Trauma Legislation Passes House, BPCI Advanced Deadline Approaches

On February 26, the U.S. House of Representatives passed by voice vote the MISSION ZERO Act (H.R. 880), authored by Rep. Michael Burgess, MD (R-TX). The legislation establishes a grant program for trauma centers to bring military trauma specialists to civilian hospitals. AAOS and the Orthopaedic Trauma Association (OTA) support the bill, which will bolster civilian trauma care and help military surgeons remain battle-ready.

“Unfortunately, no community is immune from the threat of traumatic injury. The MISSION ZERO Act will connect American patients with battle-tested trauma care and the expertise of military trauma care providers,” said Rep. Burgess. “These grants will keep our military trauma preparedness high while increasing the capacity and expertise of these domestic trauma centers across the United States. Simply put, the MISSION ZERO Act is a win for both civilian patients and military doctors.”

In January, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary bundled payment model that will qualify as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program. This new model, called “Bundled Payments for Care Improvement Advanced” (BPCI Advanced), requires participants to bear financial risk, have payments under the model tied to quality performance, and use Certified Electronic Health Record Technology. By meeting these requirements, participants can earn the Advanced APM incentive payment. Applications must be submitted via the Application Portal, which will close on 11:59 pm EST on March 12, 2018.

In New Orleans? Take advantage of the following opportunities at the AAOS 2018 Annual Meeting!

AAOS Advocacy Booth
Be sure to stop by the AAOS Advocacy Booth to enhance your understanding of the regulatory and legislative issues confronting orthopaedic surgeons. At the booth, you can learn more about the AAOS Office of Government Relations’ (OGR) work to support the orthopaedic specialty in the U.S. Congress and the statehouses. You’ll also have the opportunity to chat with knowledgeable OGR staff and physician advocacy leaders, renew your support in the AAOS Political Action Committee (Orthopaedic PAC), and take action on top legislative issues affecting your patients and practice.

The AAOS Advocacy Booth will be open between 9 a.m. – 5:00 p.m., March 7-8, and between 9 a.m. and 4 p.m., March 9. The booth is located in Hall B, Booth #4343, at the Morial Convention Center.

The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) held a joint meeting on February 22 to meet with stakeholders on the matter of reducing provider burdens related to health information technology (IT) and EHRs. Under the 21st Century Cures Act, Section 4001(a), the agencies are tasked with developing a goal, strategy, and recommendations with respect to relieving the regulatory and administrative burden of EHRs. The law also calls for the Department to obtain broad public feedback. The agencies explained that 2018 will be a significant year in terms of regulatory reform, including sub-regulatory actions that can help relieve the administrative burden.

On February 14, 2018, the House Energy and Commerce Subcommittee on Oversight and Investigations convened a hearing titled “Examining the Impact of Health Care Consolidation.” Subcommittee Chairman Gregg Harper (R-MS) began the hearing by expressing concern with the impact of hospital mergers, hospital acquisitions of physician practices, and insurance mergers on patient access and health care prices. Members also discussed other programs that may be driving consolidation and offered legislative solutions to address consolidation issues, such as reforms involving physician-owned hospitals.

California’s insurance commissioner is investigating Aetna after one of the health insurer’s former medical directors admitted under oath he never reviewed patients’ medical records when deciding whether to approve or deny claims. The admission has led to multiple regulators in California investigating Aetna’s behavior. [1]

Another case at the California Supreme Court could disrupt the workers’ compensation medical treatment approval process and expose utilization review companies and physicians to medical malpractice liability. In 2008, Kirk King sustained a work-related back injury. At some point, he was prescribed Klonopin as a treatment for the injury. After taking Klonopin for some time, his employer sent the request for Klonopin to utilization review (UR). The UR was managed by CompPartners’ UR physician, Dr. Sharma. After reviewing the California Medical Treatment Utilization Schedule (MTUS), Dr. Sharma did not believe Klonopin was medically necessary. As a result, CompPartners sent notice to King and his treating physician that Klonopin was not approved. King ceased taking Klonopin and allegedly suffered seizures from the abrupt withdrawal. He sued Dr. Sharma for medical malpractice. The California Court of Appeal said he had a viable cause of action against CompPartners and Dr. Sharma for failing to warn him that immediate cessation of Klonopin could cause seizures. CompPartners appealed to the Supreme Court of California. We should know the outcome of the case in early 2018. [2]

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-DeliveryReform/.

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

To learn more about the Advisor’s Circle, email Stacie Monroe at monroe@aaos.org.