February 5, 2019
Drug Pricing, New Part D model
For questions or concerns on these or other advocacy issues, contact us at dc@aaos.org.
House, Senate Panels Begin Hearings to Lower Drug Prices

A series of drug price hearings began Jan. 29 before the Senate Finance and the House Oversight and Reform committees. They featured academics and patient advocates, as lawmakers in both chambers investigate why drug prices are high and what Congress can do about it.

Senate Finance Committee Chairman Chuck Grassley (R-IA) said the issue is first-priority for the committee, and he wants to focus on transparency and accountability-related measures—such as including drug prices in advertisements. He also stated his support for some specific measures, including Medicaid generic drug classification reforms.

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

  • Secured additional guidance from the Centers for Medicare and Medicaid Services to help resolve confusion surrounding the removal of total knee arthroplasty from the Medicare inpatient-only list.
  • Celebrated the Orthopaedic PAC’s upcoming 20th birthday and all that it has accomplished in the last two decades fighting for the entire house of orthopaedics.
  • Commended the Department of Health and Human Services for its draft strategy to reduce regulatory and administrative burden relating to the use of health information technology and electronic health records.

For more information on all AAOS advocacy efforts, visit: http://www.aaos.org/dc.
Follow the AAOS Office of Government Relations on Twitter: www.twitter.com/AAOSAdvocacy.

CMS Attempts to Resolve Confusion in TKA Removal from IPO

On January 8, the Centers for Medicare and Medicaid Services (CMS) issued an unprecedented guidance (MLN Matters Number: SE19002) to help resolve confusion surrounding the removal of Total Knee Arthroplasty (TKA) from the Medicare inpatient-only (IPO) List. The policy change was made in the 2018 Medicare Outpatient Prospective Payment System (OPPS) Final Rule and allows payment of the procedure in either the hospital inpatient or outpatient setting. Unfortunately, there has been widespread confusion about how to interpret the policy change among payors, hospitals and physicians and the new guidance aims to clarify CMS’ intent.

When the procedure was removed effective January 1, 2018, CMS was explicit in stating, “Removal of the TKA procedure from the IPO list does not require the procedure to be performed only on an outpatient basis.” Many hospitals and Medicare Advantage plans, however, misinterpreted the policy and have been directing the site-of-service decision over the operating surgeon’s discretion.

OrthoPAC Celebrates 20th Birthday

Happy early birthday to the Orthopaedic PAC! On February 6, we will be celebrating its 20th birthday and all it has accomplished over the last two decades fighting for the entire house of orthopaedics. Just this past election cycle, OrthoPAC worked to repeal the Independent Payment Advisory Board (IPAB) and pass the AAOS-led Sports Medicine Licensure Clarity Act into law. We hope you will help us ring in this special day by participating in our 20 for 20 Program. Give a birthday gift of $20, $200, or even $2,000 by texting birthday20 to 41444.

AAOS Responds to HHS Strategy to Reduce EHR Burden

On November 28, 2018, the Department of Health and Human Services (HHS) issued a Draft Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs, as required by section 4001 of the 21st Century Cures Act. The requirement stipulated that HHS articulate a plan of action to reduce regulatory and administrative burden relating to the use of electronic health records (EHRs).

AAOS appreciates Congress’ recognition of this problem. A 2016 study found that for every hour of direct clinical time with patients, physicians spent two additional hours on EHR and desk work, and an additional one to two hours of after-hours personal time completing documentation and EHR tasks. Reducing EHR burden will allow doctors to spend more time with their patients and ultimately improve outcomes.

Support for ‘Medicare-for-All’ Fluctuates with Details

A recent Kaiser Family Foundation poll found that, although 56 percent of Americans initially say they support “Medicare-for-all,” support plunged to 26 percent and 37 percent after they are told that a government-run system could lead to delays in getting care or higher taxes. Several independent studies have estimated that government spending on health care would increase dramatically under the plan, in the range of about $25 trillion to $35 trillion or more over 10 years.

To pay for “Medicare-for-All,” Senator Bernie Sanders (I-VT) has called for a new 2.2 percent income tax, a 6.2 percent tax on employers, and increased taxes on higher income earners. Payments to hospitals and doctors may be cut as much as 40 percent, as they would be paid at Medicare rates. The likely cuts to provider rates could present serious challenges for private hospitals and physician practices operating on tight margins which are reliant on patients with private health care. Additionally, the plan would likely reduce patient choice, reduce benefits, and could lead to rationing of care. It could also be more political, and bureaucrats would interfere with the doctor-patient relationship.

CMS Announces New Part D Model to Lower Drug Prices

On January 18, the Centers for Medicare and Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) announced its plan to initiate a new payment model aimed at reducing Medicare Part D prescription drug spending and beneficiary out-of-pocket costs.

Under the current model, once a patient spends enough on prescription drugs to hit the catastrophic phase of the plan, Medicare is responsible for 80 percent of the coverage. This introduces perverse incentives and leaves insurers with little reason to negotiate lower costs for the highest-spending patients.

Results of 2018 Black Out the Map Challenge

The Orthopaedic PAC had 22 states either reach a 21 percent participation rate or raise more than $100,000. Delaware (68 percent), Puerto Rico (64 percent), and the District of Columbia (41 percent) had the highest rate of participation. The most improved states include Delaware and Puerto Rico (11 percent increase), Alabama (9 percent increase), Arkansas, the District of Columbia, and North Dakota (7 percent increase).Click here, to view the interactive version of the map below, which features each state’s PAC support for 2018.

Thank You to Our Current Orthopaedic PAC Advisor’s Circle Members!


  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 www.aaos.org/pac 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!


Leave a Comment

Error! This email is not valid.