Advocacy in Action

AAOS Lends Support to AMA-AHA Legal Challenge to No Surprises Act Final Rule

In an amicus brief that is anticipated to be filed shortly (see unofficial copy), the AAOS will join a diverse group of national medical specialty and state medical societies in supporting a legal effort–led by the American Medical Association and the American Hospital Association–challenging a narrow yet critical component of the federal regulations designed to implement the No Surprises Act. Specifically, the lawsuit targets the federal government’s decision to make the insurer-formulated Qualifying Payment Amount, calculated as the median in-network rate, the presumptive appropriate payment for resolving disputes as opposed to equally considering a range of factors that impact payment as intended by the law. This legal effort follows previous AAOS advocacy during the 2021 rulemaking process to not only emphasize the significant divergence from congressional intent, but also the inevitable negative impact on patient access to musculoskeletal care.  Read a copy of the amicus brief…

Comments Submitted on No Surprises Act Final Rule

On December 3, 2021, AAOS submitted formal comments to the Departments of Health and Human Services, Labor, and Treasury, as well as the Office of Personnel Management regarding the Part II Interim Final Rule (IFC) on Surprise Billing. AAOS strongly urged the Departments to revise the regulations on the process for resolving unanticipated out-of-network billing disputes to be more closely aligned with the No Surprises Act. It also re-emphasized alarm by the deviation from congressional intent and government overreach of the rule, which took effect on January 1, 2022, and will negatively impact the already strained health care system. Instead of creating a fair and comprehensive process for physicians and insurers to settle payment disputes in a way that protects patients, the rule as-written tips the scale in insurers’ favor. “We strongly urge the Departments to update the IFC to reflect the statutory language and intent of the law,” wrote AAOS President Daniel K. Guy, MD, FAAOS in the letter. “It is imperative to the continued practice of medicine in the United States that these consumer protections ensure both patients’ access to care and the financial health of their physicians.”  Read AAOS’ full comment letter…

Healthcare Policy News

Congress Passes Bill to Mitigate 2022 Medicare Pay Cuts

On December 9, Congress passed a bill to avoid several Medicare payment cuts that would otherwise have gone into effect Jan. 1. Specifically, the legislation delays the 4 percent PAYGO (Pay As You Go) cut until 2023, delays the 2 percent sequester cut until April 2022 (when it will start at 1 percent before going back up to 2 percent in July), and drops the 3.75 percent Medicare fee schedule cut to 0.75 percent. As a result, in 2022 orthopaedic surgeons will see a 0.75 percent cut from January through March, a 1.75 percent cut from April through June, and a 2.75 percent cut from July through December. AAOS appreciates that Congress once again heeded the pleas of the healthcare community by averting some of the cuts, but will continue to advocate for a long-term solution to Medicare’s broken payment system. Read AAOS’ media statement on the House bill…

CMS to Open Field Testing for Episode-Based Cost Measures

The Centers for Medicare and Medicaid Services (CMS), along with its contractor, Acumen, LLC, has announced that it will conduct field testing for five episode-based cost measures before consideration of their potential use within the Merit-based Incentive Payment System (MIPS) cost performance category. One of the measures being tested is ‘Low Back Pain,’ and participating clinicians or clinician groups with at least 20 episodes for the measure will receive a Field Test Report with information about their cost performance, for testing purposes only. Clinicians and other stakeholders who do not participate in the Field Testing may also provide anonymous feedback on the draft measure through an online survey. Both the field testing and survey will be open from January 10 to February 25. Check the MACRA Feedback Page after Jan. 10 for more details…

OrthoPAC Closes Out 2021 Strong, Prepares for Midterm Election

Despite a challenging political environment and start to the year, the AAOS Orthopaedic PAC (OrthoPAC) ended 2021 by raising close to $1.7M. It was also influential in several pressing 2021 legislative priorities including mitigating planned Medicare payment cuts, which were delayed until mid-2022; repealing the McCarran Ferguson Act that unfairly protected insurers from antitrust laws; and garnering support for the Dr. Lorna Breen Health Care Provider Protection Act, which helps reduce and prevent mental and behavioral health conditions, suicide, and burnout, as well as increase access to evidence-based treatment for physicians, medical students, and other health care professionals. The funds raised will help AAOS to continue this successful advocacy in 2022 with both chambers and both parties. AAOS members who are not already supporters of the OrthoPAC are encouraged to join its 2022 roster as it looks to invest in physician and physician-friendly candidates ahead of the midterm election.  Learn more and join OrthoPAC…

·         Year in Review: AAOS’ Advocacy Efforts Prove Successful (AAOS Now, December)

·         The Effects of Policy Changes and CON Laws on Ambulatory Surgical Centers (AAOS Now, December)

·         No Surprises Act faces multiple lawsuits against billing dispute provision (Healio, 1/5)