Federal Legislation

Legislation Introduced to Protect Physicians and Patients in Medicare Advantage

ASPS Supports Efforts to Make Open Payments More Fair

Medicare Releases Billing Data for Physicians

Join ASPS in Washington, DC for the 2014 Federal Regional Advocacy Programs!

Sustainable Growth Rate (SGR) - Update from January

Legislation to Protect Physician in Negotiations with Insurers Introduced

Clinical Guideline Protection Legislation Introduced

Legislation to Expand Trauma Definition Passed through Subcommittee

Regulatory

ICD-10 Update - Industry Stakeholders Frustrated with Delayed Implementation Deadline

Private Payers Will Publish Healthcare Prices

Congress asks for changes to Medicare Fee Schedule Rules

ICD-10 Compliance Date Update

ICD-10 Implementation Delayed

CMS to Offer Hardship Exemption for Meaningful Use of EHR

NQF Annual Meeting held in Washington, DC

CMS Policy and Technical Changes to the Medicare Rx Drug Benefit - Update from January

Know How to Avoid the 2015 PQRS Payment Penalty

Stage 2 Guide for the EHR Incentive Programs Now Available

ASPS Comments on 2014 Proposed Physician Fee Schedule and Hospital Outpatient and ASC Payment Systems

CMS Announces New "Open Payments" Mobile Applications

EHR Meaningful Use - Online Course for Plastic Surgeons

State Legislation

California Truth-in-Advertising Bill Sidelined for Remainder of Session

Truth-in-Advertising Legislation in Pennsylvania Advances

Breast Cancer Patient Education

Mandated Insurance coverage for Treatment of Transgender Individuals

Introducing Jake Johnson, State Government Affairs Associate

Truth in Advertising (TIA), Arizona - Update from January

Physician Profiling, Georgia

Truth In Advertising (TIA), Arizona

CMS Policy and Technical Changes to the Medicare Rx Drug Benefit Program Proposed Rule

Sunshine Act FAQ's

Governor Quinn Signs Breast Cancer Patient Education Bill in Illinois

Alabama Breast Cancer Patient Education Law Effective August 1

Back to Top

California Truth-in-Advertising Bill Sidelined for the Remainder of Session

Despite strong coalition efforts from the California Society of Plastic Surgeons and various other groups, California A.B. 916 was pulled off the agenda of the Committee on Business, Professions and Economic Development and will not move any further this session.

The bill, designed to limit the use of the terms “board,” “certified,” “certification,” or “board certified” in physician advertising, has been repeatedly pulled off the Committee’s agenda since its introduction early last year due to opposition from certain boards not meeting the rigorous standards that this legislation calls for.

ASPS will continue to support any future efforts to increase truthful advertising practices.

Back to Top

Truth-in-Advertising Legislation in Pennsylvania Advances

House Bill 2061, introduced by Representative Bryan Cutler, passed unanimously through the Committee on Health in the Pennsylvania House during the last week of June.

The legislation was written to reduce confusion surrounding who provides patients with their medical care by requiring that all health care advertising must include the type of license, certification, registration or permit held by the individual who will be performing the health care service.

ASPS submitted formal support for the measure and will continue to support the measure as it moves through the legislative process. The bill now awaits a hearing on the floor of the House.

The state of Pennsylvania does not have any bill deadlines and bills can be brought up at any time which may increase the likelihood of this measure’s passage.

Back to Top

Legislation Introduced to Protect Physicians and Patients in Medicare Advantage

Representative Rosa DeLauro (D-CT) and Senator Sherrod Brown (D-OH) have introduced the Medicare Advantage Participant Bill of Rights Act, aimed at protecting physicians and patients in Medicare Advantage (MA) from narrowing networks.

Recently, some insurance providers offering MA plans have been dropping physicians from plan networks, often without notice to the physician or to the patients they have been treating, after the open enrollment period. Since physicians are dropped after open enrollment, patients may lose access to their preferred provider during the course of treatment.

This legislation would prevent MA plans from dropping physicians from the network in the middle of a plan year without cause, with cost of the physician to the plan explicitly stated as not being a reasonable cause for removal. The bill would also require the MA plan to notify physicians and the patients they treat that the physician is removed from the plan network at least 60 days prior to open enrollment and would require the plan to notify the physician as to why they are being dropped. Notification to patients would also need to include information on other providers of similar services, information on how to request continuation of medical treatment with the same physician and at least one customer service telephone number.

