AAOS Leaders Meet with Congress, Opioid Epidemic Efforts Continue, and More

On October 3-4, the AAOS Council on Advocacy met in Washington, DC to discuss the legislative and regulatory agendas and urge Congress to take action on issues important to orthopaedics. The Council heard updates on policy issues including the Stark law, physician-owned hospitals, regulatory relief, and orthopaedic research funding. Members also discussed several recent proposed rules and comment letters submitted by AAOS. On Capitol Hill, the Council on Advocacy met with several members of Congress on relevant committees and in key positions to talk about certain improvements that should be made to MACRA and other quality payment programs, the Peer Reviewed Orthopaedic Research Program (PRORP), the Sports Medicine Licensure Clarity Act, and measures that Congress can take to help curb the opioid epidemic.

The AAOS Office of Government Relations has established a new Advocacy Fellows Program for residents and encourages you to apply or consider sharing this opportunity with residents in your network! Applications are now being accepted for 2018. The goal is to encourage the participation of orthopaedic residents in the national health policy arena. The program seeks to foster the development of orthopaedic surgeons interested in health policy and advocacy who are willing to become key members of the AAOS advocacy team. It offers orthopaedic residents the opportunity to gain a greater understanding of the health policy process and contribute to the development of new policies and programs. Dr. Stuart Weinstein, former Chairman of the AAOS Political Action Committee, is directing the program.

Two fellows will be selected for the calendar year 2018. The deadline for applications is November 15.  A full description and application instructions can be found online here. For more information contact OGR Senior Manager of Government Relations Julie Williams at jwilliams@aaos.org.

The devastating hurricanes, most recently in Puerto Rico, have prompted many of you to ask, “How can I help?”

Last month, Hurricane Maria made direct landfall on Puerto Rico and the U.S Virgin Islands, leaving millions of U.S. citizens in desperate need of immediate and substantial assistance. The hurricane came just two weeks after Hurricane Irma hit parts of the islands and caused extended damage in Florida. Hurricane Harvey also devastated parts of Texas after record rain and continued flooding. In some areas, the road to recovery for the impacted communities will take years. In particular, Puerto Rico is in the midst of what local officials have described as a full-blown humanitarian crisis, with devastation they say is “apocalyptic.” Over three million Americans are without power or electricity, running water, and most communication or cell services. Many have lost their homes. The repercussions will be ongoing.

Department of Health and Human Services (HHS) Deputy Secretary Eric Hargan will serve as the agency’s acting secretary, stepping into the position of Tom Price, MD after Price stepped down on September 29. Hargan was confirmed as deputy secretary by the Senate on a 57-38 vote earlier last month.

“Eric Hargan brings a wealth of knowledge, expertise and leadership experience to HHS,” said Don Wright, who had been serving as acting secretary since Price’s departure. “His commitment to public service and vast experience in the health care field will help guide the department as we advance President Trump’s agenda on behalf of the American people. We look forward to working with deputy secretary Hargan to enhance and protect the health and well-being of all Americans.”

On Thursday, October 5, Senator Lamar Alexander, Chairman of the Senate Committee on Health, Education, Labor, and Pensions, convened a hearing to examine how well the federal government has responded to the mounting opioid epidemic. Committee members discussed legislation that addresses prevention and treatment of the opioid crisis, including the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act (CARA), both of which include provisions intended to reduce the impact of opioid use disorders.

Chairman Alexander pointed to a study in March, which revealed that 1/5 patients who were prescribed an initial 10-day supply of opioids were found to still be using opioids a year later. He stressed the importance of a bipartisan approach to the crisis, as well as the need for public-private partnerships and state integration of drug monitor programs. Ranking Member Patty Murray raised concern for budget cuts proposed by the current administration, as well as the treatment of addiction as a criminal justice issue. In her opening statement, she warned against complacency with existing legislation alone, saying that “as we work to build upon our work in CARA and Cures, it’s absolutely critical that we put investments into ensuring these policies have the impact that families and communities need.”

