BOS Advocacy Updates

January 2018

After brief shutdown, CHIP funding included in deal to reopen government

On January 22, in the third day of a government shutdown, the Senate successfully passed a short term government funding package that includes a six-year authorization of the Children’s Health Insurance Program (CHIP). POSNA and SRS led a grassroots effort in support of CHIP in November, generating over 400 emails to Congress. Read the joint letter of support for CHIP signed by AAOS here. The agreed upon spending bill also includes a two-year moratorium on the medical device tax (2018 and 2019), a two-year delay on the ACA’s taxes on high-cost plans, known as the “Cadillac tax” (now first effective in 2022), and a one-year moratorium on the annual excise tax imposed on health insurers (2019).

ACA repeal unlikely to be priority for Congress in 2018

According to reports, top Congressional Republicans plan to move on from unsuccessful efforts to repeal the Affordable Care Act (ACA). The tighter 51-49 GOP majority in the Senate as well as political headwinds from November’s midterm elections decrease the likelihood of a successful partisan health care victory. Following passage of the GOP tax overhaul bill which ended the “individual mandate” to buy health insurance, President Trump said Republicans had “essentially repealed Obamacare.” A bipartisan plan negotiated by Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA) was originally set to be considered before the end of the year but has been postponed indefinitely.

CMS announces new voluntary bundled payment model

On January 9, 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.

According to CMS, BPCI Advanced participants may receive payments for performance on 32 different clinical episodes, including major joint replacement of the lower extremity, and may report quality improvement and patient safety measures via a registry. The Model Performance Period for BPCI Advanced starts on October 1, 2018 and runs through December 31, 2023. The deadline for applications is March 12. For more information including details on a February 21 webinar, click here.

USPSTF finalizes decision on scoliosis screening

On January 9, the United States Patient Safety Task Force (USPSTF) released updated guidance on screening for adolescent idiopathic scoliosis. The guidance was upgraded from “D”, discouraging screening, to “I”, indicating the data is inconclusive on the effectiveness of screening. POSNA and SRS led a letter in June 2017 signed by 13 other BOS societies as well as AAOS and the American Academy of Pediatrics urging the USPSTF to upgrade their recommendation. Read the USPSTF’s announcement here.

Senate committee advances HHS nominee Azar

On January 17, the Senate Finance Committee approved Alex Azar as the next secretary of Health and Human Services (HHS) by a vote of 15-12. Senator Thomas R. Carper (D-DE) was the only Democrat to support the nomination. During his confirmation hearing Azar, a former executive for the Eli Lilly pharmaceutical company, mentioned as his priorities reducing drug prices, addressing the opioid epidemic, and making healthcare more affordable. He expressed support for mandatory bundled payment programs if they were needed to get adequate data. Democrats like Senator Ron Wyden (D-OR) criticized Azar for his “documented history of raising drug prices”.

House subcommittee passes Good Samaritan medical liability legislation

On January 17, the House Energy and Commerce Subcommittee on Health passed H.R. 1876, the Good Samaritan Health Professionals Act of 2017, which helps protect health care professionals who volunteer their services when a major emergency arises. H.R. 1876 provides clear liability protections to licensed health care professionals who volunteer health care services to victims during a declared national disaster. The legislation respects existing medical liability laws and does not protect providers in cases of willful or criminal misconduct, gross negligence, or reckless misconduct. The bill will next be considered by the full House Energy and Commerce Committee. Read more and watch the vote here.

Senate committee holds hearing on opioid crisis

On January 9, the Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing entitled, “The Opioid Crisis: An Examination of How We Got Here and How We Move Forward.”  The hearing focused on ways to improve the federal and state response to the opioid crisis, as well as current policies and practices that may be contributing to opioid misuse and abuse. Chairman Lamar Alexander (R-TN) chaired the hearing and focused largely on efforts to advance the “holy grail” of non-addictive pain medication, and ways that the federal government can provide new funding and authorities to improve the state and local response efforts.

Democratic Members strongly asserted the importance of Medicaid expansion – and mental health benefits coverage generally – as a critical component of the federal opioid epidemic response.  Members also discussed the ongoing implementation of the Comprehensive Care and Recovery Act (CARA) and the 21st Century Cures Act. Read more and watch a recording of the hearing here

December 2017

CHIP flexibility granted by Congress, still no long-term fix

On December 8, the president signed a two-week extension on government funding that previously was set to expire that day. Included in that bill was a short-term fix for the Children’s Health Insurance Program (CHIP) that will allow excess funds to be routed to the states that are at risk of shortfall. Congress has so far failed to coalesce behind a solution for extending the program that expired in September. CHIP supporters in Congress hope that this will buy time to allow bipartisan negotiations on a long-term extension for the program to continue. POSNA and SRS led a grassroots effort on this issue in November, generating over 400 emails to Congress in support of CHIP. Read the joint letter of support signed by AAOS here.

