Bundled Payment Model Starts, AAOS Shoulder Coding Success, Senate Health Innovation Markup, and More
For questions or concerns on these or other advocacy issues, contact the Office of Government Relations at dc@aaos.org.
AAOS Changes CMS Position on Shoulder Coding Issue

Last week, the Centers for Medicare and Medicaid Services (CMS) shared a letter with the American Association of Orthopaedic Surgeons (AAOS) indicating that they will be remedying a shoulder coding issue after AAOS expressed concern about current coding practices. AAOS President Gerald R. Williams, Jr., MD along with Louis F. McIntyre, MD from the Arthroscopy Association of North America (AANA) and William Shaffer, MD, AAOS Medical Director, met with CMS officials in March, 2016 to discuss the issue. At the meeting, AAOS asked CMS to eliminate National Correct Coding Initiative (NCCI) edits for certain code pairs, arguing that the shoulder is technically three anatomic synovial joints and two articulations. The CMS policy had allowed the agency to deny payments when these procedures are performed or billed together. Specifically, their edits have denied CPT code 29823, Arthroscopic Shoulder Debridement, extensive, with several other arthroscopic shoulder procedures such as CPT code 29827, Arthroscopic Rotator Cuff Repair, or CPT code 29824, Arthroscopic Distal Claviculectomy.

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CJR Payment Model Starts

The Comprehensive Care for Joint Replacement (CJR) model – a bundled payment program mandated by the Centers for Medicare and Medicaid Services (CMS) – officially kicked in on April 1, 2016. The model affects hospitals in 67 geographical areas and targets the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements, both elective and non-elective, as well as other lower extremity joint replacement procedures and the repair of hip fractures.

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Don’t let small distractions come in the way of
safety while driving

Be our partner and help to spread the word in your communities

April is Distracted Driving Awareness Month. The American Academy of Orthopaedic Surgeons is releasing its “No Small Distractions” videos as public service announcements to television stations throughout the country to further highlight the importance of safety behind the wheel.

Each video features an individual with an oversized distraction—a giant lipstick, smartphone, electric razor, steaming cup of coffee, or box