Published 12/1/2012

Second Look - Advocacy

CMS issues final payment rules
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a final rule with comment period for physician fees paid under Medicare for 2013. The rule includes new or revised relative value units (RVU) for 19 musculoskeletal procedures that AAOS had submitted to CMS. However, because of changes to Practice Expense RVU methodologies, CMS estimates the impact of RVU changes for orthopaedic surgeons to be a negative 1 percent. The final rule with comment period also includes a statutorily required 27.4 percent across-the-board reduction to Medicare payment rates called for under the Sustainable Growth Rate formula.

CMS has also issued final rules for hospital outpatient prospective payment system (OPPS) and ambulatory surgery center (ASC) services for 2013. Rates and policies set in the final rule would increase OPPS payment rates by 1.8 percent. ASC payments would be increased by 0.6 percent—a projected rate of inflation of 1.4 percent minus a 0.8 percent productivity adjustment required by law.

A need for license disclosure?
The American Medical Association (AMA) Truth in Advertising initiative supports legislation requiring health professionals to identify their license type in ads, wear a clearly visible photo identification badge when seeing patients, and post their license type in their offices, reports American Medical News. Since the campaign launched 3 years ago, 25 states have introduced such laws and 12 have passed them.

New patient-satisfaction requirement
As of Oct. 1, hospitals must now reckon with a provision that ties Medicare reimbursement to results of patient-satisfaction surveys. The program is part of a broader pay-for-performance initiative in the federal healthcare overhaul, and nearly $1 billion is at stake. Many medical professionals say the requirement is unfair, especially to older urban hospitals that take in large numbers of emergency patients. Many also say that medical care delivery isn’t conducive to being rated like resorts or restaurants, and that proper care and a good outcome might not necessarily equate to a “great experience” for the patient.

HHS backs per diem call payment arrangement
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released a favorable advisory opinion regarding an existing arrangement under which a hospital pays a per diem fee to physicians for providing on-call coverage for the institution’s emergency department (ED). The OIG states that—given the facts supplied by the applicant—although the pay arrangement could potentially generate prohibited remuneration for the hospital under the anti-kickback statute if the requisite intent to induce or reward referrals of federal healthcare program business were present, the agency will not impose administrative sanctions on the applicant in connection with the arrangement.

CMS posts technical specifications for 2014 meaningful use
CMS has made available technical specifications for electronic reporting of performance on clinical quality measures for practices participating in the federal meaningful-use financial incentive program during 2014. According to CMS, beginning in 2014, the reporting of clinical quality measures (CQMs) will change for all providers. Eligible professionals, eligible hospitals, and critical access hospitals will be required to report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Programs. Although CQM reporting has been removed as a core objective, all providers are required to report CQMs to demonstrate meaningful use.

Study: Acceptance of pediatric Medicaid patients
The percentage of orthopaedic surgeons willing to see a pediatric Medicaid patient with a broken arm has fallen from 63 percent in 2006 to 23 percent in 2012, according to information presented at the annual meeting of the American Academy of Pediatrics (AAP). The researchers contacted five general orthopaedic practices in each state using a predetermined script, and found that 58 of the 250 practices agreed to schedule an appointment. Of those that declined the appointment request, 38 percent said that they do not accept Medicaid patients. Practices in the 10 states with the lowest Medicaid reimbursement rates offered an appointment 6 percent of the time, while practices in the 10 states with the highest Medicaid reimbursement rates offered an appointment 44 percent of the time. In nine states, all offices contacted refused to make an appointment.

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)