CMS Announces MACRA Flexibility, House Discusses CJR and Medicare Issues
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CMS to Provide Flexibility on MACRA Requirements

On September 8, the Centers for Medicare & Medicaid Services (CMS) announced new flexibility in the implementation of Medicare’s Quality Payment Program, which was required by the Medicare Access and CHIP Reauthorization Act (MACRA) and replaces the Sustainable Growth Rate (SGR) formula. In a CMS blog post, Acting Administrator Andy Slavitt laid out four options for reporting data under the Quality Payment Program.

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Bone building tips to share with your patients
Remind your patients and their families about the importance of building their bone bank. While the years of rapid growth during childhood are the best time to build bone density, there are important steps that people of all ages can take to improve their bone health. Click here for Academy tips and resources for your patients.
CJR Discussed At House Budget Hearing On Wednesday, September 7, 2016 the House Budget Committee held a hearing titled, “Center for Medicare and Medicaid Innovation: Scoring Assumptions and Real-World Implications.” In a media advisory statement from his office, Budget Committee Chairman Tom Price, MD, an orthopaedic surgeon from Georgia, stated that the goal of the hearing was to “focus on the integrity of Congress’s oversight authority by examining the role of the Congressional Budget Office [and] in the exercising of that authority…shine a spotlight on CBO’s estimates of the fiscal impact of proposed changes to the Center for Medicare and Medicaid Innovation (CMMI) and how CBO’s analysis may be hampering Congress’s oversight of CMMI.” Click here to read more.
AAOS Works on Medical Policy Regarding Steroid Injections On September 1, 2016, AAOS sent a letter to several officials with the Blue Cross Blue Shield (BCBS) of North Carolina regarding  a policy statement that they will not pay for corticosteroid injections for rotator cuff disease (and knee osteoarthritis), stating that it is “experimental.” In the letter, AAOS President Gerald R. Williams, Jr., MD expressed that this is a major issue for orthopaedic surgeons and the organizations representing them, and a number of groups have started gathering evidence against the policy.

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Ways and Means Committee Discusses Hospital Quality

On September 7, the House Ways and Means Health Subcommittee held a hearing to examine whether existing Medicare Part A policies are improving the quality and cost-efficiency of care in hospitals. Specifically, members of Congress heard from physicians, researchers, and administrators about lessons learned from existing systems in the hospital and opportunities to improve post-acute care settings—such as home health agencies, long-term care hospitals, or skilled nursing facilities—to deliver better outcomes for patients.

Health Subcommittee Chair Patrick Tiberi (R-OH) gave opening remarks that stressed his intention to improve the Medicare Part A program by working to enact the Medicare Post-Acute Care Value-Based Purchasing Act of 2015.

“As we work to ensure both current seniors and future generations have access to quality health care in the Medicare program, we are also looking for the best way to reform the system to ensure we are incentivizing quality,” Tiberi stated. “Last year, Congress undertook massive reforms to the way Medicare pays physicians – moving from quantity to quality. Now, this Committee is continuing that effort by looking at the Medicare Part A or hospital system. This hearing will look at where we have been, where we are, and where we are going to ensure we incentivize quality in the Medicare system.”

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What We’re Reading

CMS Will Give Providers Flexibility on MACRA Requirements, Modern Healthcare, 9/8/16

Senate Could Jam House With CR-Zika Package, Morning Consult, 9/8/16

Senate Takes Step Toward Bipartisan Mental Health Deal, The Hill, 9/8/16

Surgeons to CMS: Don’t Make Us Code Every 10 Minutes of Work, Medscape, 9/8/16

Lawmakers Grapple With HHS Efforts to Lower Costs, Morning Consult, 9/7/16

GOP Chairman Eyes Lame-Duck for Passing Medical Cures Bill, The Hill, 9/7/16

Republicans Push Obamacare Exemption for Areas With Few Plans, Bloomberg, 9/7/16

Hospital Ownership of Medical Practices Grows by 86% in Three Years, Modern Healthcare, 9/7/16

US Health Law Faces Critical Year, The Wall Street Journal, 9/7/16

GOP Senators Unveil Next Big Opioid Bill, The Hill, 9/7/16

Time to Hit the Pause Button on Medicare’s Payment Demonstration Projects? JAMA Forum, 8/31/16

In California, A Fierce Battle Over Surprise Medical Bills, Stat, 8/29/16

Health Insurers’ Pullback Threatens to Create Monopolies, The Wall Street Journal, 8/28/16

State Corner: California Passes Legislation Targeting Network Adequacy AB72 passed the California state legislature last week and will allow non-self-insured health plans to effectively dictate rates for hospital based providers. AB72 says that when patients are unknowingly treated by out-of-network providers at an in-network facility, the patient would only pay what they would for doctors within their insurance network. The private health insurance company is only required to reimburse at 125% of Medicare or the average of contracted rates to the physician. Click here to read more.
FDA Action on Opioids The Food and Drug Administration (FDA) announced on August 31, 2016, that it is requiring class-wide changes to drug labeling, including patient information, to help inform health care providers and patients of the serious risks associated with the combined use of certain opioid medications and a class of central nervous system (CNS) depressant drugs called benzodiazepines. FDA is requiring strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use.  Click here to read more.