ASPS will monitor this legislation as it moves forward.

Back to Top

ASPS Supports Efforts to Make Open Payments More Fair

The ASPS signed on to a letter with other members of the Alliance of Specialty Medicine urging Center for Medicare and Medicaid Services (CMS) Administrator Marilynn Tavenner to ensure a fair process for the resolution of disputes about value transfers between physicians and industry prior to their publication on the Open Payments website.

Open Payments is the website on which the financial transfers of value from industry to physicians will be published in accordance with the Sunshine Act provisions of the Affordable Care Act. The letter reiterates the Alliance’s earlier ask for a fair and impartial process through which disputes over incorrect or incomplete data could be resolved. Instead, as implemented currently, all dispute resolution will need to take place directly between the physician and industry. This will place another burden on physicians and could lead to false or misleading information being published on Open Payments, since the data involved in an unresolved dispute at the time of publication will still be published albeit with a disclaimer that the data is under dispute.

ASPS will continue to monitor the implementation of the Sunshine Act and will continue to provide ASPS Members with more information as it becomes available.

Phase 1 of the registration process, for the CMS Enterprise Portal, is now open. Registration for the Enterprise Portal will allow you to register for the Open Payments website in order to review your reports and to make disputes as soon as that service becomes available. It is anticipated that this second phase of registration will be open in mid-July.

Back to Top

ICD-10 Update - Industry Stakeholders Frustrated with Delayed Implementation Deadline

At a recent Standards Subcommittee meeting of the National Committee on Vital and Health Statistics (NCVHS), a wide spectrum of healthcare industry representatives testified on the impact of the latest ICD-10 implementation delay to their organizations.  

NCVHA's Standards Subcommittee monitors and makes recommendations on health data standards and has held numerous public hearings on ICD-10.  Their goal for this most recent hearing was to identify opportunities for outreach and education in the next 12 months, working with industry to develop a list of recommendation that will help both public and private payers prepare for the transition to the new coding schematic. 

Not surprisingly, there were several requests for funding to help develop customized resources and/or grants to assist with implementation costs for those providers not yet fluent in the new coding schematic.  Speakers from the Workgroup for Electronic Data Interchange (WEDI) stressed that early adoption or a phased in approach for those providers who are ready to code in ICD-10 has the potential to create coordination of benefits issues when not all payers are ready to accept claims at the same time.  

All participants agreed that future robust end-to-end testing is necessary.  In addition, both CMS and private payers should be encouraged to expand the opportunities for testing in the next year, and to develop industry wide contingency plans, should they be needed during the transition.

Several presenters asked NCVHS to assist in their efforts to broaden the public awareness of ICD-10 and to dispel any misunderstandings or myths that are currently circulating.  Straightforward, clear guidance on the implementation deadline will also be necessary.  

And finally, a representative from the American Academy of Professional Coders suggested that the "freeze" on ICD code changes be lifted to make necessary updates to sections of the ICD-10 code set that are known to have errors.    

NCVHS staff, who had previously recommended adoption of the ICD-10 code set, will present the full list of recommendations to CMS in the coming weeks.  ASPS staff will continue to monitor the ICD-10 implementation timeline and share information as it becomes available.    

Back to Top

Private Payers Will Publish Healthcare Prices

Three major health insurance companies have agreed to publish their healthcare prices in a free online portal starting next year.


Citing a need for research on private health insurance claims data to gain understanding of health care costs, Aetna, Humana and United Healthcare have partnered with the Health Care Cost Institute (HCCI) to offer timely information about the price and quality of health care services. A HCCI spokesperson has indicated other private payers are expected to join with the organization to share their pricing data as well.

HCCI, which was established in 2011, will maintain and administer the website, which is being touted as a one-stop shop to help consumers manage the cost and quality of care.

This new online tool will include aggregate pricing data from commercial health plans as well as information about Medicare Advantage and Medicaid health plans, if states agree.

The initiative follows efforts by the Obama administration to publish Medicare cost data. Earlier this year, the Centers for Medicare and Medicaid (CMS) Services published Medicare billing records for almost 800,000 physicians who received funds for Medicare Part B services they billed to the program. Last year, CMS released a database detailing the amounts hospitals charge for the 100 most common procedures and has indicated it will release updated hospital data before the end of June 2014.

