Becker's Spine Review

15 Population Health CMS Proposes ASC Policy, Payment Changes for 2016: 8 Things to Know By Carrie Pallardy C MS has released its proposed policy and payment changes rule for the CY 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. Here are eight things to know about the OPPS/ASC proposed changes. 1. CMS proposes to update OPPS rates by -0.1 percent, based on a hospital market basket increase of 2.7 percent with a -0.6 percent adjustment for multi-factor productivity and a -0.2 percent point adjustment requirement by law. ere is an additional -2 percent point adjustment aimed at address- ing inflation in OPPS payment. Considering all policy changes, CMS esti- mates a -0.2 percent adjustment for hospitals paid under OPPS in CY 2016, according to the report. 2. CMS also proposes restructuring, reorganizing and consolidating many OPPS Ambulatory Payment Classification groups. e proposal would re- sult in fewer APCs for nine clinical APC families. 3. ere are nine new Comprehensive Ambulatory Payment Classifications proposed for CY 2016. ere are currently 25 C-APCs. 4. ASC payments are updated on an annual basis based on the Consumer Price Index for all urban consumers. For CY 2016, CMS proposes a 1.7 per- cent CPI-U update. With a multi-factor productivity adjustment of 0.6 per- cent, the update is expected to be 1.1 percent. 5. CMS is proposing the removal of radiation treatment using Co-60 stereo- tactic radiosurgery from the list of ASC-covered ancillary services. 6. CMS did not propose any new measures for the ASC Quality Reporting Program. e CY 2018 ASCQR Program includes 12 measures; 11 required and one voluntary. 7. ough CMS did not propose any new ASCQR Program measures, the agency did request comment on two measures for future consideration: Normothermia Outcome and Unplanned Anterior Vitrectomy. 8. CMS is accepting comments on the proposed rule until Aug. 31. e final rule is expected to be issued on or around Nov. 1. n Neurosurgeon Named in Counterfeit Spinal Implant Lawsuit — 5 Things to Know By Laura Dyrda F ormer neurosurgeon Cully White, MD, is at the center of a whistle-blower lawsuit involving kickbacks and counterfeit implants, according to a Milwaukee Journal Sentinel report. Here are five things to know: 1. e lawsuit alleges Dr. White received kickbacks for implant- ing "counterfeit" parts in patients manufactured by Spinal So- lutions, a California-based company now considered defunct. 2. Six months ago, Dr. White completed a federal prison sentence aer pleading guilty to healthcare fraud in 2013. He served six months in a federal prison camp and then spent six months under house arrest. 3. This new whistle-blower suit also names Aurora St. Luke's Medical Center and Wheaton Franciscan Healthcare's St. Francis Hospital, where Dr. White performed procedures. The suit alleges the hospitals didn't vet Dr. White or the im- plant supplier properly. 4. Fifty insurance companies filed the suit while making simi- lar allegations against physicians and hospitals nationwide alleging "a massive healthcare fraud scheme and conspira- cy" charging patients and insurance companies for counter- feit implants. 5. Dr. White relinquished his medical license as part of a plea deal; before then, he had performed around 600 surgeries per year. n Payment models e move toward population health, coordinated care and risk-based payment models will have an impact on specialists in the future. Primary care physicians are already going at-risk for their pa- tient outcomes at a higher rate than ever before, and they share payments with their specialists. "If primary care physicians are sharing their mon- ey with a spine surgeon, he's picking the high vol- ume spine surgeon who has good outcomes and not a lot of waste," says Dr. Nash. e primary care physicians will look for surgeons who can control pain well and have high patient satisfaction, be- cause the patient's surgical experience will impact the final payment overall. ere will be transpar- ency in outcomes not only between the physicians, but also with payers and hospitals. Ultimately, much of this data will be published online and other media outlets. "If you're going to be naked, you better be buff," says Dr. Nash. "If there's no outcome, there's no income; no measurable, good coordinated care, reduced readmissions, no payment or low pay- ment." Dr. Nash suggests spine surgeons focus on these areas to prepare for population health: 1. Practice based on the best available evidence. 2. Reduce unexplained clinical variation among specialists in the practice. 3. Reduce slavish adherence to professional autonomy. 4. Continuously measure and close the feed- back loop. 5. Engage patients across the continuum. n

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