ISASS Policy & Advocacy News – December 2015

ISASS Submits Comment Letter to CMS on Final 2016 Physician Fee Schedule Rule
December 23, 2015
ISASS Policy & Advocacy News – January 2016
January 29, 2016
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Wishing you a happy, healthy, and safe 2016 from all of us at ISASS and IASP.

News and noteworthy information for the month of December:

  • Research & Reimbursement Course Scheduled for ISASS16
  • AMA Wire: Court decides whether insurers can be sued for underpaid claims
  • CMS Releases 2014 National Health Expenditure Data
  • New Data Posted on Physician Compare
  • 2016 Federal Tax and Spending Agreement
  • Patient Access and Medicare Protection Act
  • CDC Proposes Guidelines for Opioid Prescribing


Research & Reimbursement Course Scheduled for ISASS16

The ISASS Research Committee and the ISASS Coding & Reimbursement Task Force will host an exciting new session, “The Good, the Bad and the Ugly – Reimbursement in a Value-Based World: A Forum for Surgeons and Industry” at ISASS16 in Las Vegas. The session will take place on Friday, April 8 from 3:30 to 4:30 p.m. and will focus on the linkage between research and advocacy. The chairs of both committees, Dr. Lisa Ferrara and Dr. Morgan Lorio, will moderate the session which will consist of presentations of several research papers and an open discussion focused on the following themes: surgeon work and the valuation of spine procedures; measuring clinical and economic outcomes in spine surgery; use of technology in maximizing patient outcomes and cost effectiveness; harnessing the power of data to build advocacy plans and shape policy; and setting the agenda for the future of spine surgery. Don’t miss out on this informative and timely session at ISASS16.

Register for ISASS16 here:


AMA Wire: Court Decides Whether Insurers Can be Sued for Underpaid Claims

“The ruling of a U.S. court of appeal last month weighed whether physicians who are assigned insurance policy benefits have the right to bring lawsuits against insurers that fail to pay correctly for medically necessary services provided to covered patients. The decision was a victory for physicians and patients. The appeals court concluded that an assignment of the right to payment is sufficient to confer standing to sue under the Employee Retirement Income Security Act of 1974 (ERISA). In so doing, it resolves several conflicting lower court rulings.”

Full Article:


CMS Releases 2014 National Health Expenditure Data

On December 2, a study on 2014 national health expenditures by the Office of the Actuary at the Centers for Medicare & Medicaid Services was published in Health Affairs. According to the report, in 2014, per-capita health care spending grew by 4.5 percent and overall health spending grew by 5.3 percent in 2014, reaching $3.0 trillion or $9,523 per person. In addition, consumer out-of- pocket spending grew by 1.3 percent in 2014, as compared to 2.4 percent growth in 2013, reflecting the increased number of individuals with health coverage.

Overall, health care spending grew 1.2 percentage points faster than the overall economy in 2014, resulting in a 0.2 percentage-point increase in the health spending share of gross domestic product – from 17.3 percent to 17.5 percent. On a per-enrollee basis, overall spending increased by 3.2 percent in private health insurance and 2.4 percent for Medicare and decreased by 2.0 percent in Medicaid. The report concludes that the increase in spending growth from 2013 was primarily driven by millions of new people with health insurance coverage a result of the Affordable Care Act and by rapidly rising prescription drug costs.

Access additional information and the full report:


New Data Posted on Physician Compare

On December 10, the Centers for Medicare & Medicaid Services (CMS) released newly available data on the quality of care provided by individual health care professionals, group practices and Accountable Care Organizations (ACOs). The 2014 data released includes additional performance scores on preventative care, diabetes, cardiovascular care, and patient safety by some physician group practices and ACOs; new performance scores on patients’ experiences with some physician group practices and ACOs; and the first set of individual health care professional performance scores on preventative care, cardiovascular care and patient safety measures. This data was used to update the quality scores of thousands of physicians who shared benchmarks under the Physician Quality Reporting System (PQRS).