Tax bill could have major implications for health care

The Republican tax reform package, following successful votes in the House and Senate, is currently being negotiated by members of a House-Senate conference committee. While it’s unclear what will be in the final package, it could contain the most significant changes to healthcare policy since the Affordable Care Act (ACA). The Senate proposal contained a repeal of the individual mandate to purchase health insurance, and reports indicate the final version will as well. Medical expense deductions, drug industry incentives, and deductions for graduate education are all being considered in conference.

In addition, if Congress fails to waive budget rules that trigger automatic spending cuts, Medicare could see roughly $25 billion in cuts to reimbursement in 2018.  AAOS has joined other surgical groups in writing a letter to House and Senate leadership opposing cuts to Medicare as a result of the tax bill. Read the letter here.

End-of-year Medicare package could result in cuts

New details have been released about an end of year legislative package containing changes to Medicare policy. This bill, as currently written, will extend the current “misvalued code” policy, possibly resulting in another across-the-board-cut to Medicare physician reimbursements. This policy instructs CMS to shift money from misvalued specialty codes to primary care services. However, the AMA’s Relative Value Update Committee (RUC) and CMS have spent the past ten years identifying and targeting potentially misvalued codes. Since these reviews resulted in significant reductions to many specialties already, the target set by Congress may require new across-the-board reductions. The joint surgical coalition letter linked above also includes comments on this issue.

AOSSM team physicians advocate on Capitol Hill

AOSSM members at the Advanced Team Physician Course spent a day advocating for critical sports medicine legislation in Congress. They joined team physicians from the American College of Sports Medicine (ACSM) and the American Medical Society for Sports Medicine (AMSSM) in traveling to Capitol Hill and meeting with key members of Congress. Bills discussed include S. 808, the Sports Medicine Licensure Clarity Act, which would allow team physicians to take care of their teams while on the road across state lines. The team physicians also discussed H.R. 1492, the Medical Controlled Substances Transportation Act, which would provide new transparency and security in the transport and dispensing of controlled substances.

CMS finalizes cancellation of SHFFT

On November 30, 2017, CMS finalized the cancellation of the flawed Surgical Hip/Femur Fracture Treatment Model (SHFFT) and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. Read the OTA white paper that helped push CMS to cancel SHFFT here. This rule finalizes voluntary participation of hospitals in 33 of the 67 Metropolitan Statistical Areas (MSAs) that were originally selected and expands the Affiliated Practitioner List in the CJR Model to hospital employed practitioners. Additionally, all rural and low volume hospitals (less than 20 LEJR episodes in the last 3 years) have the option of voluntary participation.

Participation in the CJR model will automatically terminate for participant hospitals located in the 33 voluntary participation MSAs, low volume hospitals, and rural hospitals as of February 1, 2018 UNLESS these hospitals notify CMS of their election to continue their participation in the CJR model. The Opt-In Period will be open from January 1 to January 31, 2018. More information about the rules can be found here.

CVS to buy Aetna, touts improved care coordination

CVS has announced its intention to purchase the insurer Aetna for $69 billion in a deal CVS says would improve care coordination by leveraging convenience and data analytics. "With the analytics of Aetna and CVS Health's human touch, we will create a health care platform built around individuals," said CVS Health President Larry Merlo. Reports indicate more pharmacy/insurer mergers could be forthcoming, as companies look to get a head start on Amazon, which has moved towards entering the pharmacy space.

FDA grants approval for new genetic tumor diagnostic test

FDA has granted approval for a Foundation Medicine cancer diagnostic test and CMS agreed simultaneously to initiate the process allowing government reimbursement for the test, which examines hundreds of genes for mutations in a tumor. In a news release, the government said the sign-off on the test came within six months of FDA's receipt of Foundation's application. The approval moved through the FDA's breakthrough device program, newly established under 21st Century Cures. The information from the genetic tests can help guide treatment by directing doctors to choose drugs that target particular mutations of a given cancer. Read the FDA’s release here.