AAOS February 20, 2018
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Bipartisan Budget Deal Addresses Numerous
AAOS Priorities


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Bipartisan Budget Deal Addresses Numerous AAOS Priorities

On February 9, 2018, Congress passed a bipartisan budget deal and continuing resolution that increases military and domestic program spending caps and funds the government through March 23. Congress will next take up an omnibus appropriations bill for the current fiscal year that ends September 30.

In addition to keeping the government open, this legislation eliminated sections 3403 and 10320 of the Affordable Care Act and repeals the Independent Payment Advisory Board (IPAB). It also includes an additional $2 billion in funding for the National Institutes of Health (NIH) requested by AAOS, another extension of the Children’s Health Insurance Program (CHIP) funding, further funding to address the opioid epidemic, encouraging updates to the Medicare Access and CHIP Reauthorization Act (MACRA), a permanent repeal of the outpatient therapy caps, and it removes the current mandate that meaningful use standards become more stringent over time. Unfortunately, while AAOS urged Congress not to include a proposed misvalued codes offset or additional cuts to physician reimbursement in the legislation, Congress did add at the last minute a decrease in the scheduled 2019 Physician Fee Schedule update required under MACRA from a 0.5 percent increase to a 0.25 percent increase. This is significantly more favorable language than the misvalued codes offset AAOS opposed (which would have reduced the 0.5 percent increase to just 0.05 percent), but we continue to express to Congress the significant harm that these kinds of offsets can have on patient access to care. To read more about AAOS’s efforts related to the misvalued code offset, click here.

MACRA and Related Changes

As mentioned above, this deal includes a number of encouraging updates to the Medicare Access and CHIP Reauthorization Act (MACRA) that AAOS requested. For example, the legislation excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination; eliminates improvement scoring for the cost performance category for the third, fourth, and fifth years of MIPS; allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS; and allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year. The legislation also permanently repeals the outpatient therapy caps beginning on Jan. 1, 2018 and removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

CHIP, Opioid, and NIH Funding

Again, this legislation includes an additional $2 billion in funding for the National Institutes of Health (NIH) requested by AAOS, including during Research Capitol Hill Days (read more online here and here). AAOS believes this funding increase demonstrates Congress’s commitment towards advancing vital medical research and is optimistic it will significantly impact the future of musculoskeletal care.

“To fully address the personal, societal, and financial burdens of musculoskeletal conditions, improved treatments and eventual cures must be found,” Dr. Maloney stated. “This funding will help in that effort. Additionally, we are pleased that the legislation includes another extension of the Children’s Health Insurance Program (CHIP) funding as well as further funding to address the opioid epidemic.”

“This legislation provides funding to address domestic challenges from the opioid crisis and rare diseases to reform at the Veterans Administration and fixing our crumbling infrastructure,” stated House Majority Leader Kevin McCarthy (R-CA). “The National Institutes of Health, which continues to do in-depth scientific research to cure diseases, will receive increased funding along with programs to respond to the opioid crisis and improve our mental health system.”

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IPAB Repeal

While no members have been appointed to the IPAB at this time, repealing this board – which was charged with making recommendations to cut Medicare expenditures if spending growth reaches a certain level – has been a top priority for AAOS over the years. Even without board members, the Secretary would be directed to develop and implement proposals automatically if the IPAB protocol was triggered. Further, not only did the IPAB limit congressional authority with little accountability and preclude meaningful opportunity for stakeholder input, but AAOS had deep concerns about the specific impact that IPAB-directed cuts would have on patient access to quality musculoskeletal care. In November 2017 and as a result of AAOS efforts, the U.S. House passed a similar bipartisan measure introduced by Reps. Phil Roe, M.D. (R-TN) and Raul Ruiz, M.D. (D-CA). However, “this [bipartisan budget deal] repeals IPAB once and for all,” Dr. Roe stated.

“While we certainly commend Congress for this important achievement, it would not be possible without your help,” wrote AAOS President William J. Maloney, MD in a message to AAOS members. “IPAB repeal has been a topic at the National Orthopaedic Leadership Conference (NOLC) as well as the subject of the grassroots efforts that many of you supported. Hundreds of orthopaedic surgeons have gone to Capitol Hill and/or talked to their elected representatives about this issue, and we are happy to see our voices heard.”

As Dr. Maloney noted, AAOS will continue to address related issues while advancing our advocacy priorities and ensuring that “any policy changes improve the care of musculoskeletal patients across the country.”