Advocacy in Action

AAOS News

AAOS Advocates for Clear Process to Step Therapy Protocols
The AAOS recently joined in sending a letter to Senators Lisa Murkowski (R-AK), Maggie Hassan (D-NH), Roger Marshall, MD (R-KS), and Jacky Rosen (D-NV) in support of their Safe Step Act of 2023 (S. 652). The bill, which was reintroduced for the 118th Congress in early March, would establish guidelines for use of step therapy protocols and require a clear and transparent process for physicians and patients to request exceptions. Step therapy requires patients to try and fail on a lower cost drug before their health insurance plan will cover more costly medicine originally prescribed by their physician, and can delay care or lead to adverse health consequences. On May 11, the Senate Health, Education, Labor and Pensions Committee held a markup and passed the Pharmacy Benefit Manager Reform Act (S. 1339), which included the Safe Step Act (S. 652) as an amendment. The bipartisan legislation now heads to the Senate floor, where AAOS is urging for passage and creating a clear process for physicians and patients to seek exceptions to step therapy protocols. Read the full letter of support…

AAOS Resource Explains Impact of Public Health Emergency End for Members
Using a new resource created by the AAOS, orthopaedic surgeons can review the status of waivers and flexibilities after the end of the COVID-19 Public Health Emergency. The emergency, which officially ended on May 11, was first declared  by the Secretary of the State Department of Health and Human Services (HHS) in January 2020. It underwent several renewals and authorized the federal government to set waivers and flexibilities required for modified healthcare delivery during the pandemic. This new resource outlines waivers and flexibilities, including end dates, extension clauses, and permanent rulings now that the public emergency has come to an end. It should also be noted that Congress enacted legislation, including the Consolidation Appropriation Act, 2023 (CAA), to extend some waivers as well as provide new ones.  View the new AAOS resource…

State News

South Carolina Substantially Repeals Certificate of Need Policy
Last week, in a significant victory for physicians and the patients they serve, South Carolina Gov. Henry McMaster signed into law a measure to overhaul the state’s antiquated certificate of need (CON) program. S.164 repeals CON requirements for 85% of expenditures and services, leaving CON in place only for the construction of new hospitals in counties with an existing hospital (but not in counties without one), bed expansion, and nursing homes. In 2027, CON will be fully repealed for construction of new hospitals and bed expansion. Passage of this legislation is the culmination of years of effort by the South Carolina Orthopaedic Association, with financial support from the AAOS State Orthopaedic Society Health Policy Action, and follows the recent passage of another CON reform bill in North Carolina this year. Read more about this advocacy win…

Healthcare Policy News

Momentum Continues on Prior Authorization Reform
Large insurers continue to face growing scrutiny on Capitol Hill regarding their use of automation and software algorithms to deny patient claims and physicians’ prior authorization requests. On May 17, the Senate Governmental Affairs and Homeland Security Committee held a hearing to examine healthcare denials and delays in Medicare Advantage. The Senate panel also sent letters to the nation’s three largest Medicare Advantage insurers asking for details and records on the role software algorithms play in prior authorization denials and delays. The panel’s investigation comes on the heels of a ProPublica report which found that Cigna was using algorithms to allow its employed physicians to sign off on large batches of claims denials without reading the details of the claims. In a sign of growing bipartisan momentum, the House Energy and Commerce Committee also sent a letter to Cigna last week seeking more details on its use of automation to deny claims. The AAOS will continue to advocate for prior authorization reform and putting decision-making power in the hands of physicians and their patients. Read the letter to Cigna…

Physician-Owned Hospitals Highlighted in Health Care Competition Hearing
The House Ways and Means Health Subcommittee held a hearing last week on the role of anti-competitive practices in making health care more expensive. Health Subcommittee Chair Rep. Vern Buchanan kicked off the hearing by highlighting the federal prohibition on physician-owned hospitals as one of the key forces that is driving down competition and driving up prices for patients. Lawmakers on both sides of the aisle criticized the monopolies created by vertical integration among PBMs, pharmacies, and large insurers, which limit competition and transparency and drive up costs both for Medicare and its beneficiaries. While the subcommittee did not reach a consensus on solutions to this problem, there is broad bipartisan agreement that Congress must act to improve competition in the health care system, and AAOS will continue to advocate for making physician-owned hospital growth and expansion part of that solution. Watch the hearing…

OrthoPAC Continues Support for Bipartisan House Problem Solvers Caucus

OrthoPAC recently renewed its membership for the Across the Aisle PAC (D) and the PAC Unitatis (R), the respective PACs for the Problems Solvers Caucus consisting primarily of 58 House moderates from both parties. The caucus was formed in January 2017 to “break the gridlock” Membership must remain equal for both parties; if a member wishes to join the caucus, he or she must recruit a member of the opposite party to join as well. OrthoPAC is committed to bipartisan solutions and will continue to work with both the Problem Solvers Caucus and bipartisan members in the Senate. As more congressional members pledge to work together, AAOS legislative priorities—many of which are bipartisan “white hat” issues—will have better outcomes.  Read more about this in our new AAOS Now series..

• 70% of orthopedic surgical care will migrate to ASCs, predicts 1 CEO (Becker’s, 5/24)
• What you need to know about Biden’s antitrust enforcement (Modern Healthcare, 5/24)
• Denials of health-insurance claims are rising — and getting weirder (Washington Post 5/17)