HCCI has also partnered with leading research, actuarial and government organizations to research claims data to better understand what drives health spending and use of services.

Back to Top

Congress asks for changes to Medicare Fee Schedule Rules

Recently a group of House members from both sides of the aisle sent a request to CMS to consider a more transparent, timelier approach to the yearly sharing of information on how Medicare fees for an upcoming calendar year are determined.

CMS has long used a rulemaking process that requires both public notice and an opportunity for public comment prior to enacting new regulations.    Information about some, but not all of the coming year’s fee schedule is shared via a Proposed Rule, which is published in mid-summer.   A second, Interim Final Rule, is published in mid-November, with a Final Rule going into effect on the first day of the new calendar year.  

Because the majority of a given year’s methodological changes, including RVU updates, are typically shared in the second as opposed to the first publication from CMS, providers and Societies have less than 60 days to review and respond before rules are made final.  Changes to the Medicare fee schedule have the potential to wreak havoc on practices that are unable to learn of and prepare for the changes in a timely matter. 

The House members who signed the letter Congress are keenly aware that the current fee schedule publication process deprives the public of the opportunity to fairly and meaningfully voice their approval or concern over impending changes to the Medicare fee schedule.  The process also limits CMS’ ability to review and incorporate stakeholder’s insight into payment decisions prior to the effective date of new policy.    

In an effort to ensure physicians have adequate time to review, comment and prepare for reimbursement changes, Congress is seeking a voluntary revision of the publication schedule, asking the Agency to consider publishing all reimbursement changes in the Proposed Rule as opposed to waiting until the Interim Final Rule is released.    

As of yet, no official response from CMS has been made public. ASPS will continue to monitor the situation and provide updates as they become available. 

 

Back to Top

ICD-10 Compliance Date Update

In a brief statement issued by CMS, a new ICD-10 transition date has been identified. The Agency expects to release an interim final rule in the coming days that will recognize October 1, 2015, as the date when the use of ICD-10 becomes mandatory. Because the information will be included in an Interim Final Rule, it’s not clear yet if the public will have an opportunity to comment on the proposal before it becomes final.


ASPS will continue to monitor the situation and provide updates as they become available.


While October 2015 may seem far off, training continues to be important, as ICD-10 is a nuanced system that will require a sufficient amount of time before proficiency can be recognized.  The following steps are suggested to ensure your organization is proficient at using the ICD-10 coding system:

  1. Review the codes you are using now. If a large portion of your codes are tied to an “unspecified” ICD-9 code, make the necessary adjustments in your documentation and/or problem lists to report more specific codes instead. Transitioning to more detailed and descriptive codes now will help you prepare for ICD-10.
  2. Identify the top 25 diagnosis codes used in your office. Become familiar with the ICD-10 coding rules for these conditions and identify opportunities to further improve documentation.
  3. Continue ICD-10 education for coders, physicians and users of clinical data to promote proficiency with the new code set.
  4. Verify all necessary ICD-10 upgrades have been made to software/hardware used for billing purposes.
  5. Initiate or continue dual coding until internal data quality assessments demonstrate accuracy in ICD-10.

In related news, CMS has rescinded its plan to perform end-to-end testing of claims coded in ICD-10. The testing was scheduled for July 2014. Instead, the Agency will identify and communicate dates for future opportunities for ICD-10 testing, most likely in early 2015, as they are finalized.

Back to Top

ICD-10 Implementation Delayed

Included in the recent short-term fix of the Medicare sustainable growth rate was a provision to delay the implementation of ICD-10. The directive was a one sentence last-minute addition to the proposal and has led industry analysts to speculate that Congress did not fully understand the ramifications of the provision. For organizations that were installing new IT systems, training staff and preparing for the transition, the delay was not only a surprise, but an unwelcome one. Any ICD-10 conversion work already performed on systems will now need to be undone, and ICD-9 versions will need to be re-installed, retested and reintegrated. For organizations that were advocating for delayed implementation of ICD-10, the provision was welcomed whole heartedly. Industry surveys of healthcare executives routinely report ICD-10 preparation as the biggest IT challenge for organizations. Many smaller physician groups have yet to make necessary preparations for the conversion.This is the second delay for the adoption of the new coding schematic, and while a new start date of "no sooner than Oct. 1, 2015," has been identified, the postponement creates many unanswered questions about the timing of testing, training and level of ICD-10 education that is necessary for healthcare providers and payers. ASPS staff will continue to monitor the situation and provide updates as they become known. 

