Physician-Owned Hospital Bill Introduced, New CMS Proposed Rules, and More
For questions or concerns on these or other advocacy issues, contact the Office of Government Relations at dc@aaos.org.
 
AAOS Applauds House for Introducing Legislation to Lift Hospital Ban On February 16, 2017, Reps. Sam Johnson (R-TX) and Sheila Jackson-Lee (D-TX) introduced H.R. 1156, the Patient Access to Higher Quality Health Care Act of 2017. This legislation would repeal controversial restrictions contained within the Affordable Care Act (ACA) that prevent the expansion and new construction of physician-owned hospitals (POH)s. Section 6001 of the ACA included provisions that strictly prohibit any new POH from participating in Medicare or Medicaid. Furthermore, the ACA also prohibits existing POHs from expanding unless they meet a very complicated set of criteria as part of a long application process. H.R. 1156 will repeal these provisions.

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CMS Proposes Significant Changes to Medicare Standards for Providers and Suppliers of Prosthetics and Custom-Fabricated Orthotics   CMS has issued a proposed rule that would revise the standards for qualifications that providers and suppliers must meet in order to furnish, fabricate, or bill for prosthetics and custom-fabricated orthotics under the Medicare program.  If finalized it would take effect in future months but the agency is still considering whether to move forward with the changes and stakeholders have the opportunity to provide input via public comments. Under the proposed rule, as a condition of Medicare payment, prosthetics and custom-fabricated orthotics (as defined by CMS) must be:

  • Furnished by a qualified practitioner.  CMS proposes to define a qualified practitioner as an occupational therapist, ocularist, orthotist, pedorthist, physical therapist, physician, or prosthetist who meets specified standards.  In particular, if the practitioner is not an enrolled Medicare DMEPOS supplier, the practitioner must be:  (1) licensed in orthotics, pedorthics or prosthetics, or (2) in states without licensure, specifically trained and educated to provide and manage the provision of pedorthics, prosthetics, and orthotics, and certified by the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC), the Board for Orthotist/Prosthetist Certification International, Incorporated (BOC), or an organization with equivalent standards.

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CMS Nominee Questioned by Senate Finance Committee On February 16, 2016, the Senate Finance Committee held a hearing to consider the nomination of Seema Verma to serve as Administrator of the Centers for Medicare & Medicaid Services (CMS). As explained by the committee, CMS is the world’s largest health insurer, covering over one-third of the U.S. population through Medicare and Medicaid alone. It has a budget of over one trillion dollars and it processes over 1.2 billion claims a year for services provided to some of our nation’s most vulnerable citizens. Click here to read more.
AMA Discusses Regulatory Burden On Wednesday, February 15th, the AMA held a meeting to discuss reducing the burden of non-MACRA/QPP related regulations. Representatives of more than two dozen specialty societies participated in the discussion, including AAOS, and were able to emphasize some of the shared regulatory challenges facing physicians. As part of continuing that discussion and addressing the concerns that arose, the AMA will be forming three new working groups on Medicaid, insurance markets, and on regulatory relief more generally. Click here to read more.
California Orthopaedic Association Produces Two White Papers on Value-Based Reimbursement In the quickly changing healthcare landscape, both public and private payers are shifting from fee for service to a value-based reimbursement structure that takes a population health approach. According to these payers, the evolution toward value-based reimbursement benefits the patient, the physicians and the payer. The California Orthopaedic Association (COA) has produced two white papers that support their members in the shift towards value-based reimbursement.

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Residents! Attend the Orthopaedic PAC Resident Networking Reception at the 2017 AAOS Annual Meeting

Orthopaedic residents represent the future of the AAOS. Attend this reception on Thursday, March 16, 6:30 p.m. to 9:00 p.m. to network with influential advocacy leaders and celebrate the next generation of advocates. Join the PAC Executive Committee, the Board of Councilors, the Board of Specialty Societies, and the Resident Assembly at the Bay City Brewery for drinks, food, and great company. This brewery, the best in San Diego, is owned by an orthopaedic surgeon. Transportation will be provided and all resident and PAC donors are invited to attend. A $25 resident/$100 donation is required for drink tickets. Space is limited – please RSVP to pac@aaos.org.
What We’re Reading Trump: Obamacare Replacement Coming in a Couple of Weeks, The Hill, 2/18/17 McConnell: Health Care Overhaul Will Be Done Without Democratic Support, Morning Consult, 2/17/17 Conservatives Object to Obamacare Replacement’s Tax Credits, Bloomberg, 2/17/17 GOP Leaders Offer Outlines of Plan to Replace Obamacare, Morning Consult, 2/16/17 Emerging GOP Plan Would Replace Parts of Obamacare as It’s Repealed, Roll Call, 2/16/17 House GOP Leaders Will Elaborate on Their Obamacare Plans, The Washington Post, 2/15/17 White House Proposes New Rules to Steady Insurance Markets Under Health Law, The New York Times, 2/15/17 Freedom Caucus Backs ACA Repeal and Replace That Counts on Private Health Care, The Washington Post, 2/15/17 Senate Easily Confirms Trump Pick of Shulkin as VA Secretary, Modern Healthcare, 2/14/17 Antitrust Rulings Put Chill on Health-Insurance Mergers, The Wall Street Journal, 2/14/17 Republicans, Aiming to Kill Health Law, Also Work to Shore It Up, The New York Times, 2/12/17 The Stealth Republican Force Behind Obamacare Repeal, Politico, 2/11/17 Physician-Owned Hospitals Should Be Included in ACA Repeal Bill, D Health Daily, 2/10/17
CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018 The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.

“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” said Dr. Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services.  “This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

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