Washington Watch

Carter L. Alleman, J.D.

CMS Releases Proposed CY 2017 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) released the proposed 2017 Medicare Physician Fee Schedule (MPFS) July 7. The rule includes essentially no change to the total payment for general surgery services next year and proposes a significant data-collection effort related to global codes.

Two years ago, CMS finalized a policy that would have transitioned all 10- and 90-day global codes to 0-day codes. However, Congress intervened and prohibited the agency from implementing that policy but required CMS to collect data on global codes starting in 2017 and to use those data to revalue these codes starting in 2019. In this proposed rule, CMS sets forth a plan for data collection that would require all practitioners who provide 10- and 90-day global services to report data on these services to the agency

CMS also proposes values for new moderate sedation codes. The agency said it appeared that practice patterns for certain endoscopic procedures were changing and that anesthesia was increasingly being reported for these procedures even though payment for these services was automatically included in payment to the physician furnishing the primary services. As a result, the agency proposes separate codes for moderate sedation.

In addition, the rule includes quality-related proposals, such as updates to the Medicare Shared Savings Program, which facilitates coordination and cooperation among providers. Providers and hospitals may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). CMS proposes updates to ACO quality reporting measures that support alignment with the Quality Payment Program.

CMS Releases 2017 OPPS/ASC Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) on July 6 released the proposed 2017 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) payment rule. CMS projects that the OPPS proposals will lead to a reimbursement increase of 1.55 percent for 2017 for services provided in most hospital outpatient departments. CMS proposes that certain items and services furnished by off-campus provider-based departments would not be covered for OPPS payment.

CMS also proposes new measures for the ASC Quality Reporting Program and Outpatient Quality Reporting Program, including five measures that are collected using the Outpatient and Ambulatory Surgical Center Consumer Assessment of Healthcare Providers and Systems survey. The patient experience-of-care survey assesses patients’ access to care, interactions with facility staff, and overall experience at the facility.

Under the ASC payment system, CMS is projecting an increase of 1.2 percent in 2017 for services provided under the ASC payment system. CMS also calls for adding eight procedures to the ASC list of covered surgical procedures. In addition, CMS proposes to reduce the reporting period for demonstrating meaningful use (MU) of an electronic health record system in 2016 for previous participants in the MU program from a full year of reporting to any continuous 90-day period.

CMS at AOA House of Delegates

The CMS Acting Administrator Andy Slavitt spoke to the American Osteopathic Association House of Delegates. He highlighted his normal talking points: That administrators know they've lost the "hearts and minds" of doctors, and Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA) simplified reporting and other changes will help win them back. "Our job in implementing MACRA is to design policies that support the Cornerstones of the world in providing the care they think is best," Slavitt said. His full speech is available here.

Senate Bill Calls for Study of Surgeon Shortage Areas

Senator Charles Grassley (R-IA) and Senator Brian Schatz (D-HI), introduced S. 3166, legislation that would direct the Secretary of the U.S. Department of Health and Human Services (HHS) to conduct a study on the designation of Surgical Health Professional Shortage Areas (SHPSAs). The Ensuring Access to General Surgery Act of 2016 and its House companion bill, H.R. 4959, introduced in April by Representative Larry Bucshon, MD, FACS (R-IN), and Representative Ami Bera, MD (D-CA), specify that the study should include recommendations for legislative or administrative action regarding a general SHPSA designation. Designating a SHPSA would provide the Health Resources and Services Administration (HRSA) of HHS with a valuable tool to increase patient access to surgical care.

Evidence indicates that the U.S. is experiencing a current and continued shortage of surgeons who are available to serve the needs of the nation's patient population. A shortage of general surgeons is a clear component of the crisis in the health care workforce. Health Professional Shortage Area (HPSA) designations already exist for primary care, mental health, and dental care professionals. HRSA defines HPSAs to determine whether an area’s patient population is underserved.

CMS Publishes 2015 Open Payments Data

The Centers for Medicare & Medicaid Services (CMS) published Open Payments data from 2015 for physicians. According to the CMS Open Payments website, in 2015 health care industry manufacturers reported $7.52 billion in payments and ownership and investment interests to physicians and teaching hospitals. This amount encompasses 11.9 million records for 618,931 physicians and 1,116 teaching hospitals. Payments were broken down into three major categories: general/non-research related, $2.60 billion; research payments, $3.89 billion; and ownership or investment interests held by physicians or their immediate family members, $1.03 billion. In comparing the 2015 program year with the 2014 program year, charitable contributions increased by approximately 120 percent, while honoraria decreased by approximately 50 percent, and gifts decreased by more than 30 percent. The Open Payments website also comprises newly submitted and updated payment records for the 2013 and 2014 reporting periods.

