Already this year, the 114th Congress has introduced a number of pieces of legislation important to orthopaedics. In addition to addressing a permanent solution to the sustainable growth rate (SGR) formula, Congress is also seeking consensus on several other key issues.
Independent Payment Advisory Board
Both the House and the Senate have introduced legislation to repeal the Independent Payment Advisory Board (IPAB). The IPAB, created by the Affordable Care Act (ACA) to “reduce the per capita rate of growth in Medicare spending,” consists of 15 appointed individuals, with no accountability to Congress. The American Association of Orthopaedic Surgeons (AAOS) joined 26 other medical organizations in a letter of support for the legislation.
“Instead [of elected representatives], these major health policy decisions will rest in the hands of 15 unelected and largely unaccountable individuals,” the organizations wrote. “Additionally, fewer than half of the IPAB members can be healthcare providers, and none is permitted to be practicing physicians or be otherwise employed. Thus, not only does the creation of IPAB severely limit congressional authority, but it essentially eliminates the transparency of hearings, debate, and a meaningful opportunity for critical stakeholder input.”
Although the AAOS fully supports efforts to stabilize Medicare and reduce healthcare costs, the coalition letter emphasizes that the IPAB is simply the wrong solution for addressing these challenges. “Seniors who rely on Medicare are already dealing with the instability caused by the broken physician payment formula,” the group press release stated. “The IPAB is merely another arbitrary system that will only exacerbate an already stressed system and it must be repealed.”
Legislation that provides antitrust relief for physicians engaged in negotiations for private reimbursement with insurance companies has also been reintroduced. The bill, the Quality Health Care Coalition Act of 2015, attempts to level the playing field between physicians and insurers and address situations in which, as a result of recent healthcare industry consolidations and insurance companies’ antitrust exemption, physicians are in positions of diminished bargaining strength and health plans are able to dictate terms.
“The antitrust relief provided in this legislation is an important step in protecting physician practices and ensuring patient access to care is not compromised as a result of insurer monopsony. Physicians must be given the chance to fairly negotiate with dominant insurers and shield themselves from anticompetitive behavior, such as the unilateral, non-negotiable contracts that result from this market power,” said Frederick M. Azar, MD, AAOS past president.
Another bill progressing through the legislature would exempt patient encounters in ambulatory surgery centers from counting toward meaningful use requirements. Specifically, the legislation states, “Until such time as electronic health record (EHR) technology is certified specifically for use in ambulatory surgical centers, patient encounters that occur in such a center should not be used when calculating whether an eligible professional meets meaningful use requirements, unless an eligible professional elects to include those encounters.”
The Flexibility in Health IT Reporting (Flex-IT) Act was also recently reintroduced. The Flex-IT Act would give providers the option to choose any 3-month quarter for an EHR reporting period to qualify for the meaningful use program in 2015.
Although the AAOS shares the goal of having physicians use health information technology in a meaningful way, AAOS has continually urged the Centers for Medicare and Medicaid Services to consider these difficulties, stating that the meaningful use policies could “push healthcare delivery into larger multispecialty practices and threaten to put small and solo practitioners out of business, while simultaneously reducing access to care.”
“We strongly believe that Meaningful Use requirements should be established through phased implementation with sufficient incentives over several years, rather than a single, hard deadline with non-adoption penalties,” wrote Dr. Azar. “Requiring physicians to report a full year of Meaningful Use in 2015 is contrary to the intent of the program and may cause physicians who are in compliance to miss out on eligibility.”
Sports Medicine Licensure Clarity Act
The Sports Medicine Licensure Clarity Act of 2015 was also reintroduced. This measure clarifies medical liability rules for sports medicine professionals to ensure they are properly covered by their professional liability insurance while traveling with athletic teams in another state. Specifically, the legislation stipulates that for the purposes of liability, healthcare services provided by a covered sports medicine professional to an athlete, an athletic team, or a staff member of an athlete or athletic team in a secondary state will be deemed to have been provided in the professional’s primary state of licensure.
By specifying that healthcare services provided by a covered sports medicine professional outside the state of licensure will be covered, the bill removes questions about licensing jurisdiction and eliminates ambiguity about coverage when a provider cares for players during away games across state lines. This bill helps ensure that injured athletes have timely access to healthcare professionals who best know their medical histories.
Two different pieces of AAOS-supported legislation related to trauma issues have passed the House. HR 647, the Access to Life-Saving Trauma Care for All Americans Act, and HR 648, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act, are also supported by the Orthopaedic Trauma Association. Both bills reauthorize grants that support trauma systems as well as projects to implement and assess regionalized emergency care models. These grants aid hospitals in handling their substantial uncompensated care costs from traumatic injuries.
Medicare and Medicaid fraud
The Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act of 2015 has been reintroduced. This legislation combats waste, fraud, and abuse in Medicare and Medicaid by enhancing data sharing about suspected scammers between the programs and modernizing outdated antifraud prevention systems.
“AAOS applauds the reintroduction of the PRIME Act,” said Dr. Azar. “Fraud and abuse account for an undetermined amount of wasteful spending throughout the Medicare program and threaten the health and welfare of patients. This important legislation has the potential to save taxpayers billions of dollars by reducing improper Medicare payments and improving data sharing.”
The PRIME Act was included in the recently advanced Protecting Integrity of Medicare Act (PIMA), which includes increased outreach and education for providers by Medicare contractors, other program integrity efforts, and requires that the Health and Human Services Secretary issue guidance on the application of the “Common Rule,” which is a priority for hospital-based registries and the American Joint Replacement Registry.
Elizabeth Fassbender is the communications specialist in the AAOS office of government relations. She can be reached at firstname.lastname@example.org
How Close Is an SGR Fix?
As this issue of AAOS Now went to print, House Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.) were working together on a permanent replacement for Medicare’s sustainable growth rate (SGR) formula. It is expected that the measure will be only partially paid for; cuts to hospitals, post–acute-care providers, insurers, and Medicare beneficiaries would account for approximately $70 billion of the total package costs, currently estimated at $200 billion over the next 10 years. However, the bill would permanently eliminate the SGR, extend funding for the Children’s Health Insurance Program (CHIP), and include other Medicare health measures (known as extenders) as well as anti-fraud measures. For the most up-to-date information, visit aaos.org or follow @AAOSAdvocacy on Twitter.
Butler M: Survey examines ICD-10 implementation costs in small physician offices. Journal of AHIMA Retrieved February 19, 2015.