Sports bill signed into law; Congress passes opioid bill

The Sports Medicine Licensure Clarity Act (H.R.302) was signed into law on October 5, after more than five years of tireless advocacy. The legislation, which originated from the American Association of Orthopaedic Surgeons (AAOS), provides legal protection for traveling team physicians and safeguards injured athletes’ timely access to health care professionals who best know their medical history.

“For too long, team physicians have had to choose between treating patients at great professional risk or handing over care,” said AAOS President David A. Halsey, MD. “The licensure clarity act now ensures their protection, and we thank Congress for supporting this critical legislation. Its passage represents years of hard work trying to get it across the finish line and it is a significant win—not only for practicing sports medicine professionals, but also for the large percentage of orthopaedists involved in the treatment and care of sports-related injuries.”

On October 3, the Senate overwhelmingly passed (99-1) bipartisan legislation to combat the opioid crisis after months of work by 8 committees in the House and 5 committees in the Senate. The final agreement represents one of Congress’s most significant legislative achievements of the year, a rare bipartisan response to a public health crisis that resulted in 72,000 drug-overdose deaths last year. President Trump has announced that he plans to sign the bill into law.

What’s in the bill:

The SUPPORT for Patients and Communities Act (H.R.6) includes provisions that touch almost every aspect of the opioid epidemic, from efforts to improve substance use disorder prevention and treatment programs to a mandate on the U.S. Postal Service to screen packages for fentanyl shipped from overseas.

The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen, LLC, are conducting field testing of the new elective hip arthroplasty cost measure. This measure was developed for potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program starting in 2020. Of the 13 measures produced in this second-wave of clinical subcommittee work, the elective total hip arthroplasty (THA) measure was developed by the musculoskeletal subcommittee, which was also responsible for the total knee arthroplasty (TKA) measure field tested last year. This subcommittee was well-represented by members of both the American Association of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons.Field testing, which will run October 3-31, 2018, is an opportunity for clinicians and other stakeholders to provide feedback on the measures, the field testing process, and reporting methods. Acumen will consider this input for future work.

On October 3, the Centers for Medicare & Medicaid Services (CMS) published a change to the Medicare Program Integrity Manual as part of an effort to ensure that beneficiaries have greater access to the latest therapies and devices. The revisions will fulfill requirements under the 21st Century Cures Act, which passed in 2016, to increase transparency and accountability in the Local Coverage Determination (LCD) process. The LCD process is the manner through which Medicare Administrative Contractors (MACs) decide which items and services meet the requirements for Medicare coverage when no national coverage determination exists, or otherwise needs to be refined for local conditions.

On October 9, 2018, the Centers for Medicare and Medicaid (CMS) announced that nearly 1,300 providers have signed agreements to participate in the Administration’s Bundled Payment for Care Improvement-Advanced (BPCI Advanced) Model. This model is Medicare’s latest voluntary Advanced Alternative Payment Model (Advanced APM). It was launched on October 1, 2018 and runs through December 31, 2023. There is a second application opportunity in January 2020.

This model includes more than 12 inpatient orthopaedic bundles and builds on BPCI Classic, which ended on September 30, 2018. The top three clinical episodes selected by participants are major joint replacement of the lower extremity, congestive heart failure, and sepsis.

Physicians are organizing state-based campaigns to minimize the role of maintenance of certification (MOC) in licensing, payment, employment, or admitting privileges. These physicians have rebelled against compulsory MOC and have succeeded in getting the attention of state legislatures.

On September 10, 2018, the Antitrust Division of the U.S. Department of Justice (DOJ) responded by letter to a request from Dan K. Morhaim, MD, a Maryland state legislator and  board member of the National Board of Physicians and Surgeons (NBPAS). Dr. Morhaim asked for input on a bill in the Maryland legislature that would, if enacted, restrict hospitals, health plans, and others from making their own independent judgments about the value of board certification in the credentialing of physicians.

OrthoPAC was thrilled to attend the American Shoulder and Elbow Society’s (ASES) Annual Meeting October 2-4 in Chicago. Not only was it a successful event for the OrthoPAC’s fundraising goals, but it also signified a true partnership between AAOS and ASES. The meeting also provided shoulder and elbow surgeons the opportunity to talk with Senator John Barrasso (R-WY) at a breakfast event hosted by AAOS advocacy leaders Drs. Anthony Romeo, Frank Cordasco, Felix “Buddy” Savoie, Christopher Schmidt, Joseph Abboud, Theodore Schlegel, Brad Bushnell, Sameer Nagda, Keith Baumgarten, and Pietro Tonino. Senator Barrasso was welcomed by a crowd of surgeons who thanked him for his continued efforts in Congress and for championing orthopaedic-supported issues.

• The AAOS Office of Government Relations is now accepting applications for 2019 Resident Advocacy Fellows through November 15. Learn more here and send applications/questions to jwilliams@aaos.org.
• CMS is hosting an MLN Connects® National Provider Call about Physician Compare and the public reporting of 2017 Quality Payment Program performance on October 30 from 1:30-3:00 pm EST. Register for the call here.
• The CDC and The Joint Commission released new infection control resources for orthopaedic outpatient settings, as part of ADOPT (Adaption and Dissemination of Outpatient Infection Prevention) Guidance. The free online resources can be found here.