Advocacy in Action | January 21, 2021

Leadership Approves 2021 Unified Advocacy Agenda

The AAOS Board of Directors recently approved the 2021 Unified Advocacy Agenda (UAA). Set by the Advocacy Council each year, the UAA helps guide the AAOS’ advocacy strategy and ensure that its resources continue to be used to highlight the unique issues challenging orthopaedic surgeons and their patients. This year’s UAA prioritizes maintaining the sanctity of the physician/patient relationship by calling on AAOS to continue its work on relief from onerous prior authorization requirements and demanding that the surgeon remain in charge of setting of care determinations. Given the challenges that many orthopaedic surgeons have faced during the pandemic, it also highlights the criticalness of ensuring that AAOS members are able to continue serving their communities and maintain current staffing levels by calling for fair reimbursement rates for telemedicine visits and other types of burden relief. View the 2021 UAA… 

Value-Based Care Continuum Developed for Navigating Care Landscape

The Health Care Systems Committee within the AAOS Advocacy Council recently developed a value-based care continuum (VBCC) to help orthopaedic practices better understand and navigate various alternative payment models (APM) created to achieve value-based care. The existing landscape can be confusing and daunting, with many incentives and structures. Various stakeholders have different definitions for the same terms that are used in a clinical setting, which only adds to the complexity. The VBCC serves to create a universal lens for interpreting this—often opaque—value-based care landscape and make it more digestible and understandable. This includes identifying where a practice’s existing payment arrangements fall along the VBCC, understanding the transition sought by purchasers/payers to value-based care, and planning for continued changes in APM payer contracting arrangements. Learn more about the VBCC… 

Healthcare Policy News

New Administration Issues Healthcare Executive Orders

The Biden Administration began its tenure on January 20 by issuing multiple executive orders, including several that directly impact the public health response to COVID. The orders direct the United States to halt the process of withdrawing from the World Health Organization and rejoin with Dr. Anthony Fauci appointed as head of the U.S. delegation, and to require that masks be worn and physical distancing be maintained at all times on federal lands, in federal buildings, and by federal employees and contractors as well as during interstate travel. This action comes as part of the Administration’s “100 Days Masking Challenge” aimed at curbing the pandemic. The new Administration is also directing the Department of Education to extend the current pause on federal student loan payments to at least September 30. Beyond executive actions aimed directly at COVID, the Administration has ordered a regulatory freeze in order to review rules that the previous administration finalized in its last weeks. This process will occur in tandem with the development of a modern and equitable regulatory review system at the Office of Management and Budget. Read more about the executive orders…

Medicare Coverage of Innovative Technology Changes Finalized

On January 15, the Centers for Medicare & Medicaid Services (CMS) finalized changes to its coverage of innovative technology and definition of “Reasonable and Necessary.” When being proposed, the changes were seen by most stakeholders including the AAOS as a positive step for expanded device coverage for Medicare beneficiaries. The approval pathway remains voluntary and can afford up to four years of national Medicare coverage to newly FDA market authorized breakthrough devices. But perhaps the most significant change is that the device manufacturer now decides when coverage begins instead of it starting as soon as the device obtains market approval. Per CMS, this will allow manufacturers to better align coverage with the product’s market availability. When the coverage period ends, all current coverage options will be available such as a National Coverage Determination, Local Coverage Determinations, and claim-based decisions. Learn more about the changes…

COVID Relief Changes Related to Latest Stimulus Package

Following passage of the Consolidated Appropriations Act, 2021 in December, several changes were recently made to federal COVID economic relief programs. The Small Business Administration announced the reopening of applications for new loans through the Paycheck Protection Program. Small businesses and certain other industries may begin applying for the lesser of up to $10 million or an amount calculated using a payroll-based formula in forgivable federal loans to offset the impact of COVID. The Department of Health and Human Services also announced the release of new reporting requirements for recipients of the Provider Relief Fund. Certain recipients who have in sum received greater than $10,000 in relief funds can open a reporting account online, though there is not yet a reporting requirement deadline.  Learn more about financial relief programs…

Ohio Adopts New Law Aimed at Out-of-Network Billing

In December 2020, the Ohio General Assembly approved long-debated legislation aimed at addressing unanticipated out-of-network medical bills. The measure targeting state-regulated health insurance plans, House Bill 388, was then signed into law in January and is slated to take effect in early 2022. Health insurers will now be required to reimburse physicians, allied healthcare providers, facilities and ambulances for emergency and unanticipated out-of-network care. If the initial payment from the insurer is deemed insufficient and good faith negotiations fail to resolve the dispute, either party may initiate binding arbitration. The Buckeye State joins Georgia, Indiana, Maine and Michigan in passing legislation directed at unanticipated, out-of-network billing last year. The AAOS will continue to closely monitor these efforts in 2021. Read more about the new Ohio law… 

Political Contributions Suspended in Response to Attack on U.S. Capitol

As a result of the Jan. 6 attack on the U.S. Capitol, which the AAOS condemned in a recent message to the full membership, the nonpartisan Orthopaedic Political Action Committee (OrthoPAC) has suspended all political contributions to allow it time to assess its contribution criteria and strategy going forth. Recommendations from the AAOS Orthopaedic PAC Executive Committee will be reviewed and approved by the AAOS Advocacy Council and the AAOS Board of Directors. The AAOS remains confident that the PAC will emerge stronger and even more effective. Read the message to members..

·        Surgeon General calls on businesses to invest in community health (Modern Healthcare, 1/19)

·        Biden faces many healthcare challenges as he takes the helm at an unprecedented time (Healthcare Drive, 1/20)