Open Payments, also referred to as the Sunshine Act, was established under the Affordable Care Act and seeks to increase transparency of the financial relationships between the medical industry and health care providers. Applicable manufacturers of drugs, medical devices, and biologicals are required to track payments or other transfers of value made to physicians and teaching hospitals, and report these data to CMS annually. The program relies on voluntary participation by physicians and teaching hospitals to review the information submitted by these companies.

Medicare Proposes Bundled Payment Test for Cardiac Cases

The Department of Health & Human Services (HHS) proposed new models that continue the Administration’s progress to shift Medicare payments from quantity to quality by creating strong incentives for hospitals to deliver better care at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.

The proposal creates new bundled payment models for cardiac care and an extension of the existing bundled payment model for hip replacements to other hip surgeries. Also, the proposal creates a new model to increase cardiac rehabilitation utilization. The rule proposed pathway for physicians with significant participation in bundled payment models to qualify for payment incentives under the proposed Quality Payment Program.

The proposed bundled payment models for cardiac care includes medical as well as surgical services, which will offer new information on how these models affect quality and costs. Heart attacks and strokes cause one in three deaths and result in in over $300 billion of health care costs each year.

Justice Department Blocks Mergers of Major Health Insurers

The Justice Department is seeking to halt further health insurance industry consolidation by trying to block a pending merger between Anthem Inc. and Cigna Corp. and Aetna Inc.’s proposed acquisition of Humana Inc.

The Justice Department brought suit in federal court to prevent Anthem from pursuing its agreement last summer to buy Cigna for about $54.2 billion, a move made within a month of Aetna reaching a deal to acquire Humana for $37 billion. While the insurers immediately said that they plan to fight the lawsuit, businesses in these situations typically embark on an analysis of whether it makes more financial sense to scrap the deals.

CMS Mulling Physician Payment Delay, Shorter Reporting Periods

Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt signaled a willingness to delay the start date for the program at a Senate Finance Committee. Lawmakers in both parties expressed concerns in the hearing about how small physician practices will fare under the new rules.

"We remain open to multiple approaches," Slavitt said. "Some of the things that are on the table, that we're considering -- they include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them."

Slavitt wasn't specific on how long a delay the agency was considering. Currently, doctors face a potential 4 percent pay cut in 2019 if they perform poorly on the program's quality reporting requirements next year.

Implementing the overhaul -- a system designed to replace the much maligned Sustainable Growth Rate formula -- is among the Obama administration's biggest remaining health priorities. The changes are designed to transition Medicare away from fee-for-service care and toward paying for quality.

But the program's proposed rules were heavily criticized by doctors in small and solo practices. An Obama administration analysis showed that about 87 percent of those doctors would face Medicare payment reductions under the new program, compared with 18 percent of doctors in practices with more than 100 physicians.

Slavitt also said the agency hopes to make so-called alternative payment models more attractive to physicians -- especially those that expect doctors to lower costs and improve quality. But he added that neither physicians nor policymakers should get too caught up with the details of different alternative payment models, but instead focus on the physician and the patient relationships. The models should "work in the background" within that relationship, he said.
The agency is also considering changes to the threshold that would keep doctors who only see a few Medicare patients from being subject to the new reporting requirements.

Please Take the Global Surgery Payment Survey Today!

On July 15, 2016, the Centers for Medicare & Medicaid Services (CMS) announced a unilateral decision to implement a new sweeping mandate to collect data about global surgery services. According to the proposal (pp. 46192-46200), beginning just five months from now on Jan. 1, 2017, surgeons providing 10- and 90-day global surgery services to Medicare patients will be required to report a whole new set of codes to document the type, level and number of pre- and post-operative visits furnished during the global period for every global surgery procedure provided to Medicare beneficiaries. Under this system, surgeons would be required to use a new set of G-codes to report on each 10-minute increment of services provided.
 
In an effort to demonstrate to CMS the enormity of this task and its impact on patient care delivery, the surgical community has launched this survey to collect information that will help with our advocacy efforts opposing this overly burdensome and unfunded data collection effort.
 
Please take a few moments to complete this brief survey.  Click here to access the survey or paste the following hyperlink into your web browser: https://www.surveymonkey.com/r/globalsdata.