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September 13, 2016

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CMS to Provide Flexibility on MACRA Requirements

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CJR Discussed At House Budget Hearing

AAOS Works on Medical Policy Regarding Steroid Injections

Ways and Means Committee Discusses Hospital Quality

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CJR Discussed At House Budget Hearing 

On Wednesday, September 7, 2016 the House Budget Committee held a hearing titled, “Center for Medicare and Medicaid Innovation: Scoring Assumptions and Real-World Implications.” In a media advisory statement from his office, Budget Committee Chairman Tom Price, MD, an orthopaedic surgeon from Georgia, stated that the goal of the hearing was to “focus on the integrity of Congress’s oversight authority by examining the role of the Congressional Budget Office [and] in the exercising of that authority…shine a spotlight on CBO’s estimates of the fiscal impact of proposed changes to the Center for Medicare and Medicaid Innovation (CMMI) and how CBO’s analysis may be hampering Congress’s oversight of CMMI.”

The Congressional Budget Office (CBO) was established in 1975 as an independent federal agency in the legislative branch of the United States government. Upon request from Congress, CBO produces independent analysis of budgetary and economic issues. CBO is supposed to be strictly nonpartisan, objective, and impartial. The Center for Medicare and Medicaid Innovation (CMMI), was established through the Affordable Care Act with the purpose to test “innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits. Recently, CMMI has introduced several new payment models, including the Comprehensive Care of Joint Replacement Program (CJR), a Medicare Part-B drug program, and a cardiology bundled payment program.

In his opening statement in Wednesday’s hearing, Chairman Price explained the important link between CMMI and CBO scoring. “Under its current analysis, the Congressional Budget Office tells us that any altering of CMMI’s demonstration activities would result in a substantial loss to savings. CBO appears to come to this conclusion by assuming that CMMI’s abilities to produce savings supersede those of Congress. If there is overlap between legislative initiatives and CMMI’s authority, legislative proposals are secondary and savings assumptions favor CMMI. It is this reasoning – that the Executive is more effective at legislating than the Congress - that is so concerning.”

The Budget Committee invited five witnesses to provide testimony and answer questions: Mark Madley, Deputy Director of CBO, Joseph A. Antos, PhD, Wilson H. Taylor Scholar at the American Enterprise Institute, Ted Okon, Executive Director for the Community Oncology Alliance, Mark P. Madden, MD, an orthoapedic surgeon practicing with OrthoVirginia, and Topher Spiro, Vice President of Health Policy at the Center for American Progress.

You can access the witness’ testimony here.

Dr. Madden focused his testimony on his experience with OrthoVirginia participating in the Bundled Payments for Care Improvement (BPCI) payment initiative, one of the voluntary payment models developed by CMMI. “Statistics demonstrate that Medicare, the taxpayer, and most important, our patients are realizing substantial benefits from our BPCI initiative,” Dr. Madden noted. “Unfortunately, the story does not end there. Certain issues in the structure of and design of the Model, if not corrected, will create a significant disincentive to physicians or hospitals to participate in the BPCI or related programs such as the CJR, or any subsequent mandatory Medicare program that contains these design flaws. Without changes, the savings to the taxpayer and the benefits to the patients will be lost because the program will have become unsustainable for physicians and hospitals.”

The American Association of Orthopaedic Surgeons (AAOS) also submitted a letter for the record in advance of the hearing to express concerns about the mandatory nature of CJR and other payment models, lack of reliable data, and lack of risk-adjustment associated with these programs. “While the AAOS supports the efforts of all stakeholders to develop and evaluate payment methodologies that will incentivize coordination of care among providers and help curb health care inflation, we have expressed to CMS our concern about serious unintended consequences for Medicare beneficiaries and physicians with these mandatory programs,” said AAOS President Gerald R. Williams, Jr., MD in the letter.

Read the entire letter online here.

“Without hard data from similar programs and with all of the unknowns in the CJR program, the AAOS believes that it would be nearly impossible for CBO to correctly estimate the savings or costs associated with the Comprehensive Care for Joint Replacement bundled payment program,” the letter continued. “Furthermore, the fact that CBO continues to score all CMMI programs, including CJR, as cost-saving programs impedes Congress from being able to work with stakeholders and experts in the field to develop legislative fixes and solutions that would improve these programs that CMMI may not have considered.”

In the letter, Dr. Williams did express that AAOS was very encouraged to see that a new proposed rule makes significant changes to the CJR model and introduces and new voluntary model under the BPCI initiative (read more about that update in Advocacy Now online here). Further, AAOS remains committed to ensuring all physician payment reforms ultimately improve the care of musculoskeletal patients, and will continue to work with CMS, members of Congress, and other stakeholders to accomplish this goal.