Orthopedics This Week | December 5, 2017 | Page 22

ORTHOPEDICS THIS WEEK
VOLUME 13, ISSUE 38 | DECEMBER 5, 2017
than 200 unique Medicare patients
are exempt from the program.
• Physician practices impacted by
recent hurricanes in southern states
can receive a hardship exemption.
• Only about 40% of the 1.5 mil-
lion physicians who treat Medicare
patients will be participating in the
MIPS program.
• New billing codes will allow phy-
sicians to get reimbursed for some
types of virtual visits.
• Small, solo and rural physicians
can band together and form “vir-
tual groups“ to participate in MIPS,
with a deadline of December 1 for
the 2018 performance year.
• Physicians can use either 2014 or
2015 certified EHR technology in
2018—but Medicare gives a 10%
bonus to those using the newer
2015 version.
AAOS Supportive
The American Academy of Orthopaedic
Surgeons (AAOS) was supportive of the
CMS proposals to fully align CMS qual-
ity programs like the Physician Quality
Reporting System (PQRS), Meaningful
Use (MU), and the resource Value-Based
Payment Modifier (VBPM). These pro-
grams compose three of the four catego-
ries of measurement under the QPP MIPS
but the legacy programs (PQRS, MU and
VBPM) remain in effect for 2018.
AMA Opposes Trump
Flexible Basic
Benefits Plan
O
n October 27, 2017, the Trump
Administration proposed new
health insurance regulations that could
affect basic benefits required by the
Affordable Care Act (ACA).
Almost immediately, the nation’s largest
society of physicians said it opposes any
weakening or removal of any of the ten
categories of essential health benefits
(EHBs) required by the ACA.
After voting to protect “meaningful
health insurance coverage for patients
and promote stable health insurance
premiums,” members of the American
Medical Association (AMA) attending
their Interim Meeting in Honolulu, said
patients must have “meaningful cover-
age for hospital, surgical and medical
care and protections against catastroph-
ic expenses.”
The AMA noted that analyses have
found that categories most likely to
be removed from the EHB, if states are
allowed flexibility to do so, include
maternity care; mental health and sub-
stance abuse benefits; rehabilitative and
22
habilitative services; certain pediatric
services, including oral and vision care;
and prescription drugs.
The vote came after a report from the
AMA’s Council on Medical Service
noted, “if insurers are allowed to offer
plans with skimpier coverage, plan
designs could potentially discriminate
against people with pre-existing condi-
tions. In addition, individuals who use
services and benefits no longer includ-
ed in the EHBs could face substantial
increases in out-of-pocket costs.”
On November 14, 2017 the Association
reported it will oppose the removal of
categories from the EHB package. In
addition, the AMA will also oppose
waivers of EHB requirements that lead
to EHB categories and their associated
protections against annual and lifetime
limits, and out-of-pocket expenses,
being eliminated.
The Trump Plan
Under the Trump plan, starting in
2019, states could select from cover-
age levels in another state, which could
be less generous. Ten broad categories
of services required by the health law
would still have to be covered, but the
fine print could change.
The Academy was supportive of the
rule which calls for retroactively meet-
ing minimum thresholds for positive or
neutral payment adjustments for 2016
that will match the thresholds under
QPP MIPS because it will make it easier
for physicians to get positive or neutral
payment adjustments in 2018.
To see the entire rule, click here. — WE
AMA Interim Meeting / Courtesy of AMA
ryortho.com | 1-888-352-1952