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July 11, 2017

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House Approves Medical Liability Reform Legislation

AAOS Submits Regulatory Relief Letter to CMS

State Corner: State Legislative and Regulatory Issues (SLRI) Committee Develops Best Practices for State Orthopaedic Society Advocacy

Quality Payment Program Updates

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AAOS Submits Regulatory Relief Letter to CMS

On July 10, 2017, the American Association of Orthopaedic Surgeons (AAOS) submitted a letter to the Centers for Medicare & Medicaid Services (CMS) regarding possible areas of regulatory relief. The letter specifically addressed areas of improvement that are needed under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, as well as issues related to the ban on balance billing, access to Medicare claims data for qualified clinical data registries (QCDRs), and translation and interpreting services required by the Affordable Care Act (ACA).

“With the implementation of CMS’s Quality Payment Program (QPP) under MACRA, as well as numerous other regulatory changes, physicians are navigating a complex new reporting system,” the letter states. “Indeed, many are still working to understand the new requirements and prepare necessary infrastructure and education.”

AAOS also expressed opposition to the Independent Payment Advisory Board (IPAB), which has a mandate to contain Medicare costs and will likely subject physicians to unfair cuts in reimbursement. “The AAOS recognizes the importance of lowering health care costs and we are committed to improving the value of health care,” the letter states. “Medicare payment policy requires a broad and thorough analysis of the effects on all providers and beneficiaries. Unfortunately, IPAB threatens unnecessary and harmful cuts to physicians causing undue burden on physicians and their practices.”

Further, AAOS expressed concerns with the current Stark Law and restrictions on physician-owned hospitals. Regarding the Stark Law, the letter notes that “while the Stark Law is structured to control the volume of referred services, it is a strict liability statute that leads to heavy penalties for unintentional and technical errors by physicians and their staff.” This kind of statute does not encourage physicians to participate in coordinated care models. Additionally, AAOS noted that CMS should explore all regulatory avenues to lift the arbitrary ban on new and expanding physician-owned hospitals (POHs). For example, the Secretary of Health and Human Services has broad authority in creating a new demonstration project through the Center for Medicare and Medicaid Innovation for POHs, which would include a waiver or exemption that would allow POHs to expand if they are accepted into the program. AAOS also encouraged the Secretary to explore a defined process for states to waive the Affordable Care Act’s provisions on POHs through state and regional waivers.

Finally, the letter touched on the opioid epidemic, explaining that orthopaedic surgeons are intimately aware of the difficulties of providing pain relief amidst the opioid crisis. Many orthopaedic conditions require narcotic pain management for weeks or months, particularly those involving trauma or aggressive post-surgical physical therapy. “We appreciate the proposed change in the Pain Management category of HCAHPS, but maintain that it is unreasonable to expect physicians to solve the opioid crisis during an acute pain episode,” the letter states.

Read the entire comment letter online here.