Advocacy in Action

Recap of August In-District Advocacy Event

AAOS fellows spent the month of August meeting with their congressional representatives in person, by video call or by telephone to advocate for high-priority issues of importance to the musculoskeletal community. Although fellows are annually encouraged to meet with their representatives in-district at this time of year–when Congress is typically in recess–this is the first time that AAOS has coordinated a nationwide campaign of this scale. Despite the many challenges presented as a result of COVID-19, the virtual nature of the event allowed for more orthopaedic voices to be heard at a time when physician leadership on healthcare policy is critical. OrthoPAC ran a parallel peer-to-peer campaign during the event and raised just shy of $150,000–the highest amount of hard dollars ever raised in the month of August (see full infographic)

Healthcare Policy News

CMS Finalizes 2021 Inpatient Prospective Payment System Rule

Last week, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2021 Hospital Inpatient Prospective Payment System (IPPS) final rule. Among the notable finalized changes are the creation of new Medicare Severity-Diagnosis Related Groups (MS-DRGs) 521 and 522 for Hip Replacement with Principal Diagnosis of Hip Fracture, with or without major complication or comorbidity. Other changes include a New Technology Add-On Payment for the SpineJack Expansion Kit and broadened flexibility in Graduate Medical Education policy for displaced residents. The final rule reflects the Administration’s continued shift toward price transparency through a change in methodology for calculating MS-DRG relative weights based on the inclusion of Medicare Advantage median payer-specific negotiated charges by hospital. CMS states that it plans to begin incorporating this market-based data into the MS-DRG calculations beginning in FY 2024.

New Code Created for COVID-19 Practice Expenses

A new current procedural terminology (CPT) code has been created by the American Medical Association (AMA) to capture the additional costs endured during the COVID-19 pandemic. Physicians have been bearing the brunt of these additional expenses including extra sanitizing supplies, personal protective equipment, patient masks, as well as additional staff time to sanitize rooms, evaluate patients prior to admittance and other safety protocols. CPT code 99072, Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease,” is effective September 8 and may be reported until the end of the public health emergency which is set to expire October 23. Per AMA CPT guidance, code 99072 may be reported once per patient in-person encounter regardless of the number of services performed and should only be reported in a non-facility setting. Documentation requirements and coverage may vary among payers, so AAOS members should contact payers for specific policies.

CMS Rule Would Make Latest Medical Technologies More Accessible

On August 31, the Centers for Medicare & Medicaid Services (CMS) issued a proposed a rule that would provide Medicare beneficiaries with access to new treatments, tests, and medical technologies. The Medicare Coverage of Innovative Technology proposed rule would allow beneficiaries faster access to products considered “breakthrough” by the Food and Drug Administration (FDA). National coverage would be provided by Medicare simultaneously with FDA approval for four years, after which time the technology in question would be subject to reevaluation by CMS. The proposed rule also clarifies the “reasonable and necessary” standard CMS uses to determine whether Medicare should cover a product, like a drug, device, or biologic. Public comments will be accepted until November 2.

Seeking Applications for the PAC Resident Fellowship

The American Association of Orthopaedic Surgeons (AAOS) Political Action Committee (PAC) Resident Fellowship Program is designed to encourage participation of orthopaedic residents in the political and advocacy efforts of the Orthopaedic PAC. This program offers residents the opportunity to gain a greater understanding of the importance of the PAC while also bringing applicable experience and knowledge that will contribute to increased engagement among resident members in the PAC. The Fellow will also serve as a voting member on the PAC Executive Committee providing resident representation to the group. Through interaction with senior AAOS management, work on various PAC projects and participation in a strategy for increasing resident engagement with the Orthopaedic PAC and the AAOS’ broader advocacy efforts, the PAC Resident Fellow will develop a strong foundation toward future leadership within the AAOS. This position is open for applications until October 1.

·        Senate Democrats block Republicans’ “skinny” stimulus bill (Axios, 9/10)

·        CMS rule stipulates hospitals will receive 2.7% pay boost for inpatient Medicare services (Healthcare Finance, 9/3)

·        Survey: Insurance Companies Should Pay for Unexpected Out-of-network Bills (DBusiness Magazine, 9/8)