The AAO-HNS has a long history of working closely with regulatory agencies (e.g., Centers for Medicare & Medicaid Services, U.S. Food and Drug Administration) to maintain our visibility and credibility with national representatives regarding federal regulatory issues.
We believe that advocacy is the key to defining the future of otolaryngology. Federal regulatory advocacy is a top priority of the AAO-HNS.
Superior Agrees to Change Allergy Policy (3/25/15)
The Academy is pleased to announce that Superior HealthPlan, the largest Medicaid carrier in Texas, has agreed to auto-credential all board certified and board eligible otolaryngologist–head and neck surgeons to perform allergy testing and immunotherapy services. The Academy extends a sincere thank you to all parties that helped make this accomplishment possible, including our physician leaders and colleagues with the American Academy of Otolaryngic Allergy (AAOA), the American Board of Otolaryngology (ABOto), and Superior HealthPlan.
CMS Responds to Medicare Advantage Sign-On (4/7/2015)
The Centers for Medicare and Medicaid Services (CMS) recently responded to the AMA's sign-on letter urging more accountability and adequacy with Medicare Advantage plans. CMS is currently in the process of addressing some concerns from the letter and has taken recommendations into consideration. View the CMS Response Letter.
Academy Signs on to Surgical Coalition Letter Urging Appointment of Surgeon to MEDPAC (3/17/2015)
Given that currently zero commission members are surgeons and several of the MedPAC member terms expire in April 2015, the Academy recently signed on to a Surgical Coalition letter requesting that a surgeon be appointed to Medicare Payment Advisory Commission (MedPAC) this year. View the letter here.
Academy Signs on to AMA ICD-10 Letter Urging Further Transparency (3/4/2015)
The Academy, along with several other organizations, signed onto an AMA letter urging CMS to publish further data on ICD-10 testing results, EHR vendor readiness, details on avoiding adverse impacts on quality measurement, risk mitigation plans and more. View the letter.
Academy Signs on to AMA Letter Urging Improvement of Network Adequacy for Medicare Advantage (2/12/2015)
The AAO-HNS along with several other organizations signed onto a letter urging CMS to require insurers to certify adequate Medicare Advantage networks with documentation, provide more accurate physician network directory information,and to provide written notification to patients when physicians are dropped from a network. The letter additionally requests CMS to review data on abrupt drops in physicians from Medicare Advantage Networks over the past 2 years and to recommend a new network adequacy formula for insurers. Read the letter here.
Academy Signs on to PARTNERS Coalition Letter Calling for Increased Regulation of Cigarettes (3/27/2014)
On March 27, the Academy signed onto a letter calling for FDA regulation of the design and composition of cigarettes, essentially in effort to reverse harmful effects created through the evolution of design and composition of cigarettes. View the letter here
Academy Urges CMS to Revisit Onerous 90-Day Grace Period Policy (3/13/2014)
Under the ACA, consumers who purchase certain health insurance plans are allowed a three-month grace period if they miss a monthly premium payment. During the last two months of this grace provision, insurers are allowed to pend and/or deny claims submitted during this time frame. In other words, insurers are able to unfairly shift the burden and risk of potential loss for patient non-payment to physicians by having physicians bear the cost of the services provided. In an effort to protect members from this onerous policy, the Academy joined an AMA letter urging CMS to require insurers to notify providers of a patient’s grace period status as part of the insurance eligibility verification process. The Academy will continue to call on CMS to revisit this policy and will keep members apprised of all pertinent information via eNews, HP Update and other outreach media. View the sign-on letter here
Academy Signs on to IDSA Initiative against Antibiotic Resistance (2/26/2014)
The AAO-HNSF signed on to a letter from the Infectious Disease Society of America (IDSA) supporting the CDC’s “Detect and Protect Against Antibiotic Resistance Initiative” that is included in the FY15 President’s Budget Request. View the letter.
*NEW* Health Policy Attends March MedPAC Meeting (3/8/2014)
As members know, MedPAC is the independent commission charged with annually reviewing Medicare payment policies and making recommendations to Congress based on its review and findings. The Commission just recently released its annual report to Congress for 2014, a summary of which will be available to members shortly. In addition to its annual report, Medpac held meetings on March 6 & 7 where Health Policy staff were in attendance. Discussion at the March meetings focused on topics such as: Next Steps in Measuring Quality Across Medicare’s Delivery Systems and Developing Payment Policy to Promote Use of Services Based on Clinical Evidence.To view a summary of the March meeting, click here.
