MACRA Proposed Rule Details New Medicare Payment System

On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule detailing for the first time the physician reimbursement framework required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The American Association of Orthopaedic Surgeons (AAOS) has previously communicated with CMS on the implementation of select provisions of MACRA, including episode groups, aspects of the Merit-Based Incentive Payment System (MIPS), developing alternative payment models (APMs), and encouraging creation of physician-focused payment models. AAOS leadership and staff are closely reviewing the proposed rule and will be providing CMS with detailed comments.

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Senate Finance Committee Ranking Member Ron Wyden (D-OR), recently introduced a bill to protect seniors in Medicare from high out-of-pocket costs in Part D plans. The bill, called the “Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016” (RxCAP), would eliminate all cost-sharing for beneficiaries above the current out-of-pocket threshold of about $7,500. Co-sponsors include Sens. Ben Cardin (D-MD), Michael Bennet (D-CO), and Maria Cantwell, (D-WA).

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On May 2, 2016, the Centers for Medicare and Medicaid Services (CMS) posted their final Quality Measure Development Plan on the CMS website (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Final-MDP.pdf). The Quality Measure Development Plan is a strategic framework for clinician quality measurement development to support the new Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). CMS posted their draft plan in December, 2015 and asked for stakeholder feedback (read the AAOS feedback letter online here).

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On April 18, 2016, the Centers for Medicare and Medicaid Services (CMS) announced that participants in the Bundled Payments for Care Improvement (BPCI) initiative will have the opportunity to extend their participation in Models 2, 3 and 4 through September 30, 2018. This extension applies to the first batch of awardees in Models 2, 3, and 4 that began in October 2013 (who were scheduled to end their participation on September 30, 2016) along with those that joined later in 2014.

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On Thursday, April 28, Senators Johnny Isakson (R-GA) and Richard Blumenthal (D-CT) introduced the Veterans First Act, a comprehensive bill seeking to improve and reform the long-stressed VA medical system.  The legislation is a compilation of proposals seeking to address instances of abuse throughout the system. The bill increases accountability, protects whistle blowers, reviews the use of prescription drugs, increases access to disability compensation, expands access to education and expands health care programs. Because the House companion bill, H.R. 3016, the VA Provider Equity Act, included language elevating podiatrists to the same status as physicians, AAOS worked with AOFAS to ensure that no such language was included in the Senate bill. A number of AAOS Ambassadors were recruited to lobby to Senate Veterans Affairs Committee members on the issue and the results were successful. The Senate bill is currently awaiting floor action.

On January 10, 2016, leaders of the AAOS, AAHKS, Hip Society, and Knee Society distributed a letter on new pre-certification procedures for total joint arthroplasty.

“We understand the goal of eliminating unnecessary health care costs, but these methods must be balanced with independent clinical judgment, patient preference, best levels of evidence and preservation of timely appropriate patient access to care,” the letter states. “We will continue to bring our combined resources and expertise to bear to address and resolve the problems associated with the activities of these insurance plans. If our constructive engagement falls short of achieving the necessary results, we are prepared to bring additional pressure to bear and seek alliances with other affected stakeholders such as patients and employers.”

Read the full letter online here and share your concerns with the pre-certification process with AAOS by emailing precert@aaos.org and AAHKS members can email aahksstaff@aahks.org.

Note: visit www.aaos.org/advocacy/HIT/ for all the latest updates on health information technology and meaningful use, including information on applying for a 2015 exemption.

In an effort to allow physicians to avoid a potential 3 percent meaningful use penalty in 2017, a law was passed by Congress that allows the Centers for Medicare & Medicaid Services (CMS) to consider hardship exceptions for categories of eligible professionals (EPs) and hospitals in a new, more streamlined process. Physician groups, including the American Association of Orthopaedic Surgeons (AAOS), lobbied for the legislation because the delayed release of modifications to the Stage 2 of the program left physicians with insufficient time to report under the modified requirements (read about the changes in an earlier Advocacy Now article here).

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