AAOMS Advocacy E-news
Feb. 19, 2018

For further information, contact:
Adam Walaszek
Governmental Affairs Department


Federal Affairs

Latest appropriations bill includes several healthcare victories

Legislators have been focused on moving forward with work on appropriations for much of the beginning of 2018, with a continuing resolution (CR) passed on Feb. 9 to extend government funding until March 23. The stop-gap spending bill comes with a number of healthcare provisions, most notably one that permanently repeals Medicare’s Independent Payment Advisory Board (IPAB). Repealing IPAB – along with a provision from a previous CR to suspend the Medical Device Tax until 2020 – are two significant victories for OMSs given the history of AAOMS advocacy efforts regarding these issues.

Other healthcare-related provisions include an extension of funding for the Children’s Health Insurance Program (CHIP) by another four years, providing $3 billion for both FY 2018 and 2019 to address the opioid epidemic, an increase in National Institutes of Health (NIH) funding as well as updates to a number of Medicare and telehealth policies.

Specifically, under this appropriations deal, flexibility would be increased on a physician’s Merit-based Incentive Payment System (MIPS) score. Without this change, providers would face greater challenges to avoid cuts under MIPS. Additionally, the CR included a provision to ease meaningful use requirements for the use of electronic health records by providers by eliminating a requirement for the HHS Secretary to institute more stringent meaningful use standards over time and extending the cuts for relative value adjustment for misvalued codes for one more year.

The recently passed CR also suspends the debt ceiling through March 1, 2019, and raises discretionary caps for FY 2018 and 2019. Appropriators will now aim to finalize FY 2018 appropriations by the March 23 deadline and then look to determine the budget for FY 2019.

HHS Secretary confirmed, CDC Director resigns

The U.S. Senate voted Jan. 24 to confirm the nomination of Alex Azar, whom President Donald Trump has tapped to be the next Secretary of Health and Human Services (HHS) after the resignation of former HHS Secretary Tom Price. Azar, a former Eli Lilly executive, was successfully confirmed by a 55-43 vote in which six Democrats supported the nomination and one Republican voted in opposition. Azar is mostly in line with Trump Administration policy changes on the ACA, Medicare spending and other issues. He is expected to prioritize fighting the opioid epidemic and cutting prescription drug prices.

Dr. Brenda Fitzgerald, CDC Director, resigned from her position Jan. 31 due to conflicts of interest regarding investment in tobacco and healthcare companies that recently surfaced and gained attention in the media. Anne Schuchat, principal deputy director, has assumed the role of acting director until a replacement is appointed.

FDA releases opioid REMS education blueprint

The FDA on Jan. 30 released its “Opioid Analgesic REMS Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain.” The blueprint is a high-level outline of the Risk Evaluation and Mitigation Strategy (REMS) education that opioid manufacturers are required to provide to prescribers and other healthcare providers involved in the treatment and monitoring of pain. The blueprint will be used by accrediting continuing education providers to develop educational materials and activities for the REMS. It will be folded into the Opioid Analgesic REMS, an updated version of the 2012 FDA Extended-Release and Long-Acting Opioid Analgesic Risk Evaluation and Mitigation Strategy that the FDA announced in December is being expanded to include all immediate-release opioids used in outpatient settings that are not covered by another REMS program.

Register for Day on the Hill to advocate for important OMS issues

Join your colleagues at the AAOMS Day on the Hill on April 17 and 18 in Washington, D.C., to advocate for issues important to the OMS specialty, your patients and your practice. The issues for the 2018 Day on the Hill are:
  • Student loan repayment reform
  • Expansion of FSAs/HSAs
  • Craniofacial anomalies insurance coverage
  • Prescription drug abuse
With so many healthcare changes taking place, don’t let crucial OMS issues go unheard.

No previous political or advocacy experience is necessary. AAOMS will provide you with essential information and handouts to make your legislative visits successful. Complimentary round-trip coach airfare and one night of hotel accommodations are available for the first 30 registrants who have not attended Day on the Hill within the last five years. Act today because slots are filling up fast!

Visit AAOMS.org/DayontheHill for the complete schedule.

State Affairs

Opioid abuse discussions continue in states

States continue to focus their attention on opioid abuse and ways to combat the epidemic. In January, the National Governor’s Association (NGA) issued several recommendations to Congress on how to respond to the opioid crisis. The initiative was led by Massachusetts Gov. Charlie Baker (R), who also chairs the NGA’s Health and Human Services Committee. Of interest to OMS, the recommendations include requiring prescribers to register with their PDMP and complete evidence-based training on pain management to renew their DEA registration.