Payer Advocacy: 3P/BOG SEGR Joint Efforts
To better assist members with state and regional payer issues, the Academy’s Physician Payment Policy (3P) Workgroup is collaborating with Board of Governors (BOG) Socioeconomic Grassroots Committee Representatives to regionalize outreach and advocacy efforts. The new regionalization model was implemented January 1, 2014 in an effort to ensure members are represented on multiple levels, including addressing national, state, and local reimbursement issues. The regionalization plan divides the country into ten regions following the division used by the Department of Health and Human Services (DHHS), so that a regional representative from each region is charged with keeping the BOG up-to-date on Socioeconomic and Grassroots issues affecting that area of the country. This will be done primarily through regional reports at the fall and spring BOG meetings, conference calls and direct communication with the BOG Executive Committee. This new structure also requires that the BOG SEGR Regional representatives and leaders have an ongoing dialogue with the Academy’s Physician Payment Policy Workgroup (3P) leaders, whose primary focus and charge is to address national socioeconomic issues impacting the membership. It is the Academy’s hope that this new model will improve the flow of information at the various levels, as well as utilize Academy support resources more efficiently and effectively to better serve our members.
Communication Flow Chart
For an overview of how the 3P / BOG SEGR collaboration will work, view the Communication Flow Chart. This chart outlines the socioeconomic issues that will be tackled by the BOG at the local level, or by 3P and the Health Policy team at the national level.
Health Policy E-Care Package
To streamline communication between the two groups, and to support the BOG transition to a regional representative structure for Socioeconomic and grassroots issues, the Academy Health Policy team prepared a socioeconomic e-care package, which can be accessed here. This document outlines the wealth of practice management resources the Academy provides to members on our website. Resources include information related to common member inquiries such as: requests for coding clarification related to changes to CPT codes, national reimbursement rates, payer denials, transitioning to ICD-10 and more. These materials are intended to support the BOG SEGR representatives in responding to member’s local and state inquiries, as well as to assist members in furthering their relationships with payers and state OTO and medical societies in their regions and states.
FDA Issues Proposed Rule Deeming All Tobacco Products Subject to FDA Oversight including E-Cigs and Cigars (6/12/2014)
The Food and Drug Administration has issued a proposed rule that would “deem” any product meeting the statutory definition of “tobacco products” (Products that meet the statutory definition of “tobacco products” can include currently marketed products such as certain dissolvables, gels, hookah tobacco, electronic cigarettes, cigars, and pipe tobacco) to be subject to FDA's tobacco product authorities under chapter IX of the Federal Food, Drug, and Cosmetic Act (the FD&C Act). There is a second option to the proposed rule where the FDA would deem only a subset of cigars (i.e., to exclude from the scope of this proposed rule certain cigars that they refer to as “premium cigars”) as subject to FDA regulation. Click here to view a summary of the rule.
Academy members are encouraged to individually comment by visiting the user friendly page created by the Campaign for Tobacco Free Kids.
Submit Your Comments: HITPC Needs Physician Input on Your Experience with the EHR MU Incentive Program! (5/20/2014)
Health IT Policy Committee’s (HITPC) Meaningful Use Workgroup is seeking PHYSICIAN feedback on physician experience with Electronic Health Records (EHR) Meaningful Use (MU) Incentive Program to help inform recommendations for Stage 3 MU. As you may know, HITPC is the federal advisory committee that makes recommendations to the Secretary of Health and Human Services regarding EHR MU. While HITPC made recommendations to CMS about Stage 3 requirements this past April, on which the Academy submitted comments, HITPC is now asking for additional feedback. Specifically, HITPC’s Meaningful Use Workgroup wants feedback from physicians that have been using EHRs with feedback focusing on Clinical Decision Support (CDS), Patient Engagement, Care Coordination, and Population Management. Take advantage of this opportunity to influence policy by submitting comments. To ensure your voice is heard, members are encouraged to submit concise comments that offer constructive criticism with possible solutions and incorporate specific examples, if relevant. Submit your comments today by clicking here!
If Members would like to view the Academy’s recent comments on HITPC’s recommendations for Stage 3 to help inform their comments / recommendations to HITPC’s Meaningful Use Workgroup, click here.
