Advocacy in Action | April 26, 2023

AAOS News

Physician-Owned Hospital Expansion & Other Key AAOS Priorities Discussed in Hearing
Today the House Energy and Commerce (E&C) Health Subcommittee held a bipartisan hearing on several legislative proposals aimed at improving price transparency and lowering costs across the health care system. A number of the proposals discussed during the hearing are of particular interest to AAOS, from easing restrictions on physician-owned hospitals, to site-neutral payment policy and changes to the inpatient-only list. Of note, CMS Administrator Chiquita Brooks-LaSure was a panelist at the hearing and spoke to the related initiatives happening  in the regulatory space. AAOS has been working closely with E&C members and staff to ensure that orthopaedic surgeons’ voices are included in this discussion will be submitting its own written testimony to the committee. Learn more about the hearing…

AAOS Raises Concerns Over New Horizon BCBS and Cigna Policies
AAOS has voiced concern to both Horizon BCBS and Cigna over their new policies which create significant administrative burden for surgeons and will negatively impact patients’ access to care. Horizon’s new policy, effective February 1, has changed how it considers and reimburses claims submitted for certain evaluation and management codes appended with a modifier 25 and minor global surgical procedures for professional claims on the same date of service Horizon will now reduce the reimbursement by 50% for the service with the lower relative value units (RVUs) or the physician’s submitted charges if less. Horizon will also no longer reimburse for the practice expense component for the E/M and for the global day code. Similarly, Cigna is instituting a new policy effective May 25 that will require submission of office notes with all claims that use modifier 25 and deny payment for services submitted without them. Read the letter to Horizon here and the letter to Cigna here…

Healthcare Policy News

Safety from Violence for Healthcare Employees Act Reintroduced in the 118th Congress
On April 13, the Safety from Violence for Healthcare Employees (SAVE) Act was reintroduced in the House of Representatives for the 118th Congress by Representatives Larry Bucshon, MD (R-IN) and Madeline Dean (D-PA). This bill, which AAOS previously supported and advocated for in the 117th Congress, would establish legal penalties for assaulting or intimidating hospital employees or those contracted by a hospital, modeled after current protections for aircraft and airport workers. Threats of workplace violence or actual violence against health care workers can make it difficult for physicians to continue to provide quality patient care. These interactions can tie up valuable resources and delay the care patients may urgently need. The AAOS is thankful for Reps. Bucshon and Dean’s leadership on this very important issue Read Rep. Bucshon’s press release…

House Ways & Means Oversight Subcommittee Examines Tax-Exempt Hospitals
On April 26, the House Ways and Means Subcommittee on Oversight held a hearing titled, “Hearing on Tax-Exempt Hospitals and the Community Benefit Standard.” The hearing was led by Chairman David Schweikert (R-AZ) and Ranking Member Bill Pascrell (D-NJ) to examine the requirements of nonprofit hospitals to attain and maintain their tax-exempt status including operational requirements and community benefit standards outlined in the Affordable Care Act. In his remarks, Chairman Schweikert noted that the tax exemptions were valued at $28 billion in 2020 and some articles and studies, including one co-authored by one of the hearing witnesses, argues that for-profit hospitals may be providing, on average, more charity care than some nonprofit, tax-exempt hospitals. Watch the hearing here…

State News

Orthopaedic Surgeons in Pennsylvania Highlight Perils of Medical Liability Venue Shopping
A new guest editorial, penned by the president of the Pennsylvania Orthopaedic Society (PAOrtho), Matthew J. Kelly, MD, FAAOS, underscores a burgeoning medical liability crisis impacting physicians across the commonwealth. In particular, PAOrtho is working to address the growing impact of a state Supreme Court policy decision that upended longstanding rules which previously reigned in the practice of trial lawyers moving lawsuits from the county in which medical services are rendered to certain counites known to confer excessive awards. AAOS believes the current medical liability system limits the ability of orthopaedic surgeons to provide the highest quality patient care and systematic medical liability reform is necessary to improve the overall health care system. Read the full editorial…

OrthoPAC Attending Upcoming State Orthopaedic Society Meetings

The AAOS Orthopaedic PAC (OrthoPAC) will be attending the Virginia Orthopaedic Society’s (VOS) meeting this weekend in Hot Springs, VA. VOS members will have the opportunity to learn about AAOS advocacy efforts and the important role OrthoPAC plays in supporting members of Congress who champion musculoskeletal healthcare policy issues. OrthoPAC will also be attending the California Orthopaedic Association meeting May 18-21 and the Florida Orthopaedic Society meeting May 18-21. Contact us to host the PAC at your state or specialty society meeting..

• U.S. Representatives Reach across the Aisle (AAOS Now, April)
• More Medical Liability Premiums Increased in 2022, AMA Finds (Recycle Intelligence, 4/25)
• Congress should adopt site-neutral post-acute payments: MedPAC (Modern Healthcare, 4/18)