BOC Update Fall 2017- Economics Issues Committee

Economics Issues Committee

Some of the economic issues discussed included changes to MACRA through the Quality Payment Program (QPP), Merit-Based Incentive Payment System (MIP) & Alternative Payment Models (APM), regulatory burdens on Orthopaedic Surgeons due to precertifications and opioid prescription monitoring programs (PMP's) and regulatory relief, and economic issues that will impact Orthopaedic Surgeons in the future.

1. Medicare Access and CHIP Reauthorization Act (MACRA) The MIP's will continue in 2018 with 3 performance categories of quality, practice improvement, and advancing information(EHR). Resource use will be calculated from claims data for physicians in 2018 for 2020 offsets/bonuses, and will account for 30% of the total score. An example for an Alternative Payment Model (APM) is the Comprehensive Care for Joint Replacement Model (CJR), which began initially with 67 randomly selected metropolitan areas in April 2016. Due to changes advocated for by the AAOS, there will be major shifts in the CJR. CJR will now be voluntary for all rural and low volume hospitals-less than 20 lower extremity joint replacements (LEJR) over 3 years-and in 33 Metropolitan service areas (MSA's), but it will remain mandatory for the 34 Metropolitan service areas with the highest LEJR joint replacement cost. The AAOS urged CMS to make major changes to the Surgical Hip/Femur Fracture Treatment Model (SHFFT), and in August 2018, CMS cancelled the SHFFT program. The AAOS is continuing their efforts to expand specialist-focused and advanced APMs, in order to have physicians act as the lead or co-lead of episodes of care and to remove the 50% limit on gainsharing, and would like to have social risk factors and adjustments added to payment models.

2. The AAOS is supporting efforts to have CMS take TKA, TSA, and THA off the Medicare Inpatient Only List (IPO). Total Ankle Arthroplasty (TAA) has now been moved to a higher paying DRG, and legislation has been introduced in Congress to end the moratorium on Physician-Owned Hospitals (POH). The AAOS is continuing to work with Congress on Medical Liability Reform (MLR)-as it has passed in the House of Representatives-is working with Congress to continue funding for orthopaedic research of extremity war injuries, has partnered with NASS and AAOE to urge Congress to stop or delay the unnecessary 7% cut to computed radiology (CR)-which is set to begin in 2018, and, if it isn't repealed, will escalate to a 10% cut by 2023)-and is also working with Congress to reform the self-referral provision in the Stark law, which poses barriers to the coordination in APM and MIP.

3. The Economics Issues Committee discussed utilizing a survey of AAOS members to determine how much time and cost (FTE) is required and spent by Orthopaedic Surgeons on precertifications and opioid Prescription Monitoring Programs (PMP). The AAOS opposes efforts to impose strict limits on opioid prescriptions nationwide. Dr. Jeff Angel discussed the need to study the future economic impact on several technologies and their potential impact on Orthopaedic Surgeons: Artificial Intelligence (AI), telemedicine, robotics, biologicals, and single-payer systems.

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