Advocacy Update on CMS' Proposed Exclusion of Coverage of Osseointegrated Implants (11/3/14)
On October 31, the Centers for Medicare & Medicaid Services (CMS) released its final rule addressing the 2015 Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) fee schedule. In the proposed version of this rule, CMS stated that the Medicare reimbursement exclusion for hearing aids would encompass all types of air conduction and bone conduction auditory prosthetics (external, internal, or implanted). After carefully reviewing comments and concerns from various groups including the Academy, CMS clarifies in its final rule that the statutory Medicare hearing aid coverage exclusion will not include certain auditory implants, including cochlear implants, brain stem implants, and osseointegrated implants. Therefore, CMS will be modifying § 411.15 in the final rule to reflect that Auditory Osseointegrated Implants (AOIs) will continue to be covered under Medicare and are outside the scope of the hearing aid coverage exclusion.
The Academy’s repeated advocacy was critical to helping CMS reach this conclusion. The Academy applauds this as a decision which will only yield a higher quality of care for the hearing health community! In addition, the Academy extends a warm thank you to all of the committee members and physician leaders involved in efforts to achieve this positive outcome!
While CMS will continue to exclude coverage non-osseointegrated devices (such as non-osseointegrated bone conduction hearing aids), CMS acknowledges the important technological advances that are occurring and leaves the door open for future consideration.
CMS published a proposed rule in July focusing on the 2015 Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) fee schedule. Notably, part of the proposed rule specified that the Medicare reimbursement exclusion for hearing aids would encompass all types of air conduction and bone conduction auditory prosthetics (external, internal, or implanted). The rule essentially proposed to negate CMS' current coverage of osseointegrated implants. To view the proposed rule, click here.
In response to the proposed rule, Academy leadership and health policy staff advocated on multiple levels and engaged Academy committees, otolaryngology specialty societies, and other leaders among our membership (within Otology/Neurotology as well as health policy and government affairs) to craft comments that best represented our members and patients. More specifically, Academy leadership and staff conferenced individually and collectively with members and chairs of the Hearing and Implantable Hearing Devices Committees to gather specific examples and feedback on how the proposed rule, if enacted, would negatively impact thousands of patients who have no other recourse to better hearing. Further, the Academy participated in three direct meetings with CMS, various audiology and public interest group conferences, and meetings with presidents of the American Neurotology Society (ANS) and American Otological Society (AOS). All of these efforts were directed at raising awareness of the significant potential impact of this proposed rule and garnering support in defense of our position.
On September 2, 2014, the Academy, AOS, and ANS submitted a formal joint comment letter to CMS noting concerns about the proposal and providing a suggested alternative to the proposed rule that would allow for continued coverage of osseointegrated implants for Medicare patients. In addition, on September 3 the Academy met with Patrick Conway, MD, CMS Chief Medical Officer, Director, Center for Clinical Standards and Quality (CCSQ) and noted that our focus is on the patient and that as otolaryngologists, we are stewards of the patient’s health with the disagreement to the proposed change based on patient needs and outcomes, not personal or professional gain or concerns. We noted that while the comment letter is more focused on osseointegrated rather than non-osseintegrated bone conduction prostheses, there is a need for both. The focus on osseointegration does not mean that other types of prostheses should be excluded from coverage, just that they should be covered only when offered to patients with hearing loss due to medical/surgical conditions who cannot otherwise benefit from conventional hearing aids. The meeting went well with Dr. Conway asking Dr. Nielsen many specific questions related to our comments.
Subsequently, on October 31, CMS released its final rule and after careful consideration of comments received from various groups including the Academy, CMS clarified its definition of “hearing aid.” CMS will be revising its original proposal in the final rule to reflect that Auditory Osseointegrated Implants (AOIs) will continue to be covered by Medicare and are outside the scope of the hearing aid coverage exclusion.
Academy Comments on CY 2015 Medicare Physician Fee Schedule Proposed Rule (9/2/2014)
In July CMS released the proposed 2015 Medicare Physician Fee Schedule (MPFS) proposed rule. In its 2015 MPFS Proposed Rule, CMS proposed a new more transparent process for establishing PFS payment rates that will allow for more public input prior to finalizing rates. Under the new process, payment changes will go through notice and comment rulemaking before being adopted beginning for 2016. In addition, CMS is proposing changes to several quality reporting initiatives, changes to the Physician Compare Website and to continue phasing in of the Value Based Payment Modifier. Notably, CMS are also proposing to transform all 10- and 90-day global codes to 0-day global codes beginning in CY 2017, proposing to add roughly 80 codes to its list of potentially misvalued codes, and proposing adjustments to malpractice RVUs among other initiatives.
The Academy has reviewed and summarized the rule as a member benefit and has submitted formal comments on the rule by the September 2nd deadline. Click here to view the comment letter.