News and noteworthy information for October 2018

CMS conducts field tests of outcome cost measures for musculoskeletal conditions and procedures

The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen LLC, have been conducting field testing for 13 cost measures before consideration of their potential use in the cost-performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program in 2020 or beyond. These measures were developed with input from members of ISASS and other medical specialty societies.

Field testing is an opportunity for clinicians and other stakeholders to provide feedback on the measures. Feedback shared on the draft measure specifications will be used to consider potential refinements.

Clinicians and clinician groups that meet the minimum number of cases (episodes or beneficiaries) outlined below will receive a future Field Test Report via the CMS Enterprise Portal with information about their cost performance:

Field Test Reports and supplemental documentation will be available for the following measures currently under development:

ISASS members who are part of the field testing and have not yet provided input can provide feedback on the draft measure specifications, Field Test Report format, and supplemental documentation through this online survey through October 31.

In addition to the Field Test Reports, stakeholders may review a number of supplemental documents, which are available for download on the CMS MACRA Feedback page. Supplemental documentation includes:


The episode-based cost measures under development for potential use in the Quality Payment Program evaluate a clinician’s cost for the episode group by averaging their risk adjusted costs across all episodes attributed to the clinician during the measurement period. The cost of each episode is the sum of the Medicare Parts A and B costs for clinically related items and services as determined by input received from a measure-specific workgroup, consisting of clinicians with relevant expertise. These services can include those performed by the attributed clinician as well as other healthcare providers during the episode window.

The cohort for this cost measure consists of Medicare beneficiaries, excluding beneficiaries for whom the following conditions apply:

Measure Name: Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels Episode-Based Cost Measure


ISASS meets with CMS to discuss potential misvaluation of minimally invasive spine surgical procedures, submits comments in the Medicare Physician Fee Schedule

On October 22, 2018, ISASS held a face-to-face meeting with officials at the Centers for Medicare and Medicaid Services (CMS) headquarters in Baltimore.

ISASS was represented by Morgan Lorio, MD, chair of the ISASS Coding and Reimbursement Taskforce, and CMS was represented by Carol Blackford, the Director, Ing-Jye Cheng Deputy Director for the Office of the Department of Hospital and Ambulatory Policy Group (HAPG), and other officers in the Outpatient Care, Practitioner Services and Ambulatory Services Divisions, including Gift Tee, Acting Director Division of Practitioner Services, Marge Watchorn, Deputy Director Division of Practitioner Services, and Ryan Howe, Director Division of Ambulatory Services.

ISASS presented information regarding the misvaluation of minimally invasive spine surgical services in the Medicare Physician Fee Schedule and the increased costs and decreased patient benefits that result from these errors in valuation. The meeting was an important opportunity for ISASS to continue to advocate for proper payment for efficacious and less invasive spine surgery options on behalf of patients suffering from spine and disc conditions and seeking a full array of treatment options that best suit their needs as patients.

CMS officials indicated a significant interest in collaborating with ISASS to improve care for Medicare beneficiaries and invited Dr. Lorio and others to continue to regularly interact and continue their dialogue with them in future rulemaking comment letters and face-to-face meetings.


Leapfrog Group Expands Performance Ratings to Outpatient and Ambulatory Surgery Centers

Leapfrog Group will start publishing safety and quality performance of hospital outpatient surgery departments and ambulatory care centers in 2020, the group said on October 16, 2018.

Like its hospital safety grades, the outpatient data will be available to the public. Leapfrog will ask the centers to voluntarily submit performance data. The group has asked centers for input on which questions it should ask on the surveys.

Outpatient procedures have become more popular in recent years, but it’s hard to gauge performance quality. More than 23 million surgeries are performed annually at ambulatory care centers, but the CMS only requires they publicly report four quality measures. The White House recently approved an HHS plan to launch a patient safety database for ambulatory surgery centers.

Leapfrog’s Hospital Survey will include a new section for data from hospital outpatient surgery departments.

Ambulatory care centers will likely have to submit infection rates, medical and nursing staff information, procedure volume, outcomes data and patient experience results.

Leapfrog will limit the first year of published surveys to 250 ambulatory care centers and assess the results for potential adjustments. Leapfrog expects that centers will be eager to participate in Leapfrog’s grading system because the centers now don’t have a way to show patients and employers how they perform in an unbiased way.


Department of Health and Human Services 2019 Budget Signed Into Law

President Trump on September 29. 2018 signed into law the 2019 Department of Health and Human Services (DHHS) budget. The budget provides $90.5 billion in discretionary funding for HHS, an increase of $2.3 billion from the prior year.

National Institutes of Health (NIH): The NIH will receive $39.1 billion, an increase of $2 billion from the prior year, including:

Fighting Opioid Abuse: This section provides $3.7 billion for the Centers for Disease Control (CDC) and other agencies to fight opioid abuse, an increase of $145 million from the prior year including:

Affordable Care Act funding: No new funding was provided for the Affordable Care Act (ACA, commonly known as Obamacare) but does include the following oversight provisions:

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