The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) was bipartisan legislation signed into law in April 2015 to permanently repeal the Sustainable Growth Rate (SGR), streamline physician quality reporting programs, and provide incentive payments for physician participation in alternative payment models. MACRA sunsets the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier, and the Medicare Electronic Health Record (EHR) Incentive Program and establishes an umbrella Quality Payment Program (QPP) with two new pathways for payment: 1. Merit-Based Incentive Payment System (MIPS) and 2. Advanced Alternative Payment Models (Advanced APMs). The Centers for Medicare and Medicaid Services (CMS) recently issued a final rule to begin implementing the program effective January 1, 2017. A full summary of the final rule is available here.
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On December 5, “ISASS Recommendations/Coverage Criteria for Decompression with Interlaminar Stabilization – Coverage Indications, Limitations, and/or Medical Necessity” was published in the International Journal of Spine Surgery. The authors, Richard Guyer, MD, Michael Musacchio, MD, Frank Cammisa, MD and Morgan Lorio, MD developed the policy statement after a thorough review of the most up-to-date literature on decompression with interlaminar stabilization. The policy statement summarizes the current literature, establishes indications and limitations for coverage, discusses coding, and establishes documentation requirements and surgeon qualifications.
The policy statement was prompted in part by new Category I CPT codes effective January 1, 2017 to report insertion of lumbar interlaminar/interspinous process stabilization/distraction devices, without fusion, with open decompression. Development of this policy statement and others in the ISASS policy portfolio are intended to serve as educational and advocacy tools for surgeons and patients alike.
On November 29, President-Elect Trump announced his pick for Secretary of the U.S. Department of Health and Human Services (HHS). Republican Congressman Tom Price, MD is an orthopaedic surgeon from Georgia where he spent 20+ years treating patients in the metro-Atlanta area. He was elected to four terms in the Georgia State Senate before being elected to Congress in 2004. He serves on the House Committee on Ways and Means, including the Subcommittee on Health, and serves as the Chair of the House Committee on the Budget. In recent years, the Congressman has been especially critical of the Affordable Care Act and mandatory physician participation in alternative payment models.
The mission of HHS is to enhance and protect the health and well-being of all Americans by providing for effective health and human services and fostering advances in medicine, public health, and social services. HHS has eleven operating divisions, including eight agencies in the U.S. Public Health Service and three human services agencies. The Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA) fall under the HHS umbrella.
In addition to Congressman Price’s nomination as HHS Secretary, President-Elect Trump announced his choice for Administrator of CMS, Seema Verma, MPH. Verma is the President, CEO and founder of SVC, Inc., a national health policy consulting company. She worked closely with Vice-President-Elect Pence in Indiana to design the State’s Medicaid expansion under the Affordable Care Act.
Both Price and Verma’s nominations must be confirmed by the Senate. The Senate committees will hold confirmation hearings early in 2017 followed by a vote of the full Senate.
After two years of negotiation, on November 30, the U.S. House of Representatives passed bipartisan legislation known as the 21st Century Cures Act by a vote of 392-26; on December 7, the Senate passed the bill on a vote of 94-5.
President Obama signed the bill on December 13. The Administration is moving quickly to release funding for opioid grants to states for treatment programs.