CMS Releases 2014 Medicare Physician Fee Schedule Final Rule

Matthew J. Twetten

On Wednesday, November 27, 2013, the Centers for Medicare and Medicaid Services (CMS) released the 2014 Medicare Physician Fee Schedule final rule. In addition to covering rules and regulations proposed for implementation in calendar year 2014, the rule includes Relative Value Units (RVU) for every procedure with a code in the current fee schedule. Every year, CMS makes changes to the RVUs for procedures, including orthopaedic procedures, within the fee schedule.

The Evolution of DRGs

Brandon D. Bushnell, MD

This year (2013) marks the 30th anniversary of the introduction of the concept of diagnosis-related groups (DRG) into the national healthcare financial lexicon. First popularized by Yale University colleagues R. B. Fetter, MD, and J.D. Thompson, MD, DRGs are an application of industrial management theory in health care.

Quality Efforts Help Advance Advocacy Agenda

Elizabeth Fassbender

Healthcare reform, as it is being implemented under the Affordable Care Act, raises questions about who defines quality outcomes and who sets performance measures for orthopaedics. New payment models call for incorporating quality and value measures, but what and how meaningful these measures might be are unknowns.

Second Look—Advocacy

SGR repeal draft released The Senate Finance and the House Ways and Means Committees have released draft legislation that would repeal Medicare’s sustainable growth rate (SGR) formula, freeze physician payment levels through 2023, and create a performance-based incentive program in 2017. The incentive program would assess eligible professionals’ performance in quality, resource use, clinical practice improvement activities, and electronic health records’ meaningful use.

WHPF Call For Applications

Elizabeth Fassbender

The Washington Health Policy Fellowship (WHPF) program seeks to foster the development of orthopaedic surgeons interested in health policy and advocacy. Applications for the 2014–2015 program will be accepted through Jan. 15, 2014. This program offers orthopaedic residents the opportunity to gain a greater understanding of the health policy process and to contribute to the development of new policies and programs during a 12-month period.

Health Insurance Exchanges: What They Mean to You

John Froelich, MD; Roshan Shah, MD, JD; the Washington Health Policy Fellows

To continue to fully serve their patients, orthopaedic surgeons must determine how to successfully implement the provisions of the Affordable Care Act (ACA) into their practices. A key component of the ACA is the establishment of a marketplace or “exchange” that will be available for all citizens to purchase individual, family, or small business health insurance policies.