AAOS Advocacy in Action

Comments Submitted on Proposed 2021 Payment Policy Changes

This week, the AAOS submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed payment policy changes for Calendar Year 2021. On the Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center (OPPS/ASC) Payment System Proposed Rule, AAOS focused its attention on the proposal to eliminate the inpatient only list starting with all 266 musculoskeletal procedures. It urged the agency to consider the associated safety concerns and increased out-of-pocket costs for patients, and to waive the Two Midnight Rule which continues to be a source of confusion for hospitals and private payers and administrative burden for physicians. On the Medicare Physician Fee Schedule Proposed Rule (PFS), AAOS expressed strong disagreement with recommendations that would significantly cut physician payment noting the ongoing public health emergency and increased time spent on value-based care. As CMS begins reading through stakeholder feedback and finalizing the rules, the AAOS will continue to advocate its position and work closely with the agency on further improving the payment system. CY 2021 OPPS/ASC and CY 2021 PFS…

Physician Coalition Releases New Statement on Surprise Medical Billing

The AAOS recently joined with other prominent physician specialty organizations in outlining its preferred solution to surprise medical billing. The coalition urged Congress to avoid enacting legislation that further destabilizes physician practices, jeopardizes access to care, exacerbates disruptions in our health care system, or favors the insurance industry that is setting record profits. These asks were reiterated in anticipation of forthcoming legislation that is suspected to tie physician reimbursement to an insurer-calculated median in-network rate. According to the Congressional Budget Office, similar proposals would lead to a 15-20% payment cut for all in-network and out-of-network physicians. Especially while practices continue to face challenges related to the COVID-19 pandemic, AAOS strongly opposes granting insurers the leverage to unfairly drive down reimbursement. It continues to seek a balanced solution that protects patients first while allowing for a market-based negotiation with insurers to resolve disputes. More on AAOS’ advocacy approach to surprise billing…

Registry Program Partners with CMS on Bundled Payment Model

The AAOS Registry Program today announced its partnership with the Centers for Medicare & Medicaid Services (CMS) on its Model Year 4 Bundled Payments for Care Improvement (BPCI) Advanced program. Beginning January 1, 2021, the agency will utilize AAOS registry-reported data as part of its new Alternate Quality Measures Set—demonstrating a shared interest in promoting value-based care and ensuring that payment models for musculoskeletal care can better guide decision-making. Registry participants will have the opportunity later this fall to amend their participant agreements with CMS for each clinical episode to reflect their choice of measure set. Participants must select either Administrative or Alternate Quality Measures Set for each clinical episode; however, they are not required to select the same Quality Measure Set across all clinical episodes. Current BPCI Advanced participants will receive further information from the agency regarding deadlines for episode and measure set selection through their BPCI Participant Portal. Full press release…

Healthcare Policy News

HHS Announces Additional Provider Relief Fund Grants

On October 1, the Department of Health and Human Services (HHS) announced that a Phase 3 General Distribution of $20 billion would be open to provider applications from October 5 to November 6, 2020. These funds will be available to both providers who were previously ineligible, and those who received funds already but may need additional funds as a result of losses or changes in operating expenses resulting from the COVID-19 pandemic. Providers are eligible to apply regardless of whether or not they were previously eligible for, applied for, received, accepted, or rejected payment from earlier Provider Relief Fund distributions. Applications for this third distribution are open to applicants who meet several requirements, including billing Medicare fee-for-service during the period of January 1, 2019 to March 31, 2020 and providing patient care after January 31, 2020. HHS has already issued over $100 billion in relief funding through prior distributions and said that it recognizes many providers continue to struggle financially from COVID-19’s impact. Full list of requirements and how to apply…

President Trump Halts COVID-19 Relief Talks Until After Election

On October 6, President Trump ordered an abrupt end to negotiations between the White House and Democratic leaders on the specifics of a new COVID-19 package until after the election. Prior to the announcement made via Twitter, lawmakers had hoped to approve some relief measures before November 3 but remained largely in disagreement over total spending, liability protections, unemployment assistance, and state and local support. Most recently, the House of Representatives passed a $2.2 trillion bill along party lines that included a second round of stimulus checks, enhanced unemployment benefits, increased state and local aid, and new money for both the airline and restaurant industries. Republicans, however, called the bill too expensive and unrealistic with many senators signaling they would not be willing to support legislation for more than $1 trillion. A short-term bill intended to extend current appropriation levels to keep the government funded is still set to expire on December 11. AP news story…

Capitol Club Gains Insight from Senatorial Campaign Briefings

The Orthopaedic PAC is hosting virtual political updates exclusively for Capitol Club members. On October 6, they got to hear from Jessica Knight-Henry who is the Deputy Political Director for the Democratic Senatorial Congressional Campaign. Knight-Henry provided insight on key races across the nation and voting trends that she is seeing as the November 3rd Election Day looms closer. Members also had the opportunity to ask questions and gain clarity on the increasingly confusing election season. On October 13, Capitol Club members will have another opportunity to hear from Mark Morgan, the Political Director from the National Republican Senatorial Committee. RSVP to pac@aaos.org if you would like to participate… 

Applications Open for Two Positions on PAC Executive Committee

The Orthopaedic PAC has two open positions on its Executive Committee: Resident Fellow and Early Practice Member. The Resident Fellowship Program is designed to encourage participation of orthopaedic residents in the political and advocacy efforts of the Orthopaedic PAC. The Early Practice Member is a new position designed for surgeons who are in their first five years of practice. Both candidates will serve as voting members on the PAC Executive Committee providing unique representation to the group. Through interaction with senior AAOS management, work on various PAC projects and participation in a strategy for increasing member engagement with the Orthopaedic PAC and the AAOS’ broader advocacy efforts, the canidates will develop a strong foundation toward future leadership within the AAOS. Applications for Resident Fellow are due October 9 and applications for the Early Practice Member position are due October 20. Learn more and submit applications…

·        Health Groups Turn Up Heat on 2021 Medicare Fee Schedule (MedPage Today, 10/6)

·        CMS’ plan to end inpatient-only list worries providers (Modern Healthcare, 10/6)