5 Current Healthcare Policy Issues for Physicians & Surgeons to Know

US CapitolHere are five recent healthcare-related policy trends potentially impacting spine surgeons.


1. President Obama's budget proposal cuts more Medicare spending.
President Barack Obama released his 2014 budget proposal earlier this week, which includes a $1.8 trillion of additional deficit reduction, according to a NASS Blog post. The plan targets waste and fraud for $400 billion in savings and cuts Medicare spending for providers and patients.

The plan would target several areas to reduce Medicare spending, including additional incentives to decrease improper payments in Medicare and requiring prior authorization before advanced imaging, according to the report. The plan would also enhance the Independent Payment Advisory Board.

NASS reported that its Government Relations team will work with federal agencies on concerns over the budget proposal.

2. Final Rule on the Sunshine Act means more public physician disclosures.
The Centers for Medicare and Medicaid released the Sunshine Act final rule that requires drug, device, biologic and medical supply manufacturers to report payments and gifts to physicians and teaching hospitals, which could have a big impact on orthopedic and spine surgeon relationships with device companies.

The Rule is part of the Patient Protection and Affordable Care Act healthcare reforms stating that companies covered by any federal health program must report consulting fees, food, entertainment, travel, charitable contributions, research and honoraria provided to physicians on an annual basis. Applicable manufacturers and group purchasing organizations are also required to report certain information about physicians' ownership or investment interests.

Reporting will begin Aug. 1, and this data must be reported to CMS by March 31, 2014. CMS plans to create an online database and share payment disclosures on a public website. A survey released earlier this year reported that more than half of physicians don't fully understand the Sunshine Act and what it entails, and 43 percent said it would impact their ongoing relationship with manufacturers.

3. OIG issued a special fraud alert on physician-owned distributorships.
The Office of the Inspector General issued a special fraud alert on March 26, 2013 addressing physician-owned distributorships, focusing on the specific attributes it believes produce fraud and abuse risk.

"Longstanding OIG guidance makes clear that the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute," states the report. "The anti-kickback statute is violated even if one purpose of the remuneration is to induce such referrals."

This comes on the heals of a 2011 congressional report, which states, "The very nature of PODs seem to create financial incentives for physician investors to use those devices that give them the greatest financial return and that, in the process, patient treatment decisions may be based on personal financial gain."

4. EHR incentives are under attack.
Six Republican Senators released a white paper last week titled "Reboot: Re-Examining the Strategies Needed to Successfully Adopt Health IT" that blasted the federal incentive program for implementing electronic health records.

The federal incentive program has a $35 billion budget to give bonuses to providers demonstrating meaningful use, which physicians can receive up to $44,000 over five years through Medicare, according to a Medscape report. The biggest complaints about EHR have been lack of interoperability because not all providers have the same system, and systems do not interface with each other.

The white paper recommends stricter oversight for the bonus program and questions whether the program will be viable in the long-term. The report also raises issues about whether the Obama administration has been able to protect patient privacy during the transition to digital records. However, a recent Deloitte 2013 Survey of Physicians found 60 percent are satisfied with their EHR systems and 67 percent report communication improvement and coordinated care due to interoperatbility.

Additionally, 72 percent believed that at least 80 percent of physicians will adopt EHRs certified for meaningful use within the next three years.

5. SGR repeal still at the front of mind.
A second draft proposal on repealing the sustainable growth rate was released by the Republicans on the House Ways & Means and Energy & Commerce committees. The three-phase transition would focus more on payment for performance measures and incentivize efficiencies.

The Department of Health and Human Services declared intent to implement a 10-year SGR repeal plan, which would cut physician Medicare payments by 25 percent in 2014.

Several physician societies have supported an SGR repeal in the past, but no official plan has been developed to replace it. The National Commission on Physician Payment Reform issued 12 recommendations for healthcare payment models, recommending that cost-saving measures to offset the elimination of the SGR should come from reduced physician payments as well as the Medicare program.

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