June 19, 2018 | Net Health

3 min read

Bipartisan Budget Act 2018: What Changes Affect Wound Care?

The signing of the Bipartisan Budget Act of 2018 ended the United States’ governmental shutdown on February 9th. Most of the resolution’s focus was around the spending limits for national defense and lifting the national debt ceiling. There were certain less-publicized elements that directly affected the wound care industry. Wound Care professionals in various care models including outpatient provider-based departments saw a lot of benefit from the Bipartisan Budget Act.

Let’s look at some of the changes that specifically affected hospitals and wound care departments:

The Removal of ‘Direct Supervision’ in Critical Access Provider-based Departments (PBD)

    • Direct physician supervision in critical access hospitals began on Jan. 1, 2017, after the Centers for Medicare & Medicaid Services (CMS) declared it was going to start enforcing direct supervision in Critical Access Hospitals in 2014. Congress prevented CMS from enforcing its direct supervision requirements between 2014 and 2017 but allowed for it to begin in 2017. Many critical access hospitals didn’t have the staff resources to place physicians and/or other qualified healthcare professionals at the immediate care of patients in provider-based departments. This caused PBDs to operate without the appropriate direct supervision causing the potential for a non-compliant audit or repayment situation. After more deliberation, CMS suspended the enforcement of direct supervision in critical access hospitals for both 2018 and 2019, but not 2017. The Bipartisan Budget Act rectified this by suspending enforcement of direct supervision for critical access hospitals provider-based departments, including outpatient wound care. Thus, protecting critical access hospitals without the appropriate direct supervision in 2017 from non-compliance audits and repayments.

Cost Performance’ Category Weight Fixed in MIPS

    • Due to a lack of cost quality measures, the “cost performance” category in physicians’ Merit-Based Incentive Payment System (MIPs) was not included in the first year. The “cost performance” category was originally supposed to be phased in over the course of 3 years. It was also meant to be given the measurement weight of 10% in the first year, 15% in the second year, and 30% in the third. Although, because it was one year late in starting, CMS adjusted its weight to start at 10% in 2018 and 30% in 2019. The Bipartisan Budget Act corrected this huge 20% leap by pushing the timeline for implementation of the 30% weighting to 2023.

Geographic Practice Cost Index (GPCI) Floor Extended Through 2019

    • The GPCI is used by Medicare to aptly adjust allowable physician payment rates according to their geographic areas. Congress established a “floor” to prevent physician payments from dropping if the relative cost of physician work dropped below the national average in a certain area. The floor was scheduled to expire on Dec. 31st, 2017 for all 52 states. The Bipartisan Budget Act extended the GPCI floor through 2019.

Expanded Telehealth Services Provided by ACOs

    • Telehealth services aren’t all covered by Medicare. The highest quality care for the lowest dollar amount is a goal widely sought in healthcare and specifically targetted by accountable care organizations (ACOs). Telehealth fits well into the perimeters of this care model. Sadly, Medicare location restrictions do not allow patients to receive telehealth services within their homes and has prevented ACOs from using telehealth as a healthcare option. The Bipartisan Budget Act saw that beneficiaries assigned to ACOs are allowed telehealth services in their homes.

Permanent Repeal of Caps on Outpatient Therapy Services

    • In 1997, the Balanced Budget Act placed annual caps on physical therapy, speech-language pathology services, and occupational therapy. In some cases, therapy caps prevented patients from getting the medically necessary therapy services. After a 5 year suspension by Congress during 2000-2005, Therapy caps were reinstated in 2006. When the caps were reinstated in 2006, they included an exception process allowing additional provider-certified medically necessary therapy services. This process was authorized by Congress annually through Dec. 31st, 2017. The Bipartisan Budget Act permanently repealed therapy caps.

Want to read more about the Bipartisan Budget Act? Find it online here. 


Schaum, Kathleen D. “Wound Care Nets Reimbursement ‘Wins’ With Bipartisan Budget Act.” Today’s Wound Clinic, vol. 12, no. 5, May 2018, pp. 22–25.
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