Back to Top

Medicare Releases Billing Data for Physicians

A long standing Center for Medicare and Medicaid Services (CMS) policy that barred the release of information about the dollars paid to individual physicians was recently lifted, allowing the Agency to publicly share information on the number and types of services submitted to and paid by Medicare.  The data includes information on every test and procedure billed to Medicare Part B by individual doctors in all 50 states during calendar year 2012. Only those providers who submitted 10 or less claims to the Medicare program are excluded from information contained in the database.  The change comes after a years-long battle over the ability of the federal government to release physician specific payment information.

Historically, any release of the data was viewed as an invasion of privacy.  Legal battles since the 1980s as well as a new focus in healthcare on increased transparency and fraud detection prompted the change.  While many believe the data will offer new ways to look at just how much physicians earn under the Medicare program, others believe the information could include inaccuracies, resulting in unwarranted bias against some physicians.

View the database  

CMS cautions that the file contains cost and utilization information only, and the volume of procedures presented may not be fully inclusive of all procedures performed by a provider.    The Agency has not yet confirmed if it will be releasing data from previous years, but has indicated it will be releasing updated hospital data before the end of June.   

Back to Top

Mandated Insurance Coverage for Treatment of Transgender Individuals


Washington, DC health insurance providers must cover treatments for individuals with a diagnosis of gender dysphoria, according to a statement released by the Executive Office of Mayor Vincent C. Gray. The statement goes on to say that insurance providers must refer to the World Professional Association for Transgender Health Standards of Care as the recognized standard of medical care for transgender individuals.

“Today, the District takes a major step towards leveling the playing field for individuals diagnosed with gender dysphoria,” Mayor Gray said in the statement.  “These residents should not have to pay exorbitant out-of-pocket expenses for medically necessary treatment when those without gender dysphoria do not.”

Five states already mandate insurance coverage for treatment of transgender individuals — California, Colorado, Oregon, Vermont and, as of last month, Connecticut — according to GLAAD.

Read the full statement

Read the New York Times story

Back to Top

Join ASPS in Washington, DC for the 2014 Federal Regional Advocacy Programs

Now is a critical time to learn more about issues facing the specialty and to advance ASPS legislative priorities on Capitol Hill.

  • Educate your Members of Congress on your medical specialty
  • Interact with your Members of Congress on issues of importance to plastic surgeons, their practices and their patients
  • Advocate for the advancement of patient care and access to specialty medicine

Dates for the Program:

  • May 6-7, 2013: Southeast/Midwest Regions
  • June 19, 2013: Northeast and West Regions. This program is in conjunction with the Dueling Perspectives in Aesthetic Plastic Surgery Symposium.

All are welcome. Registration is free.

Find out more and register online.

Please RSVP and direct any questions or requests for additional information to Carrie Lamb at (202) 672-1519 or via email at clamb@plasticsurgery.org.  

Back to Top

CMS to Offer Hardship Exemption for Meaningful Use of EHR


CMS has indicated they will not delay upgrade to the EHR incentive program, but will develop procedures to allow physicians to avoid penalties if their electronic health record (EHR) vendor is slow in supplying Stage-2 compliant software.
Specifically, for those physicians who earned an EHR incentive bonus for at least two years under Stage 1 Meaningful Use criteria, the current program requires the ability to demonstrate Stage 2 compliance in calendar year 2014. Recent reports indicate only a fraction of EHR programs that had been certified for Stage 1 Meaningful Use have obtained certification for Stage 2. 
Additionally, CMS will consider granting hardship exemptions to physicians, who for reasons beyond their control cannot attain some of the Stage 2 performance thresholds this year. A hardship exemption could spare noncompliant physicians from a Medicare reimbursement cut of 2%.

Back To Top 

Introducing Jake Johnson, State Government Affairs Associate


Jake Johnson joined ASPS on February 18th and will be responsible for researching, monitoring, analyzing and influencing state legislation and regulatory proposals; working with coalitions on common state issues; and educating government officials as to the implications of various policy changes that impact the specialty of plastic surgery.  Jake will also manage the regional advocacy programs and all aspects of grassroots advocacy.

