Public Policy

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 […]
July 30, 2019

White House Announces Efforts to Promote Greater Price Transparency For Prescription Drugs

On June 25, the White House announced an initiative to encourage greater transparency in drug pricing. President Trump signed an Executive Order on June 25, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First.” The purpose of the order is to direct federal agencies to issue regulations to improve the transparency of health care prices and quality in order to create a more competitive marketplace and provide consumers with the information they need to make informed purchasing decisions.  More specifically, the executive order: Directs the Secretary of Health and Human Services (HHS) to issue regulations within 60 days that would require hospitals to publicly post standard charge information, including information based on negotiated rates, in an […]
June 25, 2019

ISASS Coding and Reimbursement Task Force Develops Policy Statements on New Spine Technologies

ISASS’ Coding and Reimbursement Task Force is undertaking drafts of policy statements on two new spine technologies, the Intracept procedure for Basivertebral nerve treatment, and the Barricaid implant for annular closure. These technologies are among the newest and most promising treatments for vertebral conditions and likely to increase in dissemination and use by practitioners.  The policy statements will be evidence-based evaluations of literature and clinical data for each procedure and will help practitioners and payers assess the merits of coverage for the services. The final drafts will be forwarded to the ISASS board for review and final publication on the ISASS website as well as in the International Journal of Spine Surgery, ISASS’ journal. ISASS is grateful for the leadership […]