Payment Reform

The Affordable Care Act included several new Medicare payment reforms designed to improve coordination and collaboration among physicians and other healthcare providers, moving towards integrating quality into payment systems. These reforms- including the ongoing efforts on the Hill to repeal the SGR and create new systems, the development of Accountable Care Organizations (ACOs), and episode groupers or bundled payments- may provide incentives for otolaryngology- head and neck surgeons to use innovative products that improve quality and create efficiencies in the delivery of care.
AAO-HNS Efforts
*NEW* AAO-HNS Submits Comments to CMMI on Innovative Specialty Payment Models
On April 10, the Health Policy team, with input from Ad Hoc Payment Model work group members, submitted comments to the CMS Innovation Center (CMMI) on policy considerations for the development of innovative payment models for specialty provider services furnished mainly as outpatient care for patients with specific medical conditions.

While there are several barriers to moving forward with exploration, including significant diversity within the specialty, limited access to data and resources, the Academy provided CMMI with several otolaryngology disease processes that have garnered some interest among the AAO-HNS physician leaders in possibly developing an episode of care or bundle. To view the letter, click here. 

Congressional Committees Reach Agreement on SGR Repeal
On February 6, 2014, leaders from three Congressional committees released a bipartisan, bicameral agreement on legislation to permanently repeal the flawed Sustainable Growth Rate (SGR) payment formula and replace it with a new Medicare payment system that better incentivizes the delivery of high-quality, efficient healthcare.   Visit the Academy's Government Affairs page for further details.

Budget Deal with SGR "Patch" Signed by President
On December 26, 2013, President Obama signed the two-year budget deal negotiated by U.S. Representative Paul Ryan (R-WI) and U.S. Senator Patty Murray (D-WA).  Included as an amendment to this bill was language to halt (for three months) the 20+percent cut in Medicare physician payments scheduled for January 1, 2014.  Instead, physicians will receive a .5% positive increase during that time.  This payment "bridge" is intended to avoid payment disruptions as Congress completes its work on permanent SGR repeal legislation in early 2014.  The budget deal, including the SGR "bridge," was previously passed by the U.S. House of Representatives (332-94) and U.S. Senate (64-36) in mid-December.

AAO-HNS Comments on SGR Repeal Proposals

This year, Congressional leaders identified repeal of the flawed Sustainable Growth Rate (SGR) formula as a top legislative priority for 2013. Since then, Congressional committees with jurisdiction over Medicare policy have spent substantial time developing legislation that would repeal the flawed SGR formula and replace it with a new payment system that better incentivizes the delivery of high-quality, and efficient, healthcare. As an active participant in this process, the AAO-HNS has submitted six formal comment letters highlighting the possible impact of various proposals on otolaryngology-head and neck surgery and offering suggestions for improving the legislative proposals. The AAO-HNS continues to work closely with key committees while this important effort continues to evolve. Members interested in receiving updates should visit the Government Affairs website or follow the Government Affairs team on Twitter @AAOHNSGovtAffrs.

View our comments to the House Ways & Means and Senate Finance Committees. (11/12/13)

Click here to access information about additional recent efforts.
Accountable Care Organizations

Academy Comments on Application of Exclusivity Rules to ACOs
The Academy recently submitted comments to CMS outlining concerns with the manner in which the Agency was interpreting exclusivity requirements for providers participating in Accountable Care Organizations (ACOs). These comments were crafted in response to feedback from various practices and specialties that had experienced issues surrounding exclusivity when trying to participate in more than one ACO.

See the letter here


*NEW* Outpatient Bundle Payment Framework for Colonoscopy
As members know, the goal of the Ad Hoc Payment Model work group is to review current and future payment trends in otolaryngology-head and neck surgery and other specialties. This month, the American Gastroentorological Association released a colonoscopy bundle payment framework for their members to use when negotiating with their local entities. For more information on the AGA’s initiative, click here. The AGA also recently hosted a webinar on bundled payment. Click here to view the slides on colonoscopy bundles.

Ad Hoc Payment Model Workgroup Collaborates on Tonsillectomy Episode Bundle(11/13/13)
goal of the Ad Hoc Payment Model Workgroup is to provide information and education to members on episode bundling and efforts to collaborate with groups such as Health Care Incentives Improvement Institute, Inc. (HCI3), who are working on developing episode bundles for commercial payers and provider groups. These efforts aim to cut down on variability in cost, help address under and over use, and reduce cost of complications to help create a shared savings opportunity. Tonsillectomy has been selected as the first procedure that is being reviewed to learn about the process of developing an episode bundle. For more information on the episode bundle tools developed by HCI3, click here.

Academy Explores Alternative Payment Models in Vancouver (10/23/13)
The Academy encourages members to utilize our resources on innovative payment strategies, beyond the current fee-for-service (FFS) system, aimed at creating a more sustainable and stable future in the practice of otolaryngology. During the Annual Meeting, Dr. Robert Lorenz, MD, MBA, elaborated on the six steps for creating bundled payment. Click here to learn the six vital steps to creating bundles.

 Other Slides on Alternative Payment Models:

The Academy Explores Bundled Payment as Option for Future Payment for Otolaryngology 
The Academy is exploring options for future payment models, including otolaryngology procedures that could be considered as episode groupers that would be included in bundled payments. For more information on bundled payments click here.


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