A newly proposed rule would expand site-neutrality to previously exempt off-campus providers and reduce payment variation, ultimately saving patients money and helping private practices flourish again.

Click here, to view the interactive version of the map below, which features each state’s PAC support for 2018.