Published 10/1/2018

Second Look—Advocacy

CMS payment for spine surgery at same-day centers

The Centers for Medicare & Medicaid Services (CMS) will decide whether to continue to pay for spine surgeries at same-day surgery centers after potentially fatal risks were reported, according to an article in Kaiser Health News. CMS will consider whether the surgeries “pose a significant safety risk” to patients and whether they still meet criteria for Medicare payment. The topic garnered attention after a Kaiser Health News and USA Today investigation discovered a number of patient deaths within a day of the surgery related to complications. A final decision is expected by the end of the year.

Medicare drug price negotiation

CMS announced that, for the first time, Medicare Advantage (MA) plans will have the option of negotiating drug prices, as private-sector insurers do, to reduce costs for beneficiaries. MA plans will have the option of applying step therapy for physician-administered and other Part B drugs. CMS Administrator Seema Verma said, “For too long, MA plans have not had the tools to negotiate a better deal for patients.” In a memo to MA plans, the agency said plans may begin using step therapy on Jan. 1, 2019.

Preexisting condition protections

In August, 10 Senate Republicans proposed a bill that would prevent insurers from discriminating against beneficiaries with preexisting conditions. The introduction of the Ensuring Coverage for Patients with Pre-Existing Conditions Act comes after several states signed onto a lawsuit that argues the Affordable Care Act is unconstitutional, following Congress’ decision to repeal the law’s penalty for those who choose not to purchase insurance. Senate Republicans said their bill would amend federal law to guarantee the availability of health insurance to all Americans, regardless of the outcome in the federal lawsuit. The legislation also would seek to prevent insurers from increasing premiums for patients with preexisting conditions. Some critics, however, say the bill would allow insurers to exclude coverage of preexisting conditions.

ONC and CMS discuss health data

During the 2018 Interoperability Forum, the Office of the National Coordinator for Health Information Technology (ONC) and CMS discussed the importance of patient ownership of health data for interoperability. CMS regulators may require that providers share patient data through a universal, standardized platform to prevent information blocking. CMS Administrator Ms. Verma said that allowing patients to have complete control of their health data would bring about “a new era of digital health.” Ms. Verma added, “Liberating data will drive innovation through the entire healthcare system and will allow the system to deliver value to patients.”

GAO reports cybersecurity issues

A report from the Government Accountability Office (GAO) revealed four cybersecurity problems and recommended 10 actions to address them. “Securing these [information technology] systems and data is vital to the nation’s security, prosperity, and well-being,” said Gene L. Dodaro, comptroller general at GAO, in an accompanying statement. “The security over these systems and data is inconsistent, and urgent actions are needed to address ongoing cybersecurity and privacy challenges,” he added. The challenges include establishing a comprehensive cybersecurity strategy and performing effective oversight, securing federal systems and information, protecting critical cyber infrastructure, and protecting privacy and sensitive data. GAO has made more than 3,000 recommendations over the past eight years regarding cybersecurity problems and said that roughly 1,000 have yet to be put in place.

Advocacy in Action

How the AAOS Office of Government Relations (OGR)
is working for you …

  • Advocatedfor the Sports Medicine Licensure Clarity Act (S.808), which recently passed the Senate Health, Education, Labor, Education, and Pensions Committee. The bill would provide legal protection for traveling sports medicine professionals and allow them to practice in secondary states.
  • Supportedmajor steps to equalize payments across previously exempt sites of service in CMS’s Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System’s proposed rule. By reducing the cost disparity, the rule would save patients an estimated $150 million in lower copayments.
  • Securedlanguage allowing funding to be used for Qualified Clinical Data Registries in the FY 2019 House Labor, Health and Human Services, Education, and Related Agencies Appropriations bill. The funding would support data-collection entities designed to improve safety, patient health outcomes, and physician performance, such as the American Joint Replacement Registry.

For more information on all AAOS advocacy efforts, visit www.aaos.org/dc.

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