AAOS Advocacy in Action

Worked with the American Association of Hip and Knee Surgeons on a congressional letter encouraging the Centers for Medicare & Medicaid Services to value pre-optimization time appropriately in its reimbursement of total knee and hip arthroplasty global codes.
Shared our positions on the most pressing health policy issues with the Biden-Harris Administration including health disparities, prior authorization, physician-owned hospitals, telehealth, and value-based payment models.
Joined with the Surgical Coalition in sending a letter of support for the Medicare Reimbursement Equity Act introduced by Senator Rand Paul (R-KY).
Final Opportunity to Prevent Scheduled 2021 Medicare Cuts
Now that the Centers for Medicare & Medicaid Services has finalized policies to cut Medicare payments by 10 percent, our last opportunity to prevent the reductions from taking effect on January 1, 2021, is through congressional intervention. AAOS, in partnership with a coalition of healthcare organizations, is urging Congress to pass H.R. 8702, the Holding Providers Harmless from Medicare Cuts During the COVID-19 Act of 2020. This bill would alleviate any Medicare reimbursement differences between 2020 and 2021/22. Help build support for this critical legislation in any year-end package by contacting your representatives today.

AAOS Urges Congress to Prevent Recently Finalized Medicare Cuts

Following the release of the final 2021 Medicare Physician Fee Schedule earlier this week (see related news item below), AAOS and a large coalition of healthcare organizations urged Congress to include legislation in any year-end package to prevent the arbitrary Medicare cuts which are scheduled to go into effect beginning January 1, 2021. Specifically, they called on Congress to pass H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, which is supported by more than 300 national, regional, state and local organizations. They reiterated that the 10 percent cut for services will be devastating to an already struggling health care system and may lead to reduced access to care for older Americans and Americans with disabilities. Read the coalition press release… 


Healthcare Policy News

2021 Medicare Outpatient and Ambulatory Surgical Center Payment Rule Finalized

On December 2, the Centers for Medicare & Medicaid Services (CMS) finalized 2021 policies that eliminate the Inpatient Only list over the next three years beginning with the removal of approximately 300 primarily musculoskeletal-related services beginning January 1. The procedures will now be eligible for Medicare reimbursement in both the hospital inpatient and outpatient settings as determined by the physician. In response to AAOS advocacy, CMS will “indefinitely exempt these procedures from site-of-service claim denials under Medicare Part A, eligibility for Beneficiary and Family-Centered Care-Quality Improvement Organization (BFCC-QIO) referrals to Recovery Audit Contractors (RACs) for noncompliance with the 2-midnight rule, and RAC reviews for ‘patient status’ (that is, site-of-service).” In another win, high Medicaid physician-owned hospitals can now expand. Additional changes include total hip arthroplasty being reimbursable at ambulatory surgical centers and CMS now requiring prior authorization for cervical fusion with disc removal and spinal neurostimulators. Read the AAOS summary of the final rule…


2021 Medicare Physician Fee Schedule Finalized

On December 1, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule. Despite year-long requests from the medical community to preserve the value of services in light of the COVID-19 public health crisis, CMS finalized changes that will result in an estimated 4% reduction to all orthopaedic surgical services. Moreover, the previously finalized updates to Evaluation and Management Office/Outpatient visit codes were not extended to global surgical codes, also negatively impacting surgeon reimbursement. The rule also finalized a 5.4% cut to the work relative value units for hip and knee arthroplasty in spite of years of advocacy and compelling evidence provided by AAOS and the American Association of Hip and Knee Surgeons that physicians invest significant time in value-based patient care. Positive changes include making permanent many of the telehealth provisions implemented during COVID-19, broadening the scope of practice for certain non-physician practitioners and making updates to the Quality Payment Program. Read the AAOS summary of the final rule…

Doc Caucus Urges Congress to Mitigate Impending Cuts and Avert a Health Crisis 

In a letter to House leadership, members of the Doc Caucus urged their congressional colleagues to address the impending Medicare cuts before the end of the year “in an effort to avert another health care crisis.” They pointed to two bipartisan legislative solutions (H.R. 8702 and H.R. 8505) developed by physician members of Congress that would provide stability for health care professionals as they respond to the COVID-19 pandemic. The group asked House leadership to consider these bills, or alternative shorter-term solutions if necessary, that mitigate cuts but maintain payment increases for primary care and complex office-based care. “As Members of Congress who directly care for patients, we understand the consequences that the upcoming reimbursement cuts will have on patient care and patient access to care,” they wrote. Read the Doc Caucus letter to House leadership…


Hospital Capacity Further Expanded During COVID-19

The Centers for Medicare & Medicaid Services (CMS) recently announced that it is further relaxing regulations regarding hospital care in non-traditional settings to mitigate the impact of steep increases in COVID-19 hospitalizations. The new flexibilities, as part of the Acute Hospital Care at Home Program, are designed to provide care to patients at home so they can continue to be with family and caregivers without the restrictions of a traditional hospital setting during the pandemic. Alternatively, the program will support the care of patients diagnosed with non-COVID illness and reduce the burden placed on traditional hospitals during surges of the virus. CMS also clarified that Ambulatory Surgical Centers participating in the Hospitals Without Walls program are only required to offer 24-hour nursing care when there is at least one patient receiving care onsite. Learn more about the new program…


Sweeping Changes to Physician Self-Referral Law and Anti-Kickback Statute

On November 20, the Centers for Medicare & Medicaid Services (CMS) released finalized changes to the Physician Self-Referral (Stark) Law and the Department of Health and Human Services’ Office of the Inspector General concurrently released changes to the Anti-Kickback Statute. Updates to these decades-old rules will result in a restructuring of the regulatory landscape which has long hamstringed physicians attempting to shift to value-based care. In formalizing a new universe of value-based care definitions for providers to collaborate within, the agencies will mitigate many regulatory or legal disparities between the two rules which create new safe harbors for value-based arrangements and reward  greater financial risk with greater regulatory flexibility. AAOS has long-advocated for such changes and applauds the agencies’ efforts to reduce burden for physicians. Read the CMS fact sheet…

OrthoPAC Corner

2020 Orthopaedic PAC State Participation Challenge

As the AAOS Orthopaedic PAC closes out the year, the political team is turning its attention to helping states cross the 20 percent participation threshold. Thus far, 11 states have done so: Connecticut (with 100 percent participation), Puerto Rico, Delaware, Iowa, District of Columbia, South Dakota, Hawaii, North Dakota, Arkansas, Alabama, and Georgia. Several states are less than 10 participants away from meeting the 20 percent participation mark: West Virginia (only one more participant needed), Nevada, Vermont, Rhode Island, Nebraska, New Hampshire, New Mexico, Wyoming, Minnesota, Louisiana, Mississippi, and Montana. View the full map…

Where does your state rank? Become an OrthoPAC Rainmaker and help your state cross the threshold. Strong participation means we have a strong voice on Capitol Hill. Contact the political staff at pac@aaos.org to learn more.
What We’re Reading

·        CMS finalizes physician-owned hospital boost, end of inpatient-only list (Modern Healthcare, 12/2)

·        2021 Medicare Fee Schedule Includes 10.2% Cut in Conversion Factor (MedPage Today, 12/2)