February 9, 2018 | Today’s News

Budget deal includes an array of healthcare provisions

Modern Healthcare reports that a federal budget act enacted earlier includes a number of provisions that may impact healthcare. Among other things, the budget law includes:

• repeal of the Medicare Independent Payment Advisory Board
• $6 billion in funding to address the opioid epidemic
• a measure to slow the rollout of the Merit-based Incentive Payment System
• 4 additional years of funding for the Children’s Health Insurance Program
• a provision to help close the so-called Medicare Part D doughnut hole

The bill also includes 2 years of funding for community health centers, and disaster aid funding for Puerto Rico’s Medicaid program, and the Chronic Care Act, which will let Medicare Advantage plans tailor coverage for patients and expand telehealth services.

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CMS proposes increased oversight of opioid prescribing

The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a proposal to increase oversight of opioid prescribing under Medicare Part D. The proposal includes:

• enhancing the overutilization monitoring system to identify high-risk beneficiaries who use so-called “potentiator” drugs, such as gabapentin and pregabalin, in combination with prescription opioids
• technical revisions to the Pharmacy Quality Alliance measures used by CMS to evaluate Part D sponsors’ progress in combatting the opioid crisis, and consideration of a new PQA measure, Concurrent Use of Opioids and Benzodiazepines
• implementation of hard formulary-level cumulative opioid safety edits at the pharmacy (to be overridden only by the sponsor) at 90 morphine mg equivalent, with a 7 days supply allowance
• a supply limit for initial fills of prescription opioids for the treatment of acute pain with or without a daily dose maximum

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CMS has revised the Medicare Claims Processing Manual to allow teaching physicians to simply verify in the medical record any student documentation of components of evaluation and management (E/M) services, rather than re-documenting the work. However, the agency states that teaching physicians “must verify in the medical record all student documentation or findings, including history, physical exam, and/or medical decision making.” In addition, the teaching physician “must personally perform (or re-perform) the physical exam and medical decision-making activities of the E/M service being billed, but may verify any student documentation of them in the medical record, rather than re-documenting this work.”

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Read the official instruction (PDF)…

Data from a study published online in the Journal of Bone and Mineral Research suggest that assessment of L1 vertebral trabecular attenuation when patients undergo computed tomography (CT) scans for any indication could help identify patients at increased risk of osteoporotic fracture. The authors conducted a retrospective, cohort study of 1,966 consecutive older adults who underwent chest and/or abdominal CT at a single institution. At median 5.8-year follow-up, they found that L1 attenuation values ≤90 Hounsfield units were significantly associated with decreased fracture-free survival. After adjustment for age, sex, prior fracture, glucocorticoid use, bisphosphonate use, chronic kidney disease, tobacco use, ethanol abuse, cancer history, and rheumatoid arthritis history, the authors noted a persistent modest effect of L1 attenuation on fracture-free survival.

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A study published in the Feb. 7 issue of The Journal of Bone & Joint Surgery suggests that a questionnaire could help physicians assess the physical and psychological impact of brachial plexus injury (BPI) on preoperative and postoperative patients and the amount of improvement expected from surgery. The researchers derived questions based on interviews with 23 patients and validated test-retest reliability in a 50-patient cohort. They grouped 43 questions into four subscales: symptoms, limitations, emotion, and improvement expected (preoperative) or improvement received (postoperative). The researchers found that preoperative scores were worse than postoperative scores for the symptoms, limitations, and emotion subscales, while more improvement was expected than was received. In addition, they noted that scores in the questionnaire correlated well with related scales on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and RAND-36 survey.

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Kentucky

The Associated Press reports that a proposal under consideration in the Kentucky Senate could alter the process of pursuing medical liability suits. If enacted, Senate Bill 20 would cap plaintiff attorney fees based on the size of the damages awarded. In addition, the proposal would require plaintiffs to obtain an affidavit of merit from a medical expert who believes the standard of care was breached. That requirement would be waived if a medical review panel finds in favor of a plaintiff on the merits of a case.

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Last call: MedPAC

AAOS seeks to nominate members to the Medicare Payment Advisory Commission (MedPAC). MedPAC is an independent congressional agency that advises the U.S. Congress on issues affecting the Medicare program. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, a 100-word biography, and a letter of interest highlighting his or her expertise in the subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted to Kyle Trivedi by Feb. 11, 2018, at 11:59 p.m. CT, at:

trivedi@aaos.org

Learn more and submit your application…  (member login required)