Advocacy in Action

AAOS News

Two Week Countdown to 2023 Orthopaedic Advocacy Week
In two weeks, from July 24-28, orthopaedic surgeons across the United States will have the opportunity to influence and ignite change for key healthcare policy issues impacting musculoskeletal care. Daily activities during the completely virtual grassroot advocacy effort include sending prewritten letters to Congress, supporting regulatory messages, sharing and amplifying social media, and investing in the Political Action Committee of the American Association of Orthopaedic Surgeons to strengthen the community’s voice on Capitol Hill. There is power in numbers, and AAOS hopes you will join us for 2023 Orthopaedic Advocacy Week. More details about the specific healthcare policy issues and daily activities are forthcoming. Learn more about the virtual advocacy effort…

AAOS Joins Organizations in Outlining Plan for Physician Payment Reform
AAOS recently joined a coalition of medical organizations representing the surgical specialties in outlining a plan for reforming the Medicare physician payment system. They emphasized that a shift in policy direction is necessary to provide Medicare patients with high-quality, patient-centered, value-based care, then followed with a list of short-term measures that must be enacted by the current Congress and Administration:

1. Stop all Medicare physician payment cuts scheduled for calendar year 2024
2. Establish an annual Medicare Economic Index (MEI) update
3. Eliminate certain budget neutrality requirements
4. Halt implementation of the G2211 add-on code
5. Appropriately value the global codes
6. Avoid payment cuts due to MEI rebasing
7. Keep Medicare savings in the Medicare program

Long-term, the plan says that Congress must exercise its oversight authority over Medicare payment policy to ensure a stable environment that allows multiple physician practice models to thrive. Read the full plan…

Healthcare Policy News

Medicare Proposes New Process for Emerging Medical Device Technologies
On June 22, the Centers for Medicare & Medicaid Services (CMS) released a notice with comment period regarding a new process it plans to use to provide transitional coverage for emerging technologies (TCET). CMS intends to use this process to deliver transparent, predictable, and expedited national coverage for certain eligible ‘Breakthrough’ devices that are market authorized by the Food and Drug Administration (FDA). This rule is the successor to a similar rule that the Trump Administration had proposed in 2020 but was later rescinded by the Biden Administration. If finalized, the rule would create a streamlined process for Medicare beneficiaries to access new technologies while device manufacturers continue evidence development in partnership with the FDA and CMS. AAOS is in the process of reviewing the rule and will submit comments ahead of the August deadline  Read AAOS’ rule summary…

Upcoming Regulatory Changes To Affect Some Orthopaedic Practices
Outpatient Facet Joint Interventions Now Require Prior Authorization
Beginning July 1, the Centers for Medicare & Medicaid Services (CMS) now requires prior authorization for Facet Joint Interventions performed in a hospital outpatient department. The new service category applies to  Current Procedural Terminology® (CPT®) codes 64490-64495 and 64633-64636 when performed in a hospital outpatient department (OPD) place of service 19 (off-campus outpatient hospital), or 22 (on-campus outpatient hospital). AAOS strongly opposes this new requirement which creates unnecessary burden for physicians. Other services that require prior authorization are cervical fusion with disc removal and implanted spinal neurostimulators, among others. AAOS members are encouraged to monitor communication from their respective Medicare Administrative Contractor and send feedback regarding the new service category…

Voluntary Reporting Begins for THA/TKA PRO-Based Performance Measure

Also beginning July 1 is the second of two voluntary reporting periods for total  hip arthroplasty/total knee arthroplasty (THA/TKA) patient-reported outcome-based performance measure (PRO-PM) in the Hospital Inpatient Quality Reporting (IQR) program. CMS is conducting two voluntary reporting periods before mandatory reporting begins July 1, 2024 for the FY 2028 payment determination. AAOS previously requested a slower adoption ramp and adequate feedback to hospitals and affected practitioners before mandatory reporting begins. AAOS members should note that this is a hospital/inpatient measure and not a physician quality measure. Read more detail about the program…

OrthoPAC Attending Upcoming AOSSM Meeting

The AAOS Orthopaedic PAC (OrthoPAC) will be attending the American Orthopaedic Society for Sports Medicine (AOSSM) in Washington, D.C. July 13-15. Attendees are welcome to come by the OrthoPAC table to learn how OrthoPAC is advancing the legislative agenda for the AAOS, including reforming the burdensome prior authorization process and fighting Medicare reimbursement cuts. OrthoPAC will also be hosting its first “Pledge Your Allegiance” fundraising campaign to see which state or specialty conference will come up on top! AOSSM attendees can text ACC, BIG10, or SEC to 41444 to support their conference and specialty.  Request OrthoPAC attendance at your state or specialty meeting…

• Congressmen Seek to Reduce Prior Authorization Burden (AAOS Now, June)
• Medicare’s new proposal to cover medical devices draws a mixed reaction (STAT, 6/30)
• Legislators urge CMS to finalize prior authorization reforms—and go further (Fierce Healthcare, 6/22)