November 13, 2018
CMS Finalizes Rules, 116th Congress Preview
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Health Care Set to be Major Issue as Congress Shifts Left

On November 6, Congressional Democrats took a majority in the House of Representatives for the first time since 2010. As we look ahead to the 116th Congress, we can predict that health care will be a major piece of Democrats’ legislative agenda just as it was on the campaign trail, while the Republican Senate and President Trump will be a limiting factor.

In the 115th Congress, Orthopaedics enjoyed many legislative victories including passage of licensure clarity for sports team doctors, repeal of the Independent Payment Advisory Board (IPAB)—which prevented major cuts to physicians, common-sense opioid legislation becoming law, funding for orthopaedic research, and more. The new Congress presents a unique challenge, as Orthopaedic voices will be more crucial than ever in educating less experienced legislators.

How the AAOS Office
of Government Relations
is working for you…

  • Succeeded in getting CMS to delay any changes to the evaluation and management (E/M) codes and prevented a collapse of payment levels 2 to 5 in its 2019 Medicare Physician Fee Schedule Final Rule.
  • Secured a separate payment method for non-opioid pain management treatments, as well as a method for equalizing payments between physician offices and off-campus provider-based departments in CMS’ 2019 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System’s Final Rule.
  • Strongly advised against a review of potentially misvalued current procedural terminology (CPT) codes— including 27130 (total hip arthroplasty) and 27447 (total knee arthroplasty)and expressed concern for the potential conflict of interest in the revaluation request.

For more information on all AAOS advocacy efforts, visit:
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OrthoPAC Midterm Recap

The 2018 Midterm Election was considered historic. Not only was it the most expensive midterm election to date, but midterm voter turnout hit a 50-year high. As the largest physician political action committee (PAC) in the nation, the Orthopaedic PAC was able to play in a large number of races, both helping our friends in the House and Senate and investing in candidates in the large number of open seats.

OrthoPAC Midterm Recap:

  • Supported 320 candidates and members
  • Had a win rate of 90 percent in the House
  • Had a win rate of 86 percent in the Senate
  • Supported 56 females
  • Invested in 20 doctors
  • Supported 44 minorities
2019 Medicare Physician Fee Schedule Final Rule Summary

On November 1, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that includes updates to payment policies for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after January 1, 2019. Below is a summary of the highlights, as well as a review of the AAOS response.

Streamlining Evaluation and Management Payment and Reducing Clinician Burden

For CYs 2019 and 2020, CMS is implementing several documentation policies to provide immediate burden reduction. These include elimination of the requirement to document the medical necessity of a home visit in lieu of an office visit. For established patient visits, when information is already in the medical record, practitioners may focus on what has changed since the last visit. Additionally, practitioners no longer need to re-enter information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. CMS also removed potentially duplicative requirements for notations in medical records that may have previously been included by other members of the medical team.

LAST CALL: 9th Annual Specialty Physician and Dentist Candidate Workshop

Registration is closing soon for AAOS’ 9th Annual Specialty Physician and Dentist Candidate Workshop in Washington, D.C., November 30-December 1, 2018. This two-day event will teach physicians how to run for elected office by pulling on the expertise of campaign, polling, media, and Political Action Committee (PAC) specialists.

2019 Hospital Outpatient Prospective Payment System Final Rule Summary

On November 2, the Centers for Medicare and Medicaid Services (CMS) issued its Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System 2019 Final Rule. Below is a summary of the highlights, as well as a review of the AAOS response.

Site Neutrality Expansion

CMS finalized its proposal to expand site-neutrality to previously exempt off-campus providers. This means it will apply an amount equal to the site-specific physician fee schedule (PFS) payment rate for nonexcepted items and services furnished by a nonexcepted off-campus provider-based department (PBD) for the clinic visit service. The AAOS supported this proposal and believes that all outpatient clinic visits should be paid similarly, regardless of whether the practice is hospital owned.

Participation Requested for Prior Authorization Survey

The Office of Government Relations continues to work with other national physician specialty organizations to reduce regulatory burdens so physicians can spend more time with patients. Prior authorization (PA) reform is a priority in achieving this goal, especially as health insurers continue to create significant barriers for patients to medically necessary care through their overuse of PA.

PA reform was highlighted in the 115th Congress with hearings in the relevant committees in both the House and Senate, as well as the introduction of the Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018, which would require Medicare’s electronic-prescription program to provide for the secure electronic transmittal of a prior authorization request from a Medicare enrollee’s prescribing health-care professional, with respect to a drug covered under the Medicare prescription drug benefit.

CMS Proposes Major Change to Medicare Part B Drug
Payment System

On October 25, the Centers for Medicare and Medicaid Services (CMS) published an Advanced Notice of Proposed Rulemaking (ANPR) for a new Medicare reimbursement model. Using the International Pricing Index (IPI), the model would lower costs for physician-administered drugs by resetting Medicare payments based on international prices. According to a recent HHS analysis, the U.S. spends 1.8 times more than our international counterpart on separately payable Part B drugs, and the new model is estimated to save American taxpayers $17.2 billion over the demonstration’s five-year period.

PAC Participation Leader Board by State

Click here, to view the interactive version of the map below, which features each state’s PAC support for 2018.


  • The American College of Radiology (ACR) released an online feedback tool for ACR Appropriateness Criteria. Submit your feedback here.
  • The American Joint Replacement Registry (AJRR)—the cornerstone of the AAOS Registry Program— released its 2018 Annual Report on hip and knee arthroplasty patient outcomes. Access the report here.
  • The AAOS launched a newly expanded Orthopaedic Video Theater (OVT) for members around the globe to share their knowledge with the orthopaedic community. Check out the new OVT at
  • The AAOS Office of Government Relations is now accepting applications for 2019 Resident Advocacy Fellows through November 15. Learn more here and send applications/questions to
  AAOS Orthopaedic PAC Online and Mobile Donations

Did you know? Supporting our Orthopaedic PAC by phone is easy: simply text AAOS to the number 41444, and follow the link, no log-in required. We encourage our supporters to share this technology with your colleagues who have yet to renew or join and to encourage signing up on a recurring basis. For just $84 a month, or $250 a quarter you can become part of our Capitol Club Program. And don’t forget! The Orthopaedic PAC website features an online contribution center, which can accept contributions via credit card by visiting the site and using your AAOS login credentials. Credit card contributions can also be conveniently scheduled for a monthly, quarterly or yearly recurring donation. Visit and select Donate to the Orthopaedic PAC for more information or to contribute today.

Don’t remember when you last contributed? Log in to the contribution center today to view your complete donation history!


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