Jake comes to ASPS from Deltek, Inc. where he was an Associate Research Analyst and conducted research on State and Local Government agencies. Jake has held positions at Stateside Associates, was the Legislative Assistant for an Illinois State Representative and a Legislative Intern for an Illinois State Senator. As part of an internship program, Jake was a U.S. Department of State Intern for the Management Section at the U.S. Embassy in Rome, Italy.  He took part in developing and completing projects in accordance to Federal policies and the needs of the Embassy, pertaining to the sustainability and environmental goals of the State Department. 

In the following weeks, to facilitate communications, Jake will be reaching out to State Societies to update their contact information. If you have updated contact information pertaining to your State or Regional Society, please contact Jake at JJohnson@plasticsurgery.org.

Back To Top 

Truth in Advertising (TIA), Arizona – Update from January


Arizona Senate Bill 1042, regarding Truth in Advertising, hastily moved through the Senate last week with board certification language that has been deemed rather weak by a variety of healthcare groups, including ASPS. The bill’s sponsor, Senator Nancy Barto, remains unwilling to amend the bill to include stronger board certification language. Since amendment of the bill was not an option for Senator Barto, American Medical Association (AMA) and other medical specialty societies were able to successfully get the measure held in the House committee, delaying any further action. ASPS will continue to work with the AMA on a strategy to introduce more substantive legislation in Arizona.

Back To Top 

Breast Cancer Patient Education


This legislative session, breast cancer patient education legislation has been a trend among state legislatures. ASPS has a proactive advocacy strategy to help ensure that these bills include comprehensive language pertaining to the education of breast reconstruction care options. In the following months, we will be working closely with the Council on State Affairs to implement our advocacy strategy.

On February 27, ASPS submitted written testimony in support of Kentucky House Bill 123, the Genea Breast Cancer Awareness Act. ASPS is currently monitoring breast cancer patient education bills in Alabama, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Iowa, Kentucky, New Jersey, South Carolina, Tennessee and the state of Washington.

Back To Top 

Sustainable Growth Rate (SGR) – Update from January


On February 6, the Senate Finance and House Energy and Commerce and Ways and Means Committees released their joint, bipartisan, bicameral proposal to permanently repeal the flawed SGR. The new legislation made some significant changes to the three previous drafts passed through the respective committees in 2013. Most notably, the proposal includes a 0.5% positive update for five years as opposed to the zero percent updates for ten years that was in previous drafts.

The proposal also eliminates the tournament style approach to payment adjustments that was included in the Senate Finance/House Ways and Means proposals, which ASPS opposed. The approach that would have pit physicians against one another for payment adjustments is replaced by a composite score system with a threshold score that must be met for positive payment adjustments and which will be known to physicians prior to the payment year. If the threshold score is not met, physicians will receive negative payment adjustments. The proposal streamlines the current law reporting programs (PQRS, EHR Meaningful Use) and the Value Based Payment Modifier into one reporting program and maintains the fee for service option. There are additional positive payment adjustments available for those physicians receiving a larger percentage of their Medicare revenue from various alternative payment models.

There remain some troubling provisions in the legislation though, most notably a provision that requires the Secretary of the Department of Health and Human Services (HHS) to identify misvalued codes in the physician free schedule. The Secretary is to identify 0.5% of the entire physician fee schedule in misvalued codes to be redistributed within the fee schedule. The RUC has already been working on a misvalued codes initiative and this provision is duplicative of that work, as well as an attempt to take from specialty codes to give to primary care codes.

The House GOP Doctors Caucus held a meeting Friday, February 28, 2014 to discuss the most recent SGR proposal before Congress. In a letter to Senate and House leadership, the Caucus stated that, the House GOP Doctors Caucus has agreed to the policies contained within this compromise proposal.”  According to Caucus, “approval of a final package would be subject to an evaluation of the totality of the legislation including of-sets.”

ASPS has not taken a position on the legislation, opting instead to take a cautious approach especially in light of the fact that the proposal does not include mechanisms by which to pay for the SGR repeal.

