CMS Removes TKA From IPO List, House Passes IPAB Repeal, and More

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) finalized the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule, which includes updates to the 2018 rates and quality provisions, and other policy changes.

Importantly, the rule finalizes changes to the Medicare inpatient-only (IPO) list for CY 2018. AAOS recognizes CMS for removing total knee arthroplasty (TKA) from the IPO list and for acknowledging this decision should be “made by the physician based on the beneficiary’s individual clinical needs and preferences. AAOS furtheracknowledges CMS for noting that the surgeons, clinical staff, and medical specialty societies who perform outpatient TKA and possess specialized clinical knowledge and experience” are most suited to create guidelines to identify appropriate candidates. AAOS is currently developing measures to assist selection of the ideal candidate for these procedures.

On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018. The calendar year (CY) 2018 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

Last week, the U.S. House of Representatives passed H.R. 849, the Protecting Seniors’ Access to Medicare Act, by a vote of 307-111. The American Association of Orthopaedic Surgeons (AAOS) commends members of the House for passing this important legislation (introduced by Reps. Phil Roe, M.D. (R-TN) and Raul Ruiz, M.D. (D-CA)), which would eliminate sections 3403 and 10320 of the Affordable Care Act (ACA) and repeal the Independent Payment Advisory Board (IPAB) before it is activated. This board – charged with making recommendations to cut Medicare expenditures if spending growth reaches a certain level – threatens the ability of elected representatives in Congress to ensure seniors have access to the health care they need when they need it. The bill now moves to the Senate and AAOS urges quick action on the legislation.

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.

On November 8, 2017, the House Energy and Commerce Subcommittee on Health held a hearing titled “MACRA and Alternative Payment Models: Developing Options for Value-based Care.” Subcommittee Chairman Michael C. Burgess, M.D. (R-TX) convened the hearing to discuss the implementation of one of the two tracks eligible professionals can be reimbursed under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – Alternative Payment Models (APMs). The committee reviewed Medicare payment reforms, including models that are already under way and those that are returning savings to the program while improving outcomes.

The House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, chaired by Tom Cole (R-OK), held a hearing on October 24, 2017 to discuss the recently proposed budget costs regarding NIH funding. The current proposal is to cap NIH Indirect Cost Reimbursement at 10% of total research costs in FY 2018, a large reduction from the 28% spent by NIH in FY 2017. Not only would this proposal adversely affect researchers and doctors in all arenas, but the proposal would also inspire the trend to keep diminishing NIH research appropriations from Congress. Decreased funding for NIH research has been a major burden for the orthopedic community over the last several years, and AAOS is working with Congress and the orthopedic community to put money back in the hands of researchers, all with the goal of improving the quality of life for Americans suffering from unfortunate musculoskeletal conditions.

Trump to Nominate New HHS Secretary Alex Azar, Roll Call, 11/13/17

Key Republican Senators Ready to Move Trump’s Health Secretary Nominee, Washington Examiner, 11/13/17

Trump Health Agency Challenges Consensus on Reducing Costs, The New York Times, 11/12/17

Unsure of CMS’ Strategy, Providers May Retreat on Risk Models, Modern Healthcare, 11/11/17

Trump May Use Executive Power to Weaken Obamacare’s Individual Mandate, Politico, 11/10/17

Senate Keeps Medical Expenses Deduction in Break with House, The Hill, 11/9/17

Individual Mandate Repeal Likely Off Table for House Tax Bill, Roll Call, 11/9/17

Elections Results Suggest GOP Lost Edge on Health Care, The Wall Street Journal, 11/9/17

CBO: Repealing Obamacare Mandate Saves $338 Billion, The Hill, 11/8/17

Using Tax Legislation to Overhaul Obamacare Still Being Discussed, The Washington Post, 11/5/17

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/.

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