Public Policy

July 30, 2019

Centers for Medicare and Medicaid Services (CMS) Issues a Proposed Rule for 2020 Medicare Physician Fee Schedule

On July 29, CMS published the proposed Physician Fee Schedule Rule for 2020. In the proposed rule, the Centers for Medicare and Medicaid Services (CMS) has proposed several changes that will affect ISASS members: With the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2020 PFS conversion factor is $36.09, a slight increase above the 2018 PFS conversion factor of $36.05. CMS proposed payments for new structural allograft codes used in orthopaedic trauma and oncology services (new CPT codes, 209X3, Osteoarticular Allograft, 209X4, Hemicortical Intercannulary Allograft, and 209X5, Interarticular Intercannulary Allograft Complex) CMS proposed updated payments for plain film X-ray codes for spine (CPT codes 72020-72220) CMS proposed updated payments for Patient Office […]
July 30, 2019

2019 Position Statement from the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacements

2019 Position Statement from the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacements Gregory D. Schroeder MD, Alexander R. Vaccaro MD, PhD, MBA, Srikanth N. Divi, MD, Ariana A. Reyes, BS, Dhruv K.C. Goyal, BA, Frank  M Phillips MD, Jack Zigler MD Introduction: Cervical and lumbar degenerative disc disease are well known causes of neck and back pain and associated radiculopathy in spine patients. The estimated 1-year incidence rate of neck pain and any episode of lower back pain is 10.4% to 21.3%1,2 and 1.5% to 36%3, respectively. Previous reports demonstrate significant socioeconomic effects of these common conditions.4,5 Many patients respond to initial conservative treatment but in recalcitrant cases,fusion procedures have been widely performed. […]
July 30, 2019

U.S. Centers for Medicare and Medicaid Innovation Invites Applicants for New Direct Contracting Voluntary Payment Model

The Centers for Medicare and Medicaid Innovation (CMMI) has announced a series of new voluntary payment models and are seeking facilities and organizations interested in participating to submit an initial Level of Interest (LOI) by Friday, August 2. One of the models being tested is a Direct Contracting model. This model is one of a set of three voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). The payment model options create opportunities for a broad range of organizations to participate with the Centers for Medicare & Medicaid Services (CMS) in testing the next evolution of risk-sharing arrangements to produce value and high-quality health care. Building on lessons learned […]
July 30, 2019

U.S. Congress Takes Up Legislation Aimed at Addressing “Surprise Billing”

In July, the U.S. House of Representatives opened hearings and introduced legislation to address the issue of surprise billing entitled the “No Surprises Act” (H.R. 3630).  By July 17, the legislation had been subject to mark-up and amendments as well in the House Energy and Commerce Committee, which reported out the proposed legislation to the full House on a voice vote. An amendment offered by Rep. Raul Ruiz, MD (D-CA) and Rep. Larry Bucshon, MD (R-IN) was adopted to add an appeals provision. Appeals would be restricted to complex cases with a claim’s threshold of $1,250 (indexed to inflation). The threshold is designed to limit the number of appeals and thereby also retain a higher level of savings to offset the cost […]