Back To Top 

NQF Annual Meeting held in Washington, DC


The National Quality Forum (NQF) Annual Conference and Membership Meeting was held in Washington, DC on February 13th and 14th. The event was titled “Making Sense of Quality Data for Patients, Providers, and Payers” and was attended for ASPS by William Wooden, MD and Carrie Lamb. Sessions and speakers focused on core issues including what and how much information should be shared with patients, the role of the patient-caregiver-physician relationship and how government quality data can be useful to patients. Breakout sessions were also held during which attendees discussed the new National Quality Partners initiative and the six National Quality Strategy priority areas.

Back To Top 

CMS Policy and Technical Changes to the Medicare Rx Drug Benefit – Update from January


As you know, on January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) released its Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs. The proposed rule would make some significant changes to the Medicare Part D program, including requiring physicians to be enrolled in Medicare in order to prescribe Part D drugs, removing the protected class status for some drugs and potential suspension from the Medicare program for physicians deemed as having abusive prescribing practices.

On February 26, the House Energy and Commerce Committee Health Subcommittee held a hearing titled “Messing with Success: How CMS’ Attack on the Part D Program Will Increase Costs and Reduce Choices for Seniors.”The hearing was called due to major concerns with the proposed rule from many Members of Congress, especially Republicans and from some of the physicians in Congress. Some Members have expressed outright opposition to the proposed rule and are calling for the rule to be rescinded.

ASPS signed-on to letters expressing concern with the CMS proposed rule with both the Alliance for Specialty Medicine and the Health Leadership Council, which has over 250 signatories.  The Biotechnology Industry Organization (BIO), the Pharmaceutical Research and Manufacturers of America (PhRMA) and the AMA are also submitting comments to CMS. 

Back To Top 

Legislation to Protect Physician in Negotiations with Insurers Introduced


This month, Representatives John Conyers (D-MI-13) and Dan Benishek, MD (R-MI-1) introduced the Quality Health Care Coalition Act of 2014 which provides limited antitrust protections for physicians in negotiations with private insurance companies. The legislation will give health care providers the ability to negotiate contract terms on an equal level with insurers, including terms that affect the quality of patient care. In introducing the bill, the sponsors and supporters noted that the immunity insurers have from antitrust laws has led to increasing concentration in the insurance market, which leaves consumers with fewer options. This legislation will work to increase choices and ensure physicians remain on a level playing field in insurance negotiations. ASPS will continue to monitor the legislation’s progress and will keep you informed as we learn more.

Back To Top 

Clinical Guideline Protection Legislation Introduced

     
On February 27, Representatives Andy Barr (R-KY-6) and Ami Bera, MD (D-CA-7) introduced legislation for the development and dissemination of clinical practice guidelines that could provide limited ‘safe harbor’ protections for physicians. H.R. 4106 would also establish the right of removal to federal court, any malpractice actions involving and federal payer like Medicare. Members of the Health Coalition on Liability and Access, of which ASPS is a member, have been working closely with Representatives Barr and Bera on drafting the language.  ASPS will continue to monitor the legislation’s progress and will keep you informed as we learn more.

Back To Top 

Legislation to Expand Trauma Definition Passed through Subcommittee


The Improving Trauma Care Act of 2013 (H.R. 3548) passed through the House Energy and Commerce Health Subcommittee on February 27. The legislation will expand the definition of ‘trauma’ in the Public Health Service Act for the purposes of certain care programs to include injury from extrinsic agents, including thermal, electrical, chemical, or radioactive agents. Currently, the definition of trauma includes only injury from mechanical force. One of the lead sponsors is Representative Michael Burgess, MD (R-TX-26) and this bill is supported by many physician organizations including the American College of Surgeons.

 

Back To Top 

Physician Profiling, Georgia


This month, Senator McKoon of the 29 District in Georgia introduced legislation (SB 173) to address physician profiling, a potentially new state/federal issue for. This issue has recently been brought to our attention by ASPS members and medical specialty associations.  It seems that several insurance companies are dropping providers from their networks with very little transparency about the reasons why these decisions are made. SB 173 would establish a physician profiling program to address these and other “profiling” mechanisms used by insurance companiesPlease note, this activity is being conducted in the private marketplace, similar to what was done in years past with Medicare Advantage. 

