Second Look – Advocacy

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required).

CMS proposed rules
A proposed rule released by the U.S. Centers for Medicare & Medicaid Services (CMS) could impact reimbursement for orthopaedic surgeons. The agency proposes to reduce 340B drug payments to hospitals by 22.5 percent in order to allow Medicare to pay for outpatient hip and knee arthroplasty procedures. For calendar year (CY) 2018, the agency proposes "to remove total knee arthroplasty from the inpatient-only list" and is "soliciting comment on whether partial and total hip should also be removed from the inpatient only list and added to the [ambulatory surgical center] Covered Surgical Procedures List."

Under a second rule, CMS proposes to reduce Medicare payments for patients who receive treatment at hospital-owned medical facilities that are located off-campus. Observers say the proposal could save CMS $25 million during CY 2018.

A third proposed rule addresses cuts in federal funding to help hospitals cover uncompensated care costs. The Affordable Care Act (ACA) mandated that the funds be cut by $43 billion between fiscal year (FY) 2018 and FY 2025. The cuts were originally supposed to take effect in 2014, but after hospitals argued that increased patient traffic under the ACA wasn't outpacing uncompensated-care costs, the U.S. Congress delayed the start date to Sept. 30, 2017.

Opioid prescribing
A report released by the Blue Cross and Blue Shield (BCBS) Association finds that 21 percent of commercially insured BCBS members filled at least one opioid prescription in 2015 and that those with an opioid use disorder diagnosis spiked 493 percent over the 7-year study period. The researchers reviewed medical claims from BCBS commercially insured members from 2010 through 2016. Other findings of the report include the following:

  • Among patients 45 years and older, women have a higher rate of opioid use disorder compared to men. However, among people younger than 45 years, men have higher rates of opioid use disorder.
  • Long-duration prescription opioid use and opioid use disorder overlap by region, with the highest rates in the South and the Appalachian Region.
  • Patients who fill high-dosage opioid prescriptions have much higher rates of opioid use disorder than patients who fill low-dose prescriptions across both short- and long-duration regimens.

Open Payments data
CMS has released Open Payments data for 2016. An article in Medscape reports that 631,000 clinicians reported a total of $8.18 billion in payments during 2016. Overall, clinicians received $4.36 billion for research, $1.02 billion in the value of ownership or investment interests, and $2.8 billion in general payments (ie, meals, consulting and speaking fees, travel, and lodging, etc.). Under the Open Payments system, drug and device makers are required to report "transfers of value" of $10 or more, as well as transfers of value that add up to more than $100 per year.

Adverse event reporting
The New York Times reports that a proposed agreement between the U.S. Food and Drug Administration (FDA) and the medical device industry may alter the reporting period for adverse events linked to certain high-risk medical devices from 30 days to 3 months. Critics of the rule change argue that it could harm patients by increasing the amount of time before a product issue is identified. The agreement is renegotiated every 5 years, and, among other things, specifies the fees that device makers must pay FDA to review their products. The agreement must be approved by the U.S. Congress.

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