Advocacy in Action | November 18, 2021

AAOS Encouraged by Congressional Pressure to Fix Surprise Billing Regulations

On Nov. 5, more than 150 members of Congress sent a letter urging regulatory agencies to amend new policies aimed at implementing the No Surprises Act. They argued that the new process for protecting patients from surprise medical bills does not create a balanced process for resolving payment disputes. Rather than allowing for all relevant information to be considered, the newly released regulations begin with the assumption that the insurer-formulated median in-network rate is the appropriate payment amount, establishing a de-facto benchmark rate. The AAOS has been extremely vocal about its concerns that this may lead to sweeping reductions in both out-of-network and in-network reimbursement over time In previous communications and advocacy action alerts, orthopaedic surgeons across the country have been encouraged to echo these same fears to their representatives in Congress. AAOS is encouraged by the pressure put on regulatory agencies through the letter to fix these policies and will share its own formal comments with AAOS members in the coming weeks. Read the letter from Congress…

AAOS Highlights Current State of Orthobiologic Regulation to the FDA

On Nov. 17, the AAOS proactively sent a letter to Acting Food and Drug Administration (FDA) Commissioner, Janet Woodcock, MD, highlighting the needs of the orthopaedic community in orthobiologic regulation. The letter identified continued enforcement of regulations on Human Cells, Tissues, and Cellular and Tissue-based products, clarification on the regulatory status of Concentrated Bone Marrow Aspirate and Cellular Bone Matrices, and the continued and enhanced use of Real-World Evidence as areas of focus in current and future orthobiologic regulation. This is a product area primed for innovation, and the AAOS hopes to encourage open dialogue with the agency in future regulation development. Read the letter to the FDA…

Healthcare Policy News

Cures 2.0 Introduced in U.S. House with AAOS-Priority Telemedicine Legislation

On Nov. 16, U.S. Representatives Fred Upton (R-MI) and Diana DeGette (D-CO) introduced their bipartisan Cures 2.0 legislation. The 173-page bill is designed to revolutionize how the U.S. provides care to patients and includes provisions aimed at speeding up the delivery of groundbreaking new cures, treatments, and innovations to those who need them most. If passed, the legislation would create a new Advanced Research Projects Agency for Health aimed at ending some of the world’s most difficult diseases such as cancer, diabetes, ALS, and Alzheimer’s. Importantly for orthopaedics, the bill includes the Telehealth Modernization Act which AAOS members advocated for during Orthopaedic Advocacy Week at the end of May. AAOS was one of the first major groups to widely advocate for the legislation, which would ensure continued telehealth flexibilities for patients and medical professionals. Learn more about the bill…

Bipartisan Infrastructure Bill Signed into Law

On Nov. 15, President Joe Biden signed into law the $1 trillion infrastructure bill. The bipartisan legislation first passed the U.S. House of Representatives with the support of 13 Republicans then passed the U.S Senate 69-30, an uncommonly bipartisan vote. The new law will put $550 billion in new money into transportation projects, the utility grid and broadband. It also includes $110 billion for roads, bridges and other major projects, along with $66 billion for passenger and freight rail and $39 billion for public transit. Notably, the measure will put $65 billion into broadband which has been a priority for many lawmakers after the coronavirus pandemic highlighted inequities in internet access for households and students across the country. Finally, the legislation will also invest $55 billion into water systems, including efforts to replace lead pipes. Read more about the infrastructure bill… 

Extreme and Uncontrollable Policy Will Automatically Apply to Individuals for 2021

In response to the ongoing COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) announced this week that it will automatically apply the extreme and uncontrollable circumstances policy to all Merit-based Incentive Payment System (MIPS)–eligible clinicians reporting individually for performance year 2021. Notably the policy does not apply to groups, virtual groups, or Alternative Payment Model (APM) Entities. The automatic policy reweights all performance categories to 0 percent so the clinician will receive a final score equal to the performance threshold and therefore avoid a negative payment adjustment for the 2023 payment year. Additionally, individual clinicians will receive a neutral payment adjustment unless they either submit data in two or more performance categories, or have a higher final score from group or APM Entity participation. Download the CMS factsheet… 

CMS Looking to Focus on Coverage, Equity and Value-based Care

The Centers for Medicare & Medicaid Services (CMS) has released new strategic plans for several of the programs that the agency oversees. CMS Administrator Chiquita Brooks-LaSure outlined these proposals for the Medicaid and Children’s Health Insurance Program, as well as for the Center for Medicare and Medicaid Innovation. Across both programs, mitigating the disparities caused by an inequitable healthcare environment will be a key priority. The agency plans to address this by increasing the quality of sociodemographic data collected, improving access to care for the uninsured, and easing the enrollment process through streamlined applications and robust community outreach. Parallel with this work, the Government Accountability Office released a report on the shift to alternative payment models (APMs) by Medicare providers in rural and underserved areas. The report, which AAOS was interviewed for during the research, discusses barriers to robust provider participation in APMs and the impact this has on patient access. Read more about the Medicaid plans… 

Resident OrthoPAC Members Invited to Virtual Pub Crawl

The Orthopaedic PAC is hosting an Ugly Sweater Pub Crawl for all 2021 resident PAC members on December 9 at 8:00 p.m. ET. Participants will have the chance to chat directly with four esteemed surgeons representing different orthopaedic sub-specialties: P. Maxwell Courtney, MD, FAAOS, for hip and knee; Theodore F. Schlegel, MD, FAAOS, for shoulder and elbow; Peter C. Amadio, MD, FAAOS, for hand; and Daniel K. Moon, MD, FAAOS, for foot and ankle. Residents will also have the opportunity to network with peers and learn about the importance of advocacy throughout an orthopaedic career. Join in the holiday fun by wearing your best ugly sweater! Please note that you must be a member of the Orthopaedic PAC to attend.  RSVP for the event…

·        Biden’s plan to stop surprise medical bills faces bipartisan pushback in Congress (NPR, 11/17)

·        Feds require health plans to report drug costs under new rule (Modern Healthcare, 11/17)