On Feb. 9, Congress passed a budget deal and continuing resolution—the Bipartisan Budget Act—that increases military and domestic program spending caps and funds the government through March 23. Congress subsequently passed an omnibus appropriations bill for the current fiscal year that funds the government through Sept. 30.
In addition to keeping the government open, the Bipartisan Budget Act eliminated sections 3403 and 10320 of the Affordable Care Act and repeals the Independent Payment Advisory Board (IPAB). As requested by the AAOS, the bill also includes an additional $2 billion in funding for the National Institutes of Health (NIH), another extension of the Children’s Health Insurance Program (CHIP) funding, further funding to address the opioid epidemic, language encouraging updates to the Medicare Access and CHIP Reauthorization Act (MACRA), a permanent repeal of the outpatient therapy caps, and removal of the current mandate that meaningful use standards become more stringent over time.
While AAOS urged Congress not to include a proposed misvalued codes offset or additional cuts to physician reimbursement in the legislation, unfortunately Congress did add a last-minute change to the 2019 Physician Fee Schedule update. The required increase under MACRA was lowered from a 0.5 percent increase down to a 0.25 percent increase. Yet, this language is more favorable than the misvalued codes offset AAOS also opposed. That approach would have reduced the 0.5 percent increase to just 0.05 percent. AAOS continues to express to Congress the significant harm that these kinds of offsets can have on patient access to care. To read more about AAOS’ efforts related to the misvalued code offset, visit http://aaos.digital-enews.com/2017/advocacy_now/dec12/pages/article3.html.
MACRA and related changes
As mentioned, the Bipartisan Budget Act includes several updates to MACRA that AAOS requested. For example, the legislation does the following:
- excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination
- eliminates improvement scoring for the cost performance category for the third, fourth, and fifth years of MIPS
- allows the U. S. Centers for Medicare and Medicaid Systems (CMS) to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS
- allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year
Beginning on Jan. 1 , the legislation also permanently repeals the outpatient therapy caps. Removing the current mandate that meaningful use standards become more stringent over time eases the burden on physicians as they would no longer have to submit and receive a hardship exception from the U.S. Department of Health and Human Services.
CHIP, opioid, and NIH funding
The Bipartisan Budget Act also includes an additional $2 billion in funding for the NIH. AAOS believes this funding increase demonstrates Congress’ commitment toward advancing vital medical research, and is optimistic it will significantly impact the future of musculoskeletal care.
“To fully address the personal, societal, and financial burdens of musculoskeletal conditions, improved treatments and eventual cures must be found,” William J. Maloney, MD, AAOS past president stated. “This funding will help in that effort. Additionally, we are pleased that the legislation includes another extension of the CHIP funding as well as further funding to address the opioid epidemic.”
“This legislation provides funding to address domestic challenges from the opioid crisis and rare diseases to reform at the Veterans Administration and fixing our crumbling infrastructure,” stated House Majority Leader Kevin McCarthy (R-Calif.). “The National Institutes of Health, which continues to do in-depth scientific research to cure diseases, will receive increased funding along with programs to respond to the opioid crisis and improve our mental health system.”
The IPAB was charged with making recommendations to cut Medicare expenditures, if spending growth reached a certain level. Although no members had yet been appointed to the IPAB, repealing this board has been a top priority for AAOS. Even without board members, the HHS secretary would be directed to develop and implement proposals automatically if the IPAB protocol was triggered. Further, not only did the IPAB limit congressional authority with little accountability and preclude meaningful opportunity for stakeholder input, but AAOS had deep concerns about the specific impact that IPAB-directed cuts would have on patient access to quality musculoskeletal care. In November 2017, and as a result of AAOS efforts, the U.S. House passed a similar bipartisan measure introduced by Rep. Phil Roe, MD (R-Tenn.), and Rep. Raul Ruiz, MD (D-Calif.). However, “this [bipartisan budget deal] repeals IPAB once and for all,” Dr. Roe stated.
“While we certainly commend Congress for this important achievement, it would not be possible without your help,” wrote Dr. Maloney in a message to AAOS members. “IPAB repeal has been a topic at the National Orthopaedic Leadership Conference (NOLC) as well as the subject of the grassroots efforts that many of you supported. Hundreds of orthopaedic surgeons have gone to Capitol Hill and/or talked to their elected representatives about this issue, and we are happy to see our voices heard.”
As Dr. Maloney noted, AAOS will continue to address related issues while advancing our advocacy priorities and ensuring that “any policy changes improve the care of musculoskeletal patients across the country.”
Elizabeth Fassbender, Esq., is the communications manager in the AAOS Office of Government Relations. She can be reached at firstname.lastname@example.org.