AAOS celebrates new proposals from CMS to address coding differentials between Medicare Advantage and Original Medicare.
AAOS submitted statements of record for hearings from the House’s Budget, Ways & Means, and Energy & Commerce committees on healthcare costs.
AAOS News
Advocacy Win: CMS Cracks Down on Upcoding in CY 2027 MA and Part D Advanced Notice
As steadfast advocates for improving Medicare beneficiaries’ quality of care, AAOS celebrates new coding proposals from CMS as a part of the CY 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and MA and Part D Payment Policies. Proposals include excluding diagnosis information from unlinked Chart Review Records — which is diagnosis information not associated with a specific beneficiary encounter — from risk score calculation starting in CY 2027. These updates aim to reduce administrative burden, create competition equally between MA plans based on value to patients, and ensure payments accurately reflect beneficiary health. This update marks an important step in MA reform and aligns with the AAOS-endorsed NO UPCODE Act introduced by Senators Bill Cassidy (R-LA) and Jeff Merkley (D-OR) last year.
Senate Delays Minibus, White House Deals with Dems
Following a failed vote late Thursday night, the White House and Senate Democrats have reached a deal to fund parts of the government including the Department of Defense (DoD) through the end of the fiscal year. Under the agreement, Homeland Security would be funded through the next two weeks while Republicans and Democrats come together to negotiate more controversial funding measures. DoD funding, including Congressionally Directed Medical Research Programs, is expected to be voted on by the House again Monday through the end of FY26.
House Budget Committee Hearing on Skyrocketing Healthcare Costs
On Jan. 21, the U.S. House Committee on Budget held a hearing titled “Reverse the Curse: Skyrocketing Health Care Costs and America’s Fiscal Future” examining healthcare affordability and policy hurdles that threaten it, including market consolidation, ACA extended subsidies, and Medicare Advantage program integrity. AAOS submitted a statement for the record highlighting Association priorities including prior authorization reform, downcoding, narrow networks, and other insurer guardrails concerning Medicare Advantage.
Ways & Means and Energy & Commerce Committees Meets with Healthcare CEOs
On January 21, the Ways and Means Committee held a hearing with health insurance CEOs on rising costs in healthcare. AAOS shared the committee’s goal of addressing the core drivers working against health care affordability — namely onerous government interference, administrative burdens, waste, fraud, and abuse, and lack of competition and patient choices. Ahead of the hearing, AAOS submitted a statement to the committee on the issues impacting musculoskeletal care teams and patients.
Several of these CEOs were also included in a hearing with the Energy & Commerce Committee on the 21st. Subcommittee Chairman Morgan Griffith (R-VA-9) called out how a repeal on the physician-owned hospital ban could help address healthcare consolidation: “Do any of you disagree that taking away the ban on physician-owned hospitals would increase competition in certain markets? Do you think there should be more competition in the insurance market, particularly in light of the fact that many of your companies own huge swaths of the healthcare industry?”
Political News
OrthoPAC Attends AOFAS Winter Meeting
The OrthoPAC team accepted an invitation to attend the Winter Meeting of the American Orthopaedic Foot and Ankle Society. This was the first time the OrthoPAC attended the meeting. They enjoyed a weekend of member engagement and robust fundraising. Dr. Wayne Johnson, chair of the OrthoPAC, and AAOS staff were excited to attend the meeting and look forward to doing so again in the future.
Congressional Retirements
As is often the case at the start of an election year, many elected officials have announced plans to retire or to seek other offices. Currently, there are at least 60 members of Congress who will not be returning, including notable members such as Rep. Nancy Pelosi (D-CA), Rep. Steny Hoyer (D-MD), Rep. Jodey Arrington (R-TX), and Rep. Don Bacon (R-NE). The Office of Government Relations team will continue to track retirements and prioritize candidate contact to ensure that new members are familiar with AAOS initiatives and priorities when the 120th Congress is gaveled into session next year.
