AAOS Advocacy | April 28, 2022

AAOS News

Congressional-led Letter Asks for $35 Million for Research Funds
A group of 42 members of Congress—led by Rep. Seth Moulton (D-MA) and Rep. Joe Wilson (R-SC)—sent a letter to the leaders of the House Appropriations Committee requesting that $35 million be appropriated to the Peer Review Orthopaedic Research Program (PRORP) as part of the Department of Defense’s Congressionally Directed Medical Research Program. PRORP has typically received $30 million in funding every year, but additional funds are needed to ensure continuity of care for the patient. Over half of all combat injuries sustained during our most recent conflicts involved extremity injuries and orthopaedic-specific conditions secondary to battle injury. Extremity injuries accounted for the greatest proportion of medical resource utilization and caused the greatest number of disabled military personnel, accounting for 65% of total inpatient resource spending and 64% of projected disability costs. Studies funded by PRORP will lead to major improvements in surgeons’ abilities to care for these devastating injuries. AAOS has been intimately involved in ensuring this program continues to receive proper funding since its inception in 2008.

HHS Secretary Becerra Asked About Declining Physician Reimbursement, Surprise Billing  

On April 27, U.S. Dept. of Health and Human Services (HHS) Secretary Xavier Becerra appeared before the House Energy & Commerce Committee for a hearing to discuss President Biden’s proposed budget for Fiscal Year 2023. During the hearing, Congressman Larry Bucshon, M.D., (R-IN) stated that adjusted for inflation in practice costs “physician pay within Medicare actually declined 20% from 2001 to 2021” and asked Secretary Becerra what HHS is doing to “stop the decline in physician reimbursement in Medicare.” Rep. Bucshon’s time expired before Secretary Becerra could verbally respond but is expected to submit a written response to the committee. In March, Secretary Becerra signaled a willingness to look at reforms to the Medicare physician fee schedule. The AAOS Office of Government Relations has been magnifying those comments on Capitol Hill to advocate for reforms to the Medicare payment system. Since the Biden Administration announced it will appeal the federal district court’s ruling that reasserted Congress’s clear writing of the No Surprises Act, Dr. Bucshon asked the Secretary to finalize a rule that follows congressional intent.

46 Mental Health Groups Endorse AAOS-supported Prior Authorization Reform Bill 

On April 5, 46 mental health advocacy organizations sent a letter in support of the AAOS-endorsed Improving Seniors’ Timely Access to Care Act, which aims to reform the prior authorization process within Medicare Advantage plans. The bill has accumulated 300 cosponsors in the U.S. House of Representatives and the U.S. Senate. AAOS is working with sponsors to ensure a timely markup and inclusion in any moving legislative package. The House Ways & Means Committee Chairman Ritchie Neal (R-MA) has recently pledged to markup the legislation, although no official announcement has been made, and AAOS used the Regulatory Relief Coalition’s Week of Action to further spread awareness. Read more…

Healthcare Policy News

HHS Poised to Appeal Court Ruling that Struck Down Components of No Surprises Act Rule
Late last week, the U.S. Dept. of Health and Human Services filed a notice of appeal in response to a federal court decision that vacated key portions of the federal rules implementing the No Surprises Act. The litigation, led by the Texas Medical Association, argued that the Administration bypassed notice and comment requirements, and further that federal regulators erred when anointing the insurer-formulated “qualifying payment amount” as the presumptive appropriate payment underpinning the new independent dispute resolution (IDR) process created by the law. Shortly following the court decision, the implementing federal agencies released updated guidance on the IDR process. Earlier this year, AAOS joined an amicus brief in support of a related lawsuit also challenging the rule and has consistently advocated that the rule disregarded congressional intent. Read more…

CMS Releases FY 2023 Medicare Inpatient Payment Rule 
On April 18, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2023 Inpatient Prospective Payment System (IPPS) proposed rule. In this rule, CMS proposes to adopt the 1) Hospital-Level Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) Patient-Reported, Outcome-Based Performance Measure (NQF #3559) and 2) Hospital-Level Risk-Standardized Complication Rate Following Elective Primary THA/TKA measure (NQF #1550) beginning with the FY 2024 payment determination. Additionally, CMS is proposing refinements to Hospital‐Level, Risk‐Standardized Payment Associated with an Episode-of-Care for THA/TKA (NQF #3474). CMS also included a request for information on metrics for social determinants of health. AAOS will be commenting on this rule by June 17, 2022.

Read the AAOS summary here…

State News

Legislative Leaders Announce Agreement on Future of MICRA
On April 27, state legislative leaders in California joined health care, legal and patient advocates to announce a compromise aimed at heading off a costly November ballot measure focused on dismantling the state’s Medical Injury Compensation Reform Act (MICRA) of 1975. The historic law notably set a $250,000 cap on non-economic damages in medical malpractice cases. The new proposed framework, which must still clear the state legislature and be signed by the governor, would increase the existing limit to $350,000 for non-death cases and $500,000 for wrongful death cases on January 1, 2023, followed by incremental increases over 10 years to $750,000 for non-death cases and $1,000,000 for wrongful death cases, after which a 2.0% annual inflationary adjustment will apply. California law allows proponents to withdraw a ballot measure if there is an agreement before June 30. Read more from the Californians Allied for Patient Protection announcement…

OrthoPAC Invites Capitol Club Members to a Virtual Candidate Meet and Greet 
The Orthopaedic PAC (OrthoPAC) invites its Capitol Club members to attend a virtual candidate meet and greet with Al Olszewski MD, FAAOS, on May 3, at 9 pm ET, moderated by John Gill, MD, FAAOS, chair of the AAOS Orthopaedic PAC. Olszewski is running for the newly created MT-01 congressional seat. Before his bid for Congress, Olszewski served in the Montana state legislature, where he led several bipartisan, commonsense healthcare initiatives – including passing legislation to reduce the over-regulation of healthcare billing processes. Dr. Olszewski was honored for his bipartisan work by the Montana Medical Society and the Montana Coalition to Prevent Suicide.

Register Here to Attend the Meet and Greet.

• Medicare Advantage Plans Often Deny Needed Care Federal Report Finds (Reed Abelson, New York Times, April 28, 2022)

• Clean Out Your Medicine Cabinet on April 30 | Opinion – pennlive.com (Paul J. Juliano, MD, pennlive.com, April 19, 2022)