The American Society for Dermatologic Surgery Association and the Georgia Dermatological Society (ASDSA) are supporting the measure. ASPS has also been in touch the new Executive Director of Georgia Society of Plastic Surgeons, Hart Health Strategies (ASPS’s legislative and regulatory firm in Washington, DC) and Stateside Associates (ASPS’s new state legislation and regulation monitoring vendor) – all will be keeping an eye on this issue moving forward. 

Back To Top 

Truth In Advertising (TIA), Arizona


While there are a number of states with TIA legislation (see attached list), in Arizona, legislative action is already moving forward.  On Wednesday, Senator Nancy Barto held a Health and Human Service Committee hearing on her bill.  Unfortunately, the board certification language in this bill is rather weak, and Senator Barto does not seem willing to amend her bill (despite opposition from the American Academy of Facial Plastic and Reconstructive Surgery and the American Society for Dermatologic Surgery Association).  ASPS and other medical specialty societies are working with the American Medical Association (AMA) on a strategy in the Arizona House to make the bill more substitutive.  We have also been in touch with the CSA representative from Arizona, the Arizona Medical Association and the Arizona Plastic Surgery Society.  More information will follow.

Back To Top 

CMS Policy and Technical Changes to the Medicare Rx Drug Benefit Program Proposed Rule


On January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) released its Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs. The proposed rule would make changes to Medicare Advantage and Part D plans, but could also impact your practice given it would 1) require prescribers of Part D drugs to enroll in Medicare and 2) allow Medicare to revoke Medicare enrollment of providers if they are deemed to have abusive prescribing practices or patterns. 

A number of advocacy groups are drafting comments to CMS (due March 7, 2014), including, the Alliance for Specialty Medicine, the Biotechnology Industry Organization (BIO), the Pharmaceutical Research and Manufacturers of America (PhRMA) and the American Medical Association. ASPS Health Policy Staff is reviewing the proposal. More information will follow.

 

Back to Top

Sunshine Act FAQ's Provided  

Check out the CMSS Physician Payment FAQs regarding the Sunshine Act.

Posted August 1, 2013 -- On February 1, 2013, the Centers for Medicare and Medicaid Services (CMS) released the final rule regarding Transparency Reports and Reporting of Physician Ownership or Investment Interests (also known as the "Sunshine Rule"). Among other things, this final rule requires applicable manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid or the Children's Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers of value provided to physicians or teaching hospitals ("covered recipients").Affordable Care Act's "Sunshine Rule" Increases Transparency in Health Care 

Back To Top 

 Know How to Avoid the 2015 PQRS Payment Penalty

Posted November 15, 2013 -- The end of the year serves as a reminder for physicians to prepare to report their quality measures to avoid the 2015 Physician Quality Reporting System (PQRS) adjustment. This adjustment of 1.5% will apply to covered professional services furnished by an eligible professional or group practice during 2015, but is based upon the reporting of quality measures during 2013. While the deadline for one option has already passed, two more opportunities exist to avoid the 2015 payment adjustment:

    • Option 1: Meet the criteria for satisfactory reporting for the 2013 PQRS Incentive of 0.5%. These criteria vary depending on whether a physician is reporting measures or measures groups and how they report their measures.
    • Option 2: Report at least one valid measure for one applicable patient via claims, participating registry or participating and qualified Electronic Health Record (EHR) vendor, or report at least one valid measures group via claims or participating registry. This second option is to avoid the 2015 payment adjustment only and has no incentive tied to it.

Physicians who do not currently have a mechanism for reporting quality measures should know that ASPS, jointly with CECity Registry developed a PQRS reporting tool for plastic surgeons, the PQRSwizard. The PQRSwizard is an easy to use online tool that helps physicians and other eligible professionals quickly and easily participate in PQRS by collecting, validating and submitting physician quality measures to CMS for payment. More information on the PQRSwizard and how to sign up can be found here.

Additional information about PQRS can be found on the CMS website.

Back to Top

 Stage 2 Guide for the EHR Incentive Programs Now Available

Posted October 10, 2013 -- Beginning in 2014, all providers must report CQMs based on new requirements outlined in the Stage 2 final rule, regardless of what stage they are in.  In preparation for this, the Centers for Medicare and Medicaid Services (CMS) has released a new resource, An Eligible Professional's Guide to Stage 2 of the EHR Incentive Programs, which provides a comprehensive overview of Stage 2 of the EHR Incentive Programs to eligible professionals (EPs). The guide outlines criteria for Stage 2 meaningful use, 2014 clinical quality measure reporting and 2014 EHR certification. Physicians can access a copy of this resource here. Additionally, more information on the EHR Incentive Programs can be found here. Questions can also be directed to Catherine French at cfrench@plasticsurgery.org.