Also in January, Arizona Gov. Doug Ducey (R) convened a special session specifically to address the opioid abuse epidemic in his state. That session resulted in the passage of SB 1001, which institutes a number of requirements, including prohibiting in-office dispensing of Schedule II substances; limiting Schedule II prescriptions to a five-day and 90 MME-per-day dosage; and mandating e-prescribing starting in 2019. Meanwhile, the Nevada Pharmacy Board finalized a regulation that requires all prescriptions for controlled substances to include the patient’s date of birth, days’ supply of the controlled substance and the ICD-10 code that corresponds to the diagnosis for which the controlled substance is prescribed.

Health Information Technology

Amazon, Berkshire Hathaway, JPMorgan Chase to partner on healthcare

Amazon, Berkshire Hathaway and JPMorgan Chase announced a partnership to cut healthcare costs and improve services for their employees. The group announced it first will address technology issues in an attempt to simplify the healthcare system. While the plan is in its infancy and initial details are sketchy, the announcement is being considered potentially game-changing for the healthcare market.

OCR addresses ways to avoid cyber extortion

In its January newsletter, the U.S. Department of Health and Human Service Office for Civil Rights (OCR) addressed cyber extortion and steps providers can take to reduce the chance of being a victim, including implementing risk analysis, training employees to identify suspicious messages, patching systems and encrypting sensitive data. With cyber extortion on the rise, it is important providers take the necessary steps to protect their practices and patients’ personal health information.

Practice Management

Transition to new Medicare ID cards begins

OMSs participating in Medicare should have received a letter from CMS in October with information concerning the transition to new Medicare cards for all Medicare beneficiaries beginning in April 2018. CMS will be removing the Social Security number (SSN) from all Medicare beneficiary ID cards in order to increase protection against fraud and identity theft. The SSN will be replaced with a Medicare Beneficiary Identifier (MBI). The CMS letter provided guidance on how to use your Medicare Administrative Contractor’s secure portal so – beginning in June – MBIs can be accessed for Medicare patients who do not yet have their new cards.

While providers have a 21-month transition period to use the patient’s SSN or the newly assigned MBI on claims, OMSs are encouraged to begin using the MBI as soon as patients present their new cards. To ensure readiness, OMSs should review their practice management systems, business processes and/or clearinghouses now to determine what changes are necessary to accommodate and use the new MBI. Those changes should be made and tested in March as people new to Medicare will only be assigned an MBI starting in April.

You may view a sample letter sent to Medicare providers or review a print-friendly fact sheet to learn more about how to get ready to use MBIs. For more information, visit the CMS website.

Anthem Modifier 25 pay cut

Anthem Blue Cross and Blue Shield announced at the end of last year plans to reduce payment for E/M services reported with Modifier 25 from 50 percent to 25 percent. Application of this payment reduction was set for Jan. 1, but has since been pushed back until March 1. The states directly affected by the change are California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio and Wisconsin.

The modifier 25 is reported when an unanticipated, separately identifiable issue is addressed during a scheduled E/M visit on the same day as a procedure or other service.

Anthem states that use of modifier 25 is considered to be a duplication of services. Its concern is that providers are using the modifier for compensation to additional office visits when not applicable. One example, a patient is scheduled to have his/her third molars removed but the patient also presents with a lump on the lip.

In this instance, using modifier 25 shows one appointment with two distinct procedures being addressed. Therefore, payment merits for both services and proper percentage reimbursements should apply.

Unfortunately, this percentage reduction may result in a financial loss for those who are using modifier 25 correctly. The provider will have a choice to either treat the same encounter and accept a lower payment or force patients into multiple appointments and delay the delivery of patient care.

To determine if you are affected by this payment reduction, it is recommended that practices pay close attention to their managed care contracts and payer newsletters. It is unknown at this time if other insurance carriers are planning to duplicate the modifier 25 reduction.

CMS provides updates to MACRA

On Nov. 2, CMS released a final rule making changes to the 2018 Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization ACT of 2015 (MACRA). This is considered to be Year 2 of MIPS and the Advanced Payment Models (APMs). MACRA continues to develop futuristic goals by managing an outline to effectively take part in the Quality Payment Program that rewards the value and outcome to eligible clinicians and their patients.
  • The Merit-based Incentive Payment System (MIPS) continues to streamline the multiple quality reporting programs.
  • Advanced APMs deliver new alternative ways to provide reimbursement to providers for the care they give to Medicare beneficiaries.
CMS kept many of the transition year policies but made some minor changes. These changes, along with more details on MACRA, can be found on the AAOMS website.
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