Advocacy in Action | October 21, 2021

Action Alert: Demand Correct Implementation of the No Surprises Act

In its attempt to implement the No Surprises Act, which became law in late 2020 and aimed to fix the problem of unanticipated medical bills, the Biden Administration has crafted regulations that disregard congressional intent and are inconsistent with the carefully negotiated statutory language. The recently released second interim final rule (see AAOS summary) gives priority to the insurer-formulated median in-network rate over all other factors when adjudicating a payment dispute, which may lead to sweeping reductions in both out-of-network and in-network reimbursement over time. AAOS members are encouraged to join AAOS in demanding that the No Surprises Act be correctly implemented by specifying that the arbiter should not default to the median in-network rate and should instead consider all of the factors outlined in the statute without disproportionately weighting one factor. Ask your representatives to sign onto the congressional letter being led by U.S. Representatives Tom Suozzi (D-NY) and Brad Wenstrup (R-OH) before the Oct. 29 deadline. Take action on this issue…

Healthcare Policy News

Reps. Bera, Bucshon and 245 Others Lead Charge Against Medicare Cuts

Last week, U.S. Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) led a letter with 245 other congressional colleagues to Speaker Nancy Pelosi (D-CA) and Leader Kevin McCarthy (R-CA) regarding the looming Medicare payment cuts set to take effect January 1, 2022. In the letter, they urge Congress to extend the 3.75% Medicare physician fee schedule conversion factor increase which was established by the Consolidated Appropriations Act of 2021. Collecting congressional signatories for the letter was a primary goal of AAOS during the recent combined National Orthopaedic Leadership Conference and fall meeting. AAOS members complimented the ask by sending nearly 700 grassroots messages to their members of Congress in support of the letter through the action advocacy center. Separate from this effort, AAOS is diligently advocating against other upcoming cuts to Medicare including the 2% sequester cut and 4% PAYGO cut. Learn more about advocacy on this issue…

Bipartisan Prior Authorization Reform Bill Introduced in the Senate

Yesterday, U.S. Senators Roger Marshall, MD (R-KS), Krysten Sinema (D-AZ), and John Thune (R-SD) introduced the Senate version of the Improving Seniors’ Timely Access to Care Act. The bipartisan legislation, that is supported by 320 organizations including AAOS, would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization in Medicare Advantage plans while also providing additional oversight and transparency. The House version of the legislation was introduced in May of 2021 by U.S. Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD (D-CA), and Larry Bucshon, MD (IN-08). Garnering support for this legislation has been a goal during both AAOS’ Orthopaedic Advocacy Week in May and the recent combined National Orthopaedic Leadership Conference (NOLC) and fall meeting. Thanks in part to these efforts, the House version has obtained 234 congressional cosponsors, surpassing the all-important threshold of gaining support from a majority of the House of Representatives. Learn more about advocacy on this issue… 

Public Comment Period Opens for Hip/Knee Performance Measure

On October 19, the call for public comment on the Total Hip Arthroplasty and/or Total Knee Arthroplasty Patient-Reported Outcome-Based Performance Measure (PRO-PM) opened via the Centers for Medicare & Medicaid Services (CMS) website. According to the agency, the measure was designed to assess the quality of care provided to Medicare beneficiaries by clinicians and clinician groups performing elective primary THA and/or TKA procedures using patient-reported outcome (PRO) data. It should also be noted that the measure was developed with input from AAOS and AAHKS experts and, if implemented, will support the growth of orthopedic-specific Merit-based Incentive Payment System measures. CMS is requesting that the public provide feedback on the measure via email by November 17. Read more or submit comments… 

Francis Collins Leaves Top Post at the National Institutes of Health

Longtime director of the National Institutes of Health (NIH) Francis Collins, MD, Ph.D., announced his plan to retire at the end of 2021. Dr. Collins served as the head scientist leading the organization for 12 years and is known for leading the All of Us Research program examining environment, lifestyle, and biology, as well as initiatives on addiction, brain disorders, and cancer. Most recently, Dr. Collins led the efforts to study COVID-19 and prevent the long-term effects of COVID. Although he will be stepping down from the leadership role, he will continue his work at the National Human Genome Research Initiative. The search for a new director, which is a presidentially appointed position, has already begun. Read more… 

Research Demonstrates Startling Rise in Health Insurance Market Consolidation

A new analysis from the American Medical Association has revealed that a staggering 73 percent of the nation’s insurer markets can be classified as highly concentrated, resulting in higher premiums and narrower networks – both of which are root causes of unanticipated medical billing. The findings can help federal and state antitrust authorities identify markets where consolidation involving health insurers may be driving competitive harm and scrutinize the impact of further proposed mergers. The full report includes maps showing the market share of the largest insurer in each state, one detailing the 10 states with the least competitive commercial health insurance markets and the 10 states with the least competitive PPO and exchange markets. Read the full report…

Registration Now Open for Virtual Physician & Dental Candidate Workshop

The OrthoPAC is co-hosting a one-day virtual candidate workshop on Friday, November 5, 2021 designed specifically to help physicians run for elected office at all levels. Workshop participants will learn important campaign preparatory information from a multitude of political experts including nationally renowned political consultants. Among the topics that will be covered are how to develop a campaign plan, messaging and fundraising strategies, the importance of polling and the pros and cons of various communication outlets. Participants will receive a realistic outlook on how to run a modern and well-executed campaign for any elected office from School Board or City Council to the U.S. Congress. Whatever your political goals are, the workshop will provide the necessary tools for you to succeed! Please note, you must be a member of the Orthopaedic PAC to attend the workshop and should RSVP by November 1 to Brittany Starr at starr@aaos.org.  Learn more about the workshop..

·        A No-nonsense Explanation of the Impending Cuts to Your Medicare Reimbursements (AAOS Now, October)

·        Understanding Ambulatory Surgical Center Ownership Models (AAOS Now, October)

·        Lawmakers clash over surprise billing law’s implementation (Roll Call, 10/20)

·        ‘Proof will be in the execution’: CMS plan focuses on accountable care (Modern Healthcare, 10/20)

·        More Physicians Are Now Employees Rather Than Owners (MedPage Today, 10/14)