In the News: July 13–19

Sg2 is dedicated to helping our clients interpret the latest news and trends in health care. Below you’ll find our analysis of this week’s key industry headlines, along with links to related Sg2 resources.

GOP ACA Repeal and Replace Bill Falters in Senate

Following statements by Senators Mike Lee (R-Utah) and Jerry Moran (R-Kansas) on Monday night, Senate Majority Leader Mitch McConnell (R-Kentucky) stated that “…it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful.” These statements follow a series of amendments to the Better Care Reconciliation Act (BCRA), the Senate Republican plan to repeal and replace the Patient Protection and Affordable Care Act (ACA).

This is the latest major development in the twists and turns of GOP efforts to repeal and replace the ACA. As the policy landscape continues to evolve, Sg2 is excited to offer an interactive way for members to get their health care policy questions answered. Register now for the upcoming Experts Live: Q&A With Sg2’s Health Care Policy Team on August 3 for an open dialogue as we explore the latest on the health care policy front.

CMS Proposes Removal of TKA from Inpatient-Only List

On July 13, CMS filed the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule for CY 2018. Following last year’s request for public comment in the OPPS/ASC Proposed Rule for CY 2017, CMS is recommending the removal of total knee arthroplasty (TKA) from its inpatient-only list. Echoing this process, CMS has requested public comment on the suggested removal of partial and total hip arthroplasty in the CY 2018 Proposed Rule.

Sg2 has projected the impending outpatient shift of total joint replacement for years. Check out the Sg2 FAQ: Preparing for Outpatient Joint Replacement to review the latest trends in outpatient hip and knee joint replacement and identify the steps that orthopedic service line leaders should take to prepare for this site of care shift.

CMS Proposes 75% Reduction in Payments for HOPDs

On July 13, CMS filed the Medicare Physician Fee Schedule (MPFS) Proposed Rule for CY 2018. Among the proposed changes, CMS recommends a further reduction (from 50% in CY 2017 to 75% in CY 2018) in Outpatient Prospective Payment System (OPPS) payment rates for off-campus hospital outpatient departments (HOPDs) that are affected by site-neutral payment provisions outlined under Section 603 of the Bipartisan Budget Act of 2015.

Since January 1, 2017, some HOPDs have been receiving lower facility rates for certain services. For CY 2017, CMS finalized that they will continue to pay all HOPDs through the OPPS but will reduce their facility payment. For a recap of site-neutral payment provisions from the Bipartisan Budget Act of 2015, see the Sg2 on-demand webinar: 2016 Health Care Policy Year in Review. The relevant section starts from minute 27:30 to 31:25 and covers slides 13 to 14.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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