CMS Proposes New Rules; House Passes HSA Legislation and ASC Payment Transparency Act

On July 25, 2018, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2019 hospital outpatient prospective payment system (OPPS) proposed rule addressing payments to hospital outpatient departments and ambulatory surgery centers (ASCs). Comments on the proposed rule are due by September 24 with a final rule expected by November 1. The AAOS will submit comments to the agency.

On July 25, 2018, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2019 hospital outpatient prospective payment system (OPPS) proposed rule addressing payments to hospital outpatient departments and ambulatory surgery centers (ASCs). Comments on the proposed rule are due by September 24 with a final rule expected by November 1. The AAOS will submit comments to the agency.One of the major proposals in this rule is the expansion of site-neutrality for outpatient services. Section 603 of the Bipartisan Budget Act of 2015 (BBA) reduced payments to off-campus provider-based hospital departments to the amount paid to physician clinics for the same service, effective January 1, 2017. BBA excluded the grandfathered sites from this requirement. In this proposed rule, CMS aims to extend this site neutrality policy beyond what is required by the BBA, i.e., it would cut payments to currently grandfathered sites for certain clinic visit services. Further, CMS proposes to expand payment cuts for covered outpatient drugs and biologicals acquired by hospitals under the 340B Program to these grandfathered sites as well. The agency would continue to exempt rural community hospitals, children’s hospitals, and certain cancer hospitals.

The U.S. House of Representatives has advanced two bills designed to increase access to Health Savings Accounts (HSAs). Both pieces of legislation contain a package of smaller bills that Republicans say will allow patients to more easily afford health care.

An HSA is a tax-advantaged medical savings account available to patients enrolled in a high-deductible health plan. Money placed into an HSA is free of federal income tax at the time of deposit, is owned by the individual, and can accumulate and roll over each year, unlike a flexible spending account, which must be used each year. Proponents see HSAs as a good solution to help curb the growing cost of health care while giving individual patients more control over their health care dollar spending.

The Centers for Medicare and Medicaid Services (CMS) has released feedback reports that will inform eligible physicians and groups on how they performed during 2017, the first full year of complying with the Quality Payment Program (QPP). The reports include their 2017 final score, 2019 Merit-based Incentive Payment System (MIPS) payment adjustment, and final performance category scores and weights, as well as detailed scoring and performance information for each of the performance categories.

To access the report, participants must log into the QPP Portal using their Enterprise Identity Management (EIDM) account, if they have one. If not, CMS strongly encourages people to obtain credentials by July 31. An EIDM User Guide has been posted with more information.

The Ambulatory Surgical Center (ASC) Payment Transparency Act of 2018 was passed by the U.S. House of Representatives on July 25, 2018.  This important piece of budget-neutral legislation would add an ASC representative to the Advisory Panel on Hospital Outpatient Payment and require that CMS disclose criteria used to determine the ASC Procedure List.According to AAOS President David Halsey, MD, “These provisions will help ASCs, specialty societies and other health care stakeholders engage CMS as it considers changes to the ASC Payment System. Further, HR 6138 will support Medicare beneficiaries as they seek the high-quality, efficient and cost-effective community care that ASCs deliver.”

Although a companion bill has not been introduced in the U.S. Senate, AAOS will work with our ASC partners to advocate for the issue this fall.

On August 2, more than 20 orthopaedic surgeons gathered to support their colleague, State Representative Julio Gonzalez, MD, JD, a practicing orthopaedic surgeon. The St. Louis community was proud to welcome him and support his candidacy. One of the hosts, Dr. John Powell of Signature Orthopaedics, said, “With his unique background, the state of Florida will be well-served, as will the entire House of Medicine.”

Dr. Gonzalez addressed how the number of physicians in Congress has dipped significantly from more than 20 to 13, just a few years ago. He articulated that our Constitutional framers intended adversaries to clash, and the product of that clash is a middle ground solution. However, if the House of Medicine doesn’t show up, the other team can sail to a touchdown.

On July 24, the U.S. House of Representatives voted to repeal the 2.3 percent medical device tax—a provision that members of both parties have criticized as harming innovation. It voted 283 to 132, with some Democrats joining Republicans to approve the measure.

The vote could help Rep. Erik Paulsen (R-Minn.), the sponsor of the bill, who faces a tough reelection fight this year. “This bill reverses a harmful tax that is hurting job growth and innovation across the country,” Paulsen said.