Advocacy in Action | April 1, 2021

Surprise Billing Principles Outlined Ahead of Rulemaking

Last week, the AAOS presented key principles for finally putting an end to surprise medical bills to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. Although the “No Surprises Act” was signed into law in December 2020 after almost two years of debates, discussions and mark-ups, many specifics of the legislation remain up to interpretation and will be ironed out through federal rulemaking. The implementation questions generally fall into three categories: breadth of the surprise billing ban, details of the median in-network rate calculation, and mechanics of the arbitration process. To preempt this upcoming process, which is mandated to occur before the end of 2021, AAOS reiterated its policy priorities in a letter to the agencies. It acknowledged that the newly passed legislation included several AAOS asks and will plan to comment further when the proposed rule is released later this year. Read the AAOS letter… 

Upcoming Webinar to Cover Medicare Physician Payment Policy Changes

As previously reported and many members are aware, the Centers for Medicare & Medicaid Services (CMS) recently finalized significant cuts to the reimbursement values for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in its Calendar Year 2021 Medicare Physician Fee Schedule final rule The agency also finalized a significant reduction to the Conversion Factor in the annual rule. Thanks to advocacy by the AAOS and other specialty societies, the Consolidated Appropriations Act modified this change by increasing the Conversion Factor recalculation. In the webinar, taking place April 15 from 7:15pm – 8:15pm CT, hosts John Heiner, MD, FAAOS and Frank Voss, MD, FAAOS will go over the CMS payment policy changes in detail while focusing on TKA/THA, how we got to this point, and what is being done to rectify the reduced reimbursement values for these procedures and to lessen the impact on orthopaedic surgeons. Register for the webinar… 

Healthcare Policy News

Delay of Medicare Sequester Cuts Passes Senate, Awaits House Action

On March 25, the Senate voted to delay $18 billion in Medicare payment cuts through the end of the year. The 2% federally mandated Medicare sequester cuts, which originally took effect in 2013, were paused by Congress last year in response to the pandemic and its effect on healthcare providers’ finances. They were scheduled to resume next week absent congressional action, but organizations like the AAOS advocated for an extension of the moratorium, arguing the pandemic continues to negatively impact the healthcare industry. The bill is expected to pass the House when representatives return in April and then will be signed into law by President Joe Biden. In anticipation of this congressional action, the Centers for Medicare and Medicaid Services issued a temporary hold on claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. Meanwhile separate from the Medicare sequester cuts, the AAOS will continue to push Congress to prevent an additional 4% cut to Medicare payments that is scheduled to take place at the end of this year. Read more about the bill…

Biden Healthcare Appointees Moving Through Nomination Process

In the last week, several of President Biden’s nominees for key health roles have been finalized. Vivek Murthy, MD, has been confirmed as U.S. Surgeon General, returning to a role he assumed under the Obama administration. According to Dr. Murthy, his priorities in office will focus on the ongoing COVID-19 pandemic, as well as mental health and substance abuse disorders. Rachel Levine, MD, has been confirmed as Assistant Secretary for Health, serving under the recently confirmed Secretary of the Department of Health and Human Services (HHS) Xavier Becerra. However, Centers for Medicare and Medicaid Services nominee Chiquita Brooks-LaSure has yet to have a confirmation hearing scheduled in the Senate. The nominee for Deputy Secretary at HHS, Andrea Palm, has also not yet had a confirmation hearing scheduled. Other key positions, including Food and Drug Administration Commissioner and Director of the White House Office of Management and Budget are still awaiting nominees. Read more about the FDA nomination…

Efforts to Expand, Preserve COVID-19 Liability Protections Increasing in States

States have employed a variety of legislative and executive actions throughout the COVID-19 pandemic to respond to medical liability concerns voiced by the medical community for physicians providing care on the front line, as well as those who have utilized telemedicine or may have been forced to make treatment decisions based on government directives. Many of those actions remain in effect, and at least six states so far this year have either extended existing protections or passed new legislation targeting COVID-19 related liability issues (AL, ID, IN, MT, SD, WV). Preserving liability protections at the state level is a priority for the AAOS. Last week, it joined with a group of medical associations and businesses in requesting that New York Gov. Andrew Cuomo veto Assembly Bill 3397, a proposal which could be devastating to health care professionals and facilities in the Empire State. The pending measure would eliminate guarantees that physicians and other health care professionals will not be held responsible for circumstances outside of their control during the pandemic. Read the letter to Gov. Cuomo….. 

First Quarter Newsletter of 2021 Now Available

The AAOS Orthopaedic PAC (OrthoPAC) has published its first quarter newsletter of 2021. The newsletter includes the following information on what the PAC accomplished in the last election cycle as well as this spring for the 2022 cycle ahead. Read the full newsletter… 

• Letter from OrthoPAC Chair John T. Gill, MD, FAAOS, outlining the need for members to stay engaged in the political process. “As we look towards the future, we know that unity will prevail,” wrote Dr. Gill. “Let us remember that as professional healers, we can work together to help heal the nation’s divide.”
• Snapshot of OrthoPAC’s activities and successes in the 2020 Election Cycle
• Updated OrthoPAC contribution criteria for the 2021-2022 election cycle
• Benchmarking OrthoPAC against other top PACs in the Medical and Dental Community in 2020
• PAC out the MAP 2020 state rankings – Advisors Circle Update
• Glimpse of the healthcare decisionmakers in the 117th Congress

·        Representing Members in the Nation’s Capital (AAOS Now, March)

• Legislative Updates in Tort Reform (AAOS Now, March)

·        Medical liability insurance premiums rising after stable decade, AMA report finds (Healthcare Dive, 3/30)

·        New cost-cutting Medicare rule may add costs to patients‘ (Washington Post, 3/21)