The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen, LLC, convened Clinical Subcommittees to develop eight episode-based cost measures for potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program. The AAOS had representation on the Musculoskeletal Clinical Subcommittee, which developed the Knee Arthroplasty measure.

Acumen will be conducting field testing for the 8 measures under consideration and is giving the public the opportunity the comment on the measures, the field testing process, and reporting methods. Given that AAOS were a part of the development process, there may be little comment necessary on the Knee Arthroplasty measure itself. However, the field test will take place from Oct 16th through November 15th for all providers who performed 10 or more arthroplasties between 6/1/16 and 5/31/17. During the testing period, providers being tested will be able to access their own confidential data, but anyone may view a mock report on which to comment.

AAOS continues to collaboratively work to address the crisis in the treatment of osteoporosis and to reduce the variation in fragility fracture care.

Most recently, AAOS supported comments to the American Society for Bone and Mineral Research (ASBMR) and the Center for Medical Technology Policy (CMTP), an independent non-profit dedicated to evidence-based policy, on their Draft Strategic Roadmap to Prevent Secondary Fractures. The roadmap focuses on people at or over the age of 50 years who have suffered a hip or vertebral fracture that comes to clinical attention because they are at extremely high risk of another fracture, yet a majority of them do not receive recommended treatments following their fracture. As a result, this group remains at high risk of second fractures despite the availability of interventions that are known to reduce this risk. Through the Fragility Fracture Work Group, which consists of representatives from the AAOS, American Orthopaedic Association (AOA), the Orthopaedic Trauma Association (OTA), and the International Geriatric Fracture Society (IGFS), input on the draft roadmap was submitted.

Senate Dem Introduces Bill to Repeal Controversial Opioid Law, The Hill, 10/16/17

Major Health Insurers Anticipated End of Subsidies, The Wall Street Journal, 10/13/17

18 States Sue Over Trump-Halted Obamacare Payments, The Hill, 10/13/17

Trump Opposes Bipartisan Obamacare Rescue Plan, Politico, 10/13/17

VA Vows Changes on Bad Health Care Providers, Lawmakers Take Action, USA Today, 10/12/16

Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again, The New York Times, 10/12/17

In Start to Unwinding the Health Law, Trump to Ease Insurance Rules, The Wall Street Journal, 10/11/17

Physicians Feel Sidelined in Value-Based Care Discussion, Fierce Healthcare, 10/11/17

Trump Names Hargan as Acting Health and Human Services Secretary, Bloomberg, 10/10/17

Trump Executive Order Could Divide the Health Insurance Market, The Wall Street Journal, 10/8/17

Bundled-Payment Joint Replacement Programs Winning Over Surgeons, Modern Healthcare, 10/7/17

Senate Committee Advances Children’s Health Care Bill, Roll Call, 10/4/17

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, and the Centers for Medicare & Medicaid Services (CMS) then replaced it with the Quality Payment Program. Remember – the Quality Payment Program has two tracks you can choose: Advanced Alternative Payment Models (APMs) OR the Merit-based Incentive Payment System (MIPS). AAOS has shared the details of QPP and MIPS, which can be found on our website, here: www.aaos.org/MACRA_QualityPaymentProgram/ and here: www.aaos.org/MACRA-DeliveryReform/.

CMS has announced the availability of an interactive look-up tool through which 2017 Advanced Advanced Alternative Payment Model (APM) participants can look up their qualifying participant (QP) status based on calculations from claims with dates of service between Jan. 1, 2017 and March 31, 2017. Under the Quality Payment Program, eligible clinicians who meet certain criteria are considered QPs in Advanced APMs, and are therefore excluded from the Merit-based Incentive Payment System (MIPS) quality reporting program. QPs identified based on the 2017 performance year will receive a 5 percent, lump sum Medicare incentive payment in 2019. CMS states that the online tool will be updated soon with calculations from claims with dates of services between Jan. 1, 2017 and June 30, 2017. Access the tool online here.

Learn more about how QP status is determined (PDF) here.

Click here, to view the interactive version of the map below, which features each state’s PAC support for 2017.