CMS Actions, Opioid Declaration, CHIP Progress, and More

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) officially withdrew a proposed rule titled Establishment of Special Payment Provisions and Requirements for Qualified Practitioners and Qualified Suppliers of Prosthetics and Custom-Fabricated Orthotics (CMS-6012-P). AAOS communicated to CMS serious concerns with the proposed rule, and thus, applauds the decision to withdraw it and avoid adding burdensome and unwarranted requirements related to prosthetics and orthotics.

The AAOS Office of Government Relations has established a new Advocacy Fellows Program for residents and encourages you to apply or consider sharing this opportunity with residents in your network! Applications are now being accepted for 2018. The goal is to encourage the participation of orthopaedic residents in the national health policy arena. The program seeks to foster the development of orthopaedic surgeons interested in health policy and advocacy who are willing to become key members of the AAOS advocacy team. It offers orthopaedic residents the opportunity to gain a greater understanding of the health policy process and contribute to the development of new policies and programs. Dr. Stuart Weinstein, former Chairman of the AAOS Political Action Committee, is directing the program.

Two fellows will be selected for the calendar year 2018. The deadline for applications is November 15.  A full description and application instructions can be found online here. For more information contact OGR Senior Manager of Government Relations Julie Williams at jwilliams@aaos.org.

According to House Majority Leader Kevin McCarthy, the House will take up legislation this week to extend federal funds for the Children’s Health Insurance Program (CHIP). Funding for the program, which provides health coverage for nearly 9 million children around the country, expired on September 30, 2017. CHIP covers children in working families who are not eligible for Medicaid and who lack access to affordable private coverage. While the program has received bipartisan support for the last 20 years, it was threatened this year by partisan disputes over the methods used to pay for the program.

On Thursday, October 26, President Trump addressed the nationwide dramatic increases in opioid use in the ongoing and evolving crisis, declaring the opioid epidemic a public health emergency. The declaration, which lasts for a duration of 90 days, allows for increased access to telemedicine for residents in rural areas, a problem that many members on the House Energy and Commerce Committee have highlighted in the past.

“Nobody has seen anything like what is going on now. As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction,” said President Trump in his address.

According to the American Academy of Pediatrics, sports-related concussions in youth athletes are underreported. Coaches, parents, and teachers often fail to recognize the signs of concussions in young athletes. A coalition of physician organizations including many state orthopaedic societies, athletic trainers, youth sports associations, and professional sports teams have led efforts to pass state laws requiring coaches, teachers, and athletic trainers to have training in the identification of concussion. This coalition secured legislation in all 50 states addressing concussion protocol for student athletes.

In February, President Trump signed an executive order requiring federal agencies to designate an agency official as Regulatory Reform Officer (RRO) and establish Regulatory Reform Task Forces to evaluate existing regulations for possible repeal, replacement, or modification. The House Oversight and Government Reform Committee held a “check-in” hearing on Tuesday with three of the 24 agencies that the Committee had asked for an update.

Tuesday’s hearing included updates from the Departments of Defense and Transportation, and the General Services Administration. Among its progress so far, Defense identified over $10 million in savings and 88 rules it may be able to repeal subject to approval. The committee’s Democratic members expressed a largely unified uneasiness about the implementation of the executive order. In particular, many were concerned about agencies’ ability to keep Americans safe while complying with the order.

For questions or to provide feedback, please email Dena McDonough, PA-C, MHCDS, AAOS Manager, Payment Policy at mcdonough@aaos.org.

The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen, LLC, convened Clinical Subcommittees to develop eight episode-based cost measures for potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program. The AAOS had representation on the Musculoskeletal Clinical Subcommittee, which developed the Knee Arthroplasty measure.

Trump Declares the Opioid Crisis a Public Health Emergency, The Washington Post, 10/26/17

House to Vote on Funding for Children’s Health Insurance Program Next Week, The Hill, 10/26/17

Advocates Push Passage of Health Deal as Open Enrollment Nears, Roll Call, 10/26/17

Federal Judge Refuses to Order the Trump Administration to Resume ACA Payments, The Washington Post, 10/25/17

Lawmakers to DEA: Use More Legal Muscle Against Opioids, The Washington Post, 10/25/17

House, Senate Committee Leaders Reach Deal on Obamacare Fixes, Washington Examiner, 10/24/17

VA Touts Private Health Care for Vets but Cost Issues Linger, Associated Press, 10/24/17

Trump Tells Senate to Fix Taxes – Not Obamacare, Politico, 10/24/17

U.S. Hospitals Wrestle With Shortages of Drug Supplies Made in Puerto Rico, The New York Times, 10/23/17

Trump’s Support for Bipartisan Health Bill Hinges on Rollbacks Long Sought by Conservatives, The Wall Street Journal, 10/19/17

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, and the Centers for Medicare & Medicaid Services (CMS) then replaced it with the Quality Payment Program. Remember – the Quality Payment Program has two tracks you can choose: Advanced Alternative Payment Models (APMs) OR the Merit-based Incentive Payment System (MIPS). AAOS has shared the details of QPP and MIPS, which can be found on our website, here: www.aaos.org/MACRA_QualityPaymentProgram/ and here: www.aaos.org/MACRA-DeliveryReform/.

CMS has announced the availability of an interactive look-up tool through which 2017Advanced Alternative Payment Model (APM) participants can look up their qualifying participant (QP) status based on calculations from claims with dates of service between Jan. 1, 2017 and March 31, 2017. Under the Quality Payment Program, eligible clinicians who meet certain criteria are considered QPs in Advanced APMs, and are therefore excluded from the Merit-based Incentive Payment System (MIPS) quality reporting program. QPs identified based on the 2017 performance year will receive a 5 percent, lump sum Medicare incentive payment in 2019. CMS states that the online tool will be updated soon with calculations from claims with dates of services between Jan. 1, 2017 and June 30, 2017. Access the tool online here.

Learn more about how QP status is determined (PDF) here.

Click here, to view the interactive version of the map below, which features each state’s PAC support for 2017.