AAOS Advocacy Now

AAOS Advocacy Mitigates Medicare Cuts, Ends Surprise Billing

Just before the holidays, AAOS President Joseph A. Bosco III, MD, FAAOS, reported several significant accomplishments for AAOS advocacy that were included in the combined $900 billion COVID-19 aid package and $1.4 trillion omnibus spending bill. The legislation was passed by Congress on December 21 then signed into law by the president on December 27. Importantly, the package contained language to help mitigate the impact of impending Medicare cuts and finally end surprise medical bills, which have plagued patients for years (read more on both health policy issues below). He credited the positive developments to the tireless advocacy of AAOS members throughout 2020 who sent over 19,000 grassroots messages to Congress through the Advocacy Action Center, met with legislators during our August In-District Advocacy Event, and supported the AAOS Political Action Committee. Read Dr. Bosco’s message… 

AAOS Supports Coronavirus Vaccine

With the initial distribution and administration of a COVID-19 vaccine underway across the globe, AAOS reiterated the importance of evaluating scientific evidence when weighing the risks and benefits of a vaccination’s effects on the musculoskeletal system. In a January 6 press release, the Academy noted that to-date there is no high-quality evidence that indicates vaccinations administered correctly to the shoulder area can injure the shoulder and gave its full and unqualified support for the widespread adoption of the COVID-19 vaccination. As new high-quality evidence emerges, AAOS will continue to examine these studies using its stringent process which evaluates study design, randomization, control measures, risks and other elements and update its guidance and quality tools, as appropriate. Read the AAOS press release… 

Healthcare Policy News

Impact of Payment Policy Changes Reduced for 2021

Following months of pressure to mitigate the impact of planned pay cuts, Congress passed year-end legislation that made several significant updates to the 2021 Medicare Physician Fee Schedule (MPFS). Importantly, a blanket 3.75% increase was made to all payments which were originally going to be decreased by 10.6%. Additionally the conversion factor was recalculated to mirror budget neutrality changes and is now $34.89 for 2021, up from the planned decrease to $32.41 this year from $36.09 in 2020. For total hip and knee arthroplasty codes, the combined impact of the decrease in work RVUs and budget neutrality is lessened from an approximately 10% to 7% decrease—the new payment rates for 2021 will be $1,322.45 for THA and $1,320.70 for TKA. Fortunately, office/outpatient evaluation and management (E/M) codes will see an overall increase of up to 30% and implementation of the G2211 add-on code for complex visits is suspended until 2024. Finally, CMS is delaying the scheduled Medicare sequestration cut of 2% until March 31, 2021. These combined changes will lessen the severe impact of cuts to physician payment, but the AAOS will continue to advocate for long-term changes that prevent further reductions to the value of orthopaedic care in 2022 and beyond. Learn more about the changes…

Surprise Medical Billing Finally Banned in Year-End Package

After nearly two years of debate on a fix to end surprise medical billing, Congress finally banned the practice as part of the year-end COVID-19 relief and government funding package. The version of the “No Surprises Act” that passed represents significant progress from earlier proposals and incorporates several longstanding AAOS priorities for protecting patients and preserving physicians’ ability to negotiate with health plans. They include an independent dispute resolution (IDR) process and the ability to batch claims without requiring a monetary threshold for access. It also clarifies that the initial response from an insurer—required within 30 days of service—must be an initial payment or a specific notice of denial of payment. Insurers are prohibited from factoring in public payer rates, physicians have more time to file for negotiations, and an interim report into the effects of the included 90-day waiting period is required to ensure that it is not preventing the process from working as it should. The AAOS will continue to advocate for all possible improvements during federal rulemaking before the bill’s effective date on January 1, 2022.  Read more about the final compromise…

Congress Votes to Repeal McCarran-Ferguson Antitrust Exemption

The Senate and House of Representatives recently voted in favor of repealing an antitrust exemption that has been unfairly protecting health insurance companies from federal competition laws for decades. The newly passed Competitive Health Insurance Reform Act of 2020, led by Reps. Peter DeFazio (D-OR) and Paul Gosar (R-AZ), would amend the outdated McCarran-Ferguson Act of 1945 to include: “Nothing contained in this Act shall modify, impair, or supersede the operation of any of the antitrust laws with respect to the business of health insurance (including the business of dental insurance and limited-scope dental benefits).” In essence, the government will be empowered to enforce the full range of federal antitrust laws against health insurance companies engaged in anticompetitive conduct, including collaboration on pricing. The bill is supported by AAOS, which is committed to ensuring fair antitrust laws more broadly, and now awaits President Trump’s signature to become law. Read more about the anti-trust exemptions…

Deadline Extended to Apply for MIPS Extreme, Uncontrollable Circumstances

To further support clinicians affected by the pandemic, the Centers for Medicare & Medicaid Services (CMS) has extended the deadline to submit a COVID-19 related extreme and uncontrollable circumstances application for Performance Year 2020 to February 1. This exception allows MIPS eligible clinicians, groups, and virtual groups to re-weight any or all performance categories to 0% due to the current COVID-19 public health emergency. An application can be submitted if the COVID-19 pandemic has prevented collection of 2020 MIPS performance period data for an extended time or if it could negatively impact cost measure performance. Learn more or apply for the exception…

OrthoPAC Thanks 2020 Contributors

The AAOS Orthopaedic Political Action Committee (OrthoPAC) would like to thank the more than 3,200 AAOS members who contributed in 2020 and give special thanks to the approximately 500 Capitol Club members who contributed over $1,000. OrthoPAC raised over $1.8 million in 2020 and over $3.7 million throughout the 2020 election cycle. Every AAOS member, as well as their patients, benefits from the success of the OrthoPAC which continues to be one of the most powerful tools in the association’s advocacy arsenal. Continuing this success into 2021 is critical for forming relationships with new members and leaders of the 117th Congress. OrthoPAC hopes that ongoing contributors will renew their support in 2021 and that AAOS members who have never contributed will consider joining the team. Renew your support or join the PAC today…

·        With New Majority, Here’s What Democrats Can (and Can’t) Do on Health Care (New York Times, 1/7)

·        HHS to distribute $22 billion to aid COVID-19 testing, vaccination (Modern Healthcare, 1/6)

·        Congress recalibrates Medicare Physician Fee Schedule after lobbying (Modern Healthcare, 1/5)

·        Here’s what’s in the second stimulus package (CNN, 12/28)