Advocacy Update

Aug. 10, 2017: National Advocacy Update


The U.S. Senate recessed Aug. 3, joining the House of Representative in a month-long summer break. While the Senate will hold pro-forma sessions throughout the month of August, no legislative business will be conducted by either chamber until the week of Sept. 4. When they return, Congress will have its plate full with many must-pass items as well as lingering questions over the future of the Affordable Care Act (ACA).

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While efforts s to repeal significant portions of the ACA through the reconciliation process stalled, work remains to be done to stabilize the non-group health insurance market. Prior to recess, Sen. Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions, announced that his committee would hold hearings the week Congress returns on necessary steps. These include ensuring payment of the ACA cost-sharing reductions (CSRs) and, potentially, reinsurance for plans participating the ACA exchanges. Other conversations have also begun on bipartisan efforts to address problems with the ACA, including by a group of a dozen senators of both parties—the bipartisan House Problem Solvers Caucus—and other groups of moderates from both sides of the aisle.

When they do return, Congress members will face a long list of initiatives that must be passed before the end of September, including raising the debt ceiling, passing a budget and providing appropriations for the 2018 fiscal year that begins Oct. 1. Action must also be taken on dozens of programs that expire at the end of September, including the Children's Health Insurance Program (CHIP) and numerous Medicare and public-health provisions. Beyond health care, action will also be required to extend the authorizations for the Federal Aviation Administration and the national flood insurance program. Making matters even more challenging, the House is only scheduled to be in session for 12 days during September, and the Senate for 17 days.

In the 2018 Inpatient Prospective Payment System (IPPS) rule, Medicare finalized its proposal to remove a trio of pain-management questions from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). The AMA supported the removal of these questions as they became increasingly controversial due to concerns that they may inappropriately incentivize hospital-based providers to overprescribe paid medication, thereby fueling the opioid epidemic.

The Centers for Medicare and Medicaid Services (CMS) finalized its proposal to replace the old questions with three new HCAHPS questions (Communication about Pain composite measure) that shift the focus away from the methods of pain management toward the frequency and quality of communications between providers and patients. The AMA supports CMS' decision to finalize a delay of public reporting of the revised Communication about Pain composite measure on the HospitalCompare website until October 2020. That will allow hospitals to familiarize themselves with the new questions. The AMA will also continue urging the administration to remove pain-management questions from HCAHPS, given concerns about the appropriateness of including them in a patient-experience survey that is used for accountability.

Also in the 2018 IPPS proposed rule, CMS proposed to require accrediting organizations to post survey reports and plans of corrections from CMS-approved accreditation programs on their public-facing websites.

The AMA expressed concerns that accreditation survey data may be overwhelming for consumers, is unlikely to lead to better health care decisions and could increase the regulatory burden on physicians and health care facilities. In the final IPPS rule issued Aug. 2, CMS decided to withdraw this proposal after consideration of the comments it received, including those from AMA.