AAOS Advocacy in Action

AAOS News

AAOS Urges Congress to Provide Short-term Fiscal Stability, Long-term Reform

The AAOS joined with 103 other healthcare organizations urging Congress to take further action to mitigate another round of reimbursement cuts within the recently released Calendar Year (CY) 2023 Medicare Physician Fee Schedule (MPFS) proposed rule (see AAOS rule summary). In a letter submitted to Congress on July 27, the groups stressed that further action is needed to address Medicare’s broken payment system and instability for healthcare professionals. The AAOS Office of Government Relations is in the process of reviewing the CY 2023 MPFS proposed rule and will submit formal comments to the Centers for Medicare & Medicaid Services ahead of the Sept. 6 deadline. Read the full coalition letter…

AAOS Expresses Support for Prior Authorization Exemption Legislation
The AAOS recently wrote a letter to U.S. Representatives Michael Burgess (R-TX), MD and Vicente Gonzalez (D-TX) in support of their Getting Over Lengthy Delays in Care as Required by Doctors (GOLD CARD) Act of 2022 (H.R. 7995). This legislation would allow physicians who have a 90% prior authorization approval rating to be exempt from prior authorization requirements under Medicare Advantage plans. In the letter, AAOS cited a 2022 report from the HHS Office of Inspector General which found that Medicare Advantage plans inappropriately denied tens of thousands of prior authorization requests. These denials inevitably lead to adverse health outcomes. The AAOS believes this important legislation will help decrease the burden physicians face with prior authorization and allow patients to receive timely care.  Read the full letter of support…

Healthcare Policy News

CMS Requesting Feedback on the Medicare Advantage Program
On July 28, the Centers for Medicare & Medicaid Services released a Request for Information (RFI) seeking public comment on the Medicare Advantage (MA) program. The agency is seeking broad feedback on what works and what does not in the MA program, including risk adjustment, quality ratings, beneficiary information sharing and access to care. In addition to feedback on the MA program, CMS is also seeking input on how to improve traditional Medicare versus MA benefits information for beneficiaries, especially those who belong to underserved populations. With a focus on expanding access, CMS is requesting comment on how MA plans use utilization management techniques such as prior authorization, steps that CMS can take to ensure utilization management does not impact beneficiaries’ access to medically-necessary care, and what data should be collected to make it meaningful for beneficiaries, healthcare providers and plans. The AAOS will be submitting comments on behalf of members ahead of the  August 31 deadline. Read the RFI…

AAOS-endorsed Prior Authorization Legislation Passes Committee
On July 27, the U.S. House Ways and Means Committee unanimously passed the AAOS-endorsed Improving Seniors’ Timely Access to Care Act. The legislation aims to streamline the burdensome prior authorization process within Medicare Advantage plans by making it electronic and transparent. The Energy and Commerce Committee is also expected to review the legislation in September. AAOS is asking congressional leadership to pass this legislation before the end of the year and is working to build support for prior authorization reform more generally during the ongoing Orthopaedic Advocacy Week. Learn more about this advocacy effort…

Changes Finalized for 2023 Inpatient Payment System
On August 1, the Centers for Medicare & Medicaid (CMS) released the FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule. The agency finalized adoption of the Hospital-Level, Risk Standardized Patient-Reported Outcomes Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) (NQF #3559). It will begin with two voluntary reporting periods (July 1, 2023 through June 30, 2025), followed by a mandatory reporting period (July 1, 2025 through June 30, 2026) with payment implications in FY 2028. When the changes were being proposed, AAOS urged CMS (see comment letter) to allow for a longer implementation timeline with an up to a four-year voluntary reporting period and to create a reimbursement pathway for PRO-PM reporting. CMS also adopted the Hospital-Level Risk-Standardized Complication Rate Following Elective Primary THA/TKA measure beginning with the FY 2024 payment year and finalized refinements to the Hospital‐Level, Risk‐Standardized Payment Associated with an Episode-of-Care for Primary Elective THA and/or TKA measure. Learn more about the final rule…

Physician Burnout Tied to Administrative Burden in Surgeon General Report
Earlier this year, Surgeon General, Vivek Murthy, MD, MBA, released a 76-page advisory report detailing how administrative burden contributes to clinician burnout. It indicated that electronic health record vendors and health IT companies have an important role in addressing the issue and could work alongside healthcare professionals to improve systems for greater efficiency. The advisory report contains statistics from the 2020 CAQH Index, which tracks adoption of all electronic transactions between healthcare providers and payors. It found that making all prior authorization transactions electronic could potentially save $417 million annually, promote efficiency, save healthcare workers up to 12 minutes per transaction, thereby reducing administrative burden and allowing physicians to spend more time with patients. See the full report…

OrthoPAC Gives Back Through Charity Match During “Day of Giving”

As part of tomorrow’s “Day of Giving” during Orthopaedic Advocacy Week, OrthoPAC is offering a new Charity Match benefit. It will match OrthoPAC contributions received from July 7-August 7 with a donation to a charity of choice, allowing you to make twice the difference with the same dollar. Up to $100,000 has been allocated for the match, and the top charities thus far include: AOAO Foundation, ASES Foundation, Pediatric Orthopedic Project, Inc., UNICEF, and the American Red Cross. OrthoPAC is also running a Winner’s Choice Sweepstakes as part of the “Day of Giving” with three categories: $5,000 contributors, $1,000 contributors, and $100 for active fellows and $25 for residents. All 2022 contributors will be entered to win (retroactive from Jan. 1, 2022). Text SWEEPS or PACMATCH to 41444 to donate…

·        Coming to a contract negotiation near you: the No Surprises Act (Modern Healthcare, 8/3)

·        AAOS’ Response to Medicare Payment Reform Is Nuanced (AAOS Now, August)