Advocacy in Action

Recap of Orthopaedic Advocacy Week

From May 24-28, AAOS members amplified year-long advocacy efforts on behalf of the musculoskeletal community during Orthopaedic Advocacy Week. The first-ever completely virtual event comprised of daily advocacy activities for delivering critical messages to lawmakers on key healthcare policy issues including prior authorization reform, flexibility for telemedicine services, as well as reducing and preventing mental health issues for healthcare professionals. The concerted effort of 249 event registrants from 39 states and Puerto Rico resulted in 582 letters sent to policymakers from the Advocacy Action Center, 202 meetings with legislators, and 81 member signatories on AAOS-led regulatory letters. As part of the event, the Orthopaedic PAC hosted a “Day of Giving” sweepstakes that raised $269,111 from 986 contributors (read more in below OrthoPAC Corner). View event recap infographic…

Prior authorizations on procedures can be a cumbersome process. Each payer may have different policies and guidelines on which procedures require prior authorization, making it difficult for physicians and their staff to keep track of changing policies. This upcoming webinar presented by Eric Stiefel, MD, FAAOS and Christopher Kauffman, MD, FAAOS, from 7:15 PM – 8:15 PM CT on July 8 will go over in detail the burden prior authorizations and peer-to-peer review process takes on physicians, as well as strategies to work through these hurdles. Register for the webinar…

Healthcare Policy News

Congress Asks for Greater Transparency in Value-Based Care Models

The Center for Medicare and Medicaid Innovation (CMMI), a product of the Patient Protection and Affordable Care Act, has been a point of frustration due to the lack of information/communication the agency provides to participants. Last week, a group of 24 bipartisan congressional legislators sent a letter to CMMI Director Liz Fowler requesting additional transparency and insight into the value-based care models the center oversees. Lawmakers stated that real-time data and information would better inform the impact of models on healthcare professionals and patients, and that the agency should allow more stakeholder engagement. They also requested disclosure of the modeling that produces estimates of savings and how quality can be affected. Read the full letter…

Health Provisions Within President Biden’s FY 2022 Budget Request

Earlier this month, President Joe Biden released his FY 2022 budget request. Although the funding levels are not formalized until congressional appropriators choose to officially enact them, the annual request signifies areas of priority and investment for the Administration. There were numerous healthcare items within the request, however some of the largest areas of investment fell within the $133.7 billion for the Department of Health and Human Services which would be a 23% increase from the FY 2021 budget.

• $8.7 billion for the Centers for Disease Control and Prevention, a $1.6 billion increase from the 2021 enacted level;
• $10.7 billion in funding for efforts to combat the opioid crisis;
• $1.6 billion for the Community Mental Health Services Block Grant;

The budget area also includes funds for the Health Resources and Services Administration to help rural healthcare professionals stay open and care for their rural communities, as well as increased funding for rural residency programs. Learn more about the FY 2022 budget request…

Texas Becomes Latest State to Advance Prior Authorization Reform

In the final days of this year’s 87th Texas Legislature, the Texas Orthopaedic Association joined with other physician organizations and patient advocates in helping to advance legislation reigning in unnecessary prior authorization hurdles that delay patient care. If signed by Texas Gov. Greg Abbott, House Bill 3459 will create a “gold card” for surgeons who were approved at least 90 percent of the time for a specific service during the most recent six-month evaluation period, no longer requiring them to seek prior authorization for that service for the next six months. The measure would apply to state-regulated health plans, including some HMO and PPO plans and the state’s employee and teacher plans. See the legislation… 

Approximately $270,000 Raised for Day of Giving

On May 28, the Orthopaedic PAC held its inaugural “Day of Giving” as part of the AAOS Orthopaedic Advocacy Week. All 2021 PAC donors who contributed  on or before that day were automatically entered into a sweepstakes drawing for the chance to win the trip of a lifetime. The event was a resounding success having raised $269,211 from 987 contributors, 20% who were first-time contributors and 25% who increased their contribution from 2020. David Thordarson, MD, FAAOS, and Michael Schuck, MD, FAAOS, were the sweepstakes winners. Although the event has passed, it is not too late to become a member of the OrthoPAC and help strengthen its power to fight numerous healthcare policy challenges – reforming prior authorization, ensuring flexibilities for valuable telemedicine services, and mitigating the up to 10% Medicare payment cuts that orthopaedic surgeons face at the end of this year. Read more about Day of Giving…

·         Newest Podcast Addresses How AAOS Identifies and Tackles ‘Active Pursuit’ Issues (AAOS Now, May)

·         Physician Organizations Challenge PA Name Change (MedPage Today, 6/9)

·         How Covid-19 Reshaped The Telemedicine Market (Forbes, 6/8)

·         Lawmakers call for CMMI to be more transparent and accountable as model review continues (Fierce Healthcare, 6/3)

·         Expanding insurance coverage is top priority for new CMS administrator (Modern Healthcare, 6/3)