Defense Health Funding Success, EMS legislation, Tax Reform, and More

The Senate on Nov. 16 approved the final version of the National Defense Authorization Act (NDAA), which sends the measure to the White House. The American Association of Orthopaedic Surgeons (AAOS) applauds members of Congress for removing harmful language in this final bill that would have impeded vital defense health research. Specifically, the language would have instituted a prohibition on conduct of certain medical research and deployment projects like the Peer Reviewed Orthopaedic Research Program (PRORP). The PRORP, championed by AAOS, works to help military surgeons find new limb-sparing techniques to save injured extremities, avoid amputations, and preserve and restore the function of injured extremities.

Last week, President Trump signed H.R. 304, the Protecting Patient Access to Emergency Medications Act of 2017, into law. Endorsed by AAOS and OTA, the bill improves the Drug Enforcement Administration (DEA) registration process for emergency medical services (EMS) agencies, and clarifies that EMS professionals are permitted to administer controlled substances pursuant to standing or verbal orders when certain conditions are met.

“We greatly appreciate the bipartisan leadership provided by the Energy and Commerce Committee to bring this bill forward on a consensus basis,” AAOS stated in a support letter to Speaker Paul Ryan (R-WI) and House Minority Leader Nancy Pelosi (D-CA). “We are truly grateful for your collective commitment to work on a bipartisan basis with stakeholders to arrive at the best policy and legislative text and to move the bill on a very timely basis.”

On November 16, 2017, the U.S. House of Representatives passed their tax reform package, H.R. 1, the Tax Cuts and Jobs Act by a vote of 227-205. Focus now turns to the Senate, where the bill is different in part due to the Senate’s complex budget rules. The Finance Committee voted along party lines, 14-12, to forward the proposal on to the full Senate. Additionally, while the House-passed bill doesn’t include a repeal of the Affordable Care Act’s “individual mandate,” legislation approved by the Senate Finance Committee does. Lawmakers will have to address the differences – though House members appear supportive of including the individual mandate repeal – and hope to have compromise legislation to President Trump’s desk by the end of the year.

By William Hill, Howard University College of Medicine’s Orthopaedic Surgery Interest Society

Advocacy is a vital aspect of the profession of medicine but it is often neglected or forgotten. The Washington Office of the American Association of Orthopaedic Surgeons (AAOS) does a tremendous job advocating on behalf of all orthopaedic surgeons throughout the year on Capitol Hill. The support of the AAOS Orthopaedic Political Action Committee (PAC) bolsters the impact of the AAOS advocacy efforts, which is evident by the 2016 94 percent win rate of AAOS-backed candidates. During a time of vast change in health care, the level of advocacy needs to be further increased to effect change on policies that will have a direct effect on orthopaedic surgeons and the patients they serve. This belief is shared by current AAOS President, Dr. William Maloney, and immediate past President, Dr. Gerald Williams. At the 2017 Annual Meeting, they expressed the need for increasing orthopaedic surgeons’ investment in advocacy and growing the Orthopaedic PAC into the largest medical PAC in Washington. To foster the investment in advocacy and policy efforts by orthopaedic surgeons, there needs to be early exposure and education. With the exception of a few medical schools introducing advocacy programs into their curriculum, the majority of schools lack advocacy and policy education. Residency programs also are lacking when it comes to training their residents on the importance of advocacy to the advancement of the profession of orthopaedic surgery. AAOS started the Resident Assembly in 2014, which has a Health Policy Committee and this has helped educate residents on advocacy and policy.

AAOS delegate members attended the American Medical Association (AMA) House of Delegates (HOD) Interim meeting from November 11-14, 2017 in Honolulu, Hawaii. The HOD is the legislative and policy-making body of the AMA and is composed of hundreds of physicians, medical students, residents and fellows. The delegation addressed issues to promote medicine and improve patient care.

Karen Hackett FACHE, CAE, former AAOS CEO, received the AMA 2017 Medical Executive Lifetime Achievement Award for her outstanding contributions to the goals and ideals of the medical profession.

On November 8, 2017, the House Energy and Commerce Subcommittee on Health held a hearing titled “MACRA and Alternative Payment Models: Developing Options for Value-based Care.” Subcommittee Chairman Michael C. Burgess, M.D. (R-TX) convened the hearing to discuss the implementation of one of the two tracks eligible professionals can be reimbursed under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – Alternative Payment Models (APMs). The committee reviewed Medicare payment reforms, including models that are already under way and those that are returning savings to the program while improving outcomes.

Higher Premiums Would Cancel Out Some Tax Cuts, Axios, 11/22/17

Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet, Bloomberg, 11/21/17

Displaced Puerto Ricans Face Obstacles Getting Health Care, Kaiser Health News, 11/21/17

States Face Children’s Health Coverage Uncertainty, Roll Call, 11/20/17

U.S. Hospitals Feeling the Pain of Physician Burnout, Reuters, 11/21/17

HHS Concerned About Medicare’s Long-Term Sustainability, Modern Healthcare, 11/20/17

Veterans Affairs Chief Wants Bigger Role for Private Health Care, The Wall Street Journal, 11/20/17

GOP Senator: Obamacare Fix Could be in Funding Bill, The Hill, 11/20/17

White House Open to Removing Obamacare Mandate Repeal from Tax Bill, The Washington Post, 11/19/17

Tax-Exempt Mayo Clinic Grows, but Rural Patients Pay a Price, Politico, 11/16/17

Reconsidering the Affordable Care Act’s Restrictions on Physician-Owned Hospitals, JBJS, 11/15/17

Trump Health Agency Challenges Consensus on Reducing Costs, The New York Times, 11/12/17

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/.

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