Back to Top

 ASPS Comments on 2014 Proposed Physician Fee Schedule and Hospital Outpatient and ASC Payment Systems

Posted September 11, 2013 -- On September 6, the American Society of Plastic Surgeons (ASPS) provided comments on behalf of its members to the Centers for Medicare and Medicaid Services (CMS) on two proposed rules for 2014:  Medicare physician fee schedule and the hospital outpatient prospective payment system and quality reporting programs.  ASPS registered several concerns about:

      • The increased number of measures that would be required for satisfactory reporting under the Medicare Physician Quality Reporting System (PQRS)
      • The search functionality on the Medicare Physician Compare website
      • The Agency's plans to cap payments to services performed in the non-facility setting when those payments are greater than what is paid when the same service is performed in either the hospital outpatient or ambulatory surgical center facility setting
      • The CMS proposal to unconditionally package all drugs and biologicals that function as supplies or devices in a surgical procedure

You can read ASPS' comment letter to CMS on the CY 2014 physician fee schedule here and the comment letter on the hospital outpatient and ASC payment systems here. ASPS anticipates the final rules will be published in early November and will provide an update for members. 

Back to Top

Governor Quinn Signs Breast Cancer Patient Education Bill in Illinois

Posted September 11, 2013 -- On Aug. 16, Illinois Governor Pat Quinn signed legislation (H.B. 3175) that will help ensure breast cancer patients are informed of their reconstructive options. The new law, which was modeled after the ASPS federal bill, requires the Illinois Department of Health to develop and implement an education campaign to inform breast cancer patients, especially those in racial and ethnic minority groups, of the availability and coverage of breast reconstruction. ASPS supported the efforts of Rep. Kay Hatcher, the bill's sponsor, to pass this legislation.

Back to Top

Alabama Breast Cancer Patient Education Law Effective August 1

Posted September 11, 2013 -- The Alabama Breast Cancer Patient Education Act of 2013 (S.B. 22), which was signed into law earlier this year by Governor Robert Bentley, became effective Aug. 1. The new law requires the Alabama Department of Public Health (ADPH) to develop standardized information for breast cancer patients about treatment and breast reconstruction options and insurance coverage availability for these treatments. Certain physicians are then required to disseminate the summary to breast cancer patients.

Back to Top

CMS Announces New "Open Payments" Mobile Applications

Use of app technology helps to bring greater transparency to payments and other financial interactions between doctors and health care industry. 

Posted August 8, 2013 -- On July 17, CMS introduced two free mobile device applications (apps) to help physicians and health care industry users to track their payments and other financial transfers the industry will report under the Open Payments program (Physician Payments Sunshine Act). Created by a provision of the Affordable Care Act, Open Payments creates greater public transparency about the financial transactions between doctors, teaching hospitals, drug and device manufacturers, and other health care businesses. 

CMS has made these apps available to facilitate accurate reporting of required information, which will be available to the public and will be published annually on the Open Payments website. To support the "Open Payments" program, CMS designed the mobile applications (one each for physicians and health care industry users) merging this proven and efficient format with real-time 24-hour tracking technology. The apps offer on-the-go convenience for users to track financial data. Both apps are compatible with the iOS (AppleTM) and Android platforms; they are available free through the iOS AppleTM Store and Google PlayTM Store.  

Back to Top

Back to Top

EHR Meaningful Use - Online Course for Plastic Surgeons

Posted May 15, 2013 -- The American Recovery and Reinvestment Act (ARRA) of 2009 authorized The Centers for Medicare and Medicaid Services (CMS) to provide financial incentives to physicians that demonstrate Meaningful Use of certified electronic health record (EHR) technology. Physicians will need to engage in meaningful use of EHRs by 2015 to avoid 1% penalty in 2015, 2% penalty in 2016, and a 3% penalty in 2017; penalty could increase up to 5% by 2021.

This online interactive course demonstrates key items plastic surgeons should know about Meaningful Use - Stage 1. Additionally, 0.5 Patient Safety credit can be earned.

Back to Top