It’s that fun time of even-numbered years again when events in Washington bog down with the impending congressional summer recess and the November elections hanging over the heads of nearly everyone in Congress. Despite that Damoclean discomfort, shouldn’t we be rewarded with a regular set of spending bills?
As best as I can tell, Congress had passed no spending bills for fiscal 2015 on or about July 10, which means we’re almost certainly headed for another series of CRs, or continuing resolutions. The fate of H.R. 4800, the bill that would fund FDA, seems to be that of a paperweight made of – you guessed it – paper. How deliciously ironic.
As matters currently stand, Congress and President Obama are hard at work on a supplemental appropriation for the child migrant predicament. Thankfully the Ryan-Murray budget deal from December of last year puts the sequester on hold for the upcoming fiscal year. Otherwise, device makers would be watching a large amount of user fees going down the nation’s fiscal rabbit hole again.
Alphabet soup; OPPS floats to the surface
If you’re into a mind-bending level of detail, just read through the Medicare outpatient prospective payment system proposal (try saying that three times fast) for calendar year 2015. Not only is it called OPPS by insiders, it talks a lot about CPT and HCPCS (pronounced hick-picks if you’re among the coverage/reimbursement cognoscenti) codes and lots of fun things like that.
CMS posted this and the physician fee proposal July 3 in a vain attempt to ruin everyone’s Fourth of July weekend, but anyone in the cardiology business might want to read through this riveting 600-plus page document. The agency indicated it would like to compress six comprehensive ambulatory payment classification codes (C-APCs) for vascular procedures into three.
Among these are C-APCs 0082 and 0083, which deal with clogged coronary and non-coronary arteries. 0082 is the code for cleaning out the affected artery whereas 0083 applies to angioplasty and valvuloplasty. CMS floated a similar proposal for some electrophysiology codes, squishing another six codes into three, rendering four codes total for levels I through IV for defibrillators, pacemakers and “related devices.”
I won’t pretend to know enough about how this would work in practice to predict whether these proposals would create more headaches than they’d solve, but hospital administrators might think it’s a good thing any time you can reduce the number of codes.
Pronouncing “MPFS” without hurting yourself
What struck me about the Medicare physician fee schedule proposal (MPFS) for calendar 2015 was a discussion about 10- and 90-day global codes for surgical procedures. CMS spent a lot of time explaining the problems with the current set-up, including that the framework was established a couple of decades ago, and OIG has published two reports highlighting the difficulties with these “global” issues. So why tackle it now?
This might be the reason. The continued existence of these codes in their present form may “present obstacles to the adoption of new payment models,” the proposal said.
Not to make too fine a point of it, but the agency might have done the reader a favor and just said up front, “the current set-up stinks and we want to do more bundled payments.” That would have saved me a lot of time.
And while we’re at it … enough already with “next-generation” DNA sequencing. Why is it that every generation of sequencing technology is the next generation? What happened to the current generation?
One supposes I could just be grateful they’re not claiming their technology is “disruptive” anymore.