Regulatory


The American College of Osteopathic Surgeons analyzes and advocates on regulatory issues that affect you, the practicing osteopathic surgeons, and the care you provide your patients. Key issues include physician, hospital, and ambulatory surgical center reimbursement policies, Centers for Medicare & Medicaid (CMS) incentive programs, value-based purchasing, bundled payment, accountable care organizations, and other policy areas.
Topics of interest can be viewed below by browsing the following links:

Meaningful Use

Members Only



Medicare Access and CHIP Reauthorization Act


The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 permanently repealed the flawed Sustainable Growth Rate (SGR) and creates new two tracks for payment. First, it replaces the existing Physician Quality Reporting System (PQRS), Value-Based Modifier, and Meaningful Use of Electronic Health Records (EHR) programs with a new, single Merit-Based Incentive Payment System (MIPS) program that expands the pay-for-performance incentives in the fee-for-service system. The second track, Alternative Payment Models (APMs), provides bonus payments for physicians who participate in "alternative payment models" that hold providers financially accountable for health care costs.

Key Provisions of MACRA

  • Full and permanent repeal of the broken sustainable growth rate (SGR) formula used to calculate Medicare physician payments
  • Annual positive updates of 0.5 percent from July 2015 to 2019
  • Maintenance of fee-for-service as a payment option
  • Elimination of current-law penalties from the existing quality programs, such as the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Meaningful-Use Program and the Value-Based Modifier (VBM) Program in 2019, and combining these programs into a single Merit-Based Incentive Payment System (MIPS). The merit-based program would be based on physicians achieving a threshold, or benchmark. Such a system makes it possible for all providers who reach these quality benchmarks to achieve positive incentives or payment updates
  • Incentives to move into advanced alternative-payment models (APMs), including 5 percent bonus payments from 2019 to 2024, and exemption from some other reporting requirements
  • Inclusion of appropriate pathways for surgeons to develop, test, and participate in APMs, such as the Clinical Affinity Groups (CAGs) in ACS’s Value-Based Update (VBU) proposal
  • Prohibits CMS from implementing its plan to transition 10- and 90-day global payments to 0-day global payments
  • Clarification that no standard or guideline created under federal health programs shall be construed as setting the standard of care for purposes of malpractice claims.

Useful Links

Physician Fee Schedule


Medicare Part B pays for physician services based on the Medicare Physician Fee Schedule (MPFS), which lists the more than 7,400 unique covered services and their payment rates. Physicians' services include office visits, surgical procedures, anesthesia services and a range of other diagnostic and therapeutic services.

Meaningful Use/EHR Incentive Program


The Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the American Recovery and Reinvestment Act (ARRA) of 2009, authorizes the U.S. Department of Health and Human Services to provide financial incentives to surgeons and hospitals that “meaningfully use” certified electronic health record (EHR) technology. Providers who began participating in the program prior to 2012 were eligible to receive the maximum incentive payments of up to $44,000 over a period of five years. However, 2014 was the last year to begin participation in the program and receive an incentive payment. No incentives are scheduled for providers who become first-time meaningful users in 2015 and beyond, and providers who do not participate in the program will face a penalty. More information is available here.

The Physician Payments Sunshine Act


The Physician Payments Sunshine Act, commonly referred to as the Sunshine Act, is a provision of the Affordable Care Act that will make information about interactions between physicians and biopharmaceutical professionals available to the public. Specifically, the Sunshine Act requires that manufacturers of drugs, devices, biological and medical supplies report payments or other transfers of value they make to physicians and teaching hospitals. Find out more from the AOA here.

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IPAB Opposition

On April 25, 2013, the ACOS signed on to a letter with 500 other organizations urging Congress to repeal the Independent Payment Advisory Board (IPAB). As noted in the letter, we are deeply concerned about the impact IPAB will have on patient access to quality healthcare.” View the full letter here.

OIG Advisory Opinion

From the AMA:

On Oct. 30, the HHS Office of Inspector General (OIG) published an advisory opinion addressing whether the anti-kickback statute may be triggered when a hospital pays a per diem fee to physicians for providing on-call hospital emergency department coverage. The OIG concluded that the arrangement in question presented a low risk of fraud and abuse and would not give rise to administrative sanctions due to a variety of factors outlined in the summary. The OIG also outlined compensation structures to avoid when developing an on-call coverage arrangement.

ICD-10

March 21, 2013: The CMS recently published the ICD-10 Implementation Guide for Small and Medium Practices.

On December 20, 2012, the ACOS and other medical organizations, sent a letter of appreciation to the Centers for Medicare and Medicaid Services for delaying the implementation of ICD-10. It further echoed the cumbersome, expensive burdens to physicians in ICD-10 implementation and renewed calls to eliminate it. View the ICD-10 sign on letter in its entirety.


Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reductions


ACOS and AOAO partnered to deliver a response to the proposed rule on Medicare Part II Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reductions in a letter April 8, 2013. View the full letter here.