Questions have been raised by physician groups about whether the data used to update Physician Compare is accurate and complete and whether the information could ultimately mislead and confuse patients visiting the Physician Compare website. The American Medical Association (AMA) notes that CMS has attempted to provide clarity to patients accessing Physician Compare explaining that the data may not be comprehensive and patients should not assume that doctors are deficient in areas where no information is provided. However, the AMA also notes that the location of the data disclaimer may not be immediately obvious to patients.

Check Your Physician Compare Profile:

CMS Fact Sheet:


2016 Federal Tax and Spending Agreement

After weeks of bi-partisan negotiations and a continuing resolution to keep the federal government operating, on December 15, Congressional leaders released a $650 billion tax package and a $1.1 trillion spending package that will fund federal agencies and programs through September 30, 2016. The packages include a two-year moratorium on the medical device tax, a two-year delay of the “Cadillac tax” on high-cost, employer sponsored health insurance plans for 2018 and 2019 as well as a one-year delay of the health insurance tax for 2017. Congress passed H.R. 2029, “Consolidated Appropriations Act, 2016”, on December 18 before adjourning for the year, and President Obama subsequently signed the budget agreement into law.

Provisions related to healthcare include:

  • $15 billion cut in operational funding for the Independent Payment Advisory Board (IPAB), a controversial 15-member board established under the Affordable Care Act tasked with reducing Medicare spending growth (Note: the panel has not been established to date);
  • $30 million cut to the Agency for Healthcare Research & Quality (AHRQ) (Note: an earlier House version of the package zeroed out agency funding);
  • $2 billion increase to the National Institutes of Health (NIH)—the largest funding increase the center has received in 12 years, putting its total budget at $32 billion;
  • $133 million increase to the U.S. Food and Drug Administration (FDA);
  • $70 million to the Centers for Disease Control and Prevention (CDC) for opioid prescription drug overdose prevention;
  • $160 million in mostly new funding to the CDC for the Antibiotic Resistance Initiative; and
  • Preventing the CMS Program Management appropriation account from being used to support insurer risk corridor payments—a program established under the Affordable Care Act that aims to mitigate risks for insurers taking on newly insured, costlier patients.

“Consolidated Appropriations Act, 2016”:


Patient Access and Medicare Protection Act

Prior to adjourning for the year, Congress also approved a blanket hardship exemption from electronic health record meaningful use penalties for providers that fail to meet meaningful use in 2015. In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use Stage 2 for a period of 90 consecutive days during calendar year 2015. However, the Centers for Medicare and Medicaid Services (CMS) did not publish the Modifications Rule for Stage 2 of meaningful use until October 16. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year. The legislation, S. 2425, the “Patient Access and Medicare Protection Act”, included a provision granting CMS the authority to expedite applications for exemptions from Electronic Health Record Meaningful Use Stage 2 requirements for the 2015 calendar year. This alleviates burdensome administrative issues for both providers and the agency. Physicians will have until March 15, 2016 to apply for the exemptions.

“Patient Access and Medicare Protection Act”:


CDC Proposes Draft Guidelines for Opioid Prescribing

On December 14, the Centers for Disease Control and Prevention (CDC) announced draft guidelines for opioid prescribing. The draft guidelines provide recommendations regarding initiation or continuation of opioids for chronic pain; opioid selection, dosage, duration, follow-up, and discontinuation; and assessment of risk and addressing harms of opioid use. The draft guidelines are intended to be used by primary care providers who are treating patients with chronic pain (i.e., pain lasting longer than 3 months or past the time of normal tissue healing) in outpatient settings. The draft guidelines are intended to apply to patients aged 18 years of age or older with chronic pain outside of palliative and end-of-life care and are not intended to apply to patients in treatment for active cancer.

The CDC is accepting public comments on the draft guidelines until January 13, 2016. Rather than finalizing the guidelines after the public comment period, the CDC announced that the draft guidelines will be subject to further review and likely will not be finalized until later in 2016. This announcement came after complaints from other federal agencies and consumer advocacy groups that the CDC was not transparent in formulating the draft guidelines and the draft guidelines are based on weak scientific evidence.

View the Draft Guidelines:!documentDetail;D=CDC-2015-0112-0002

Submit a Comment to the CDC:

More Information from the CDC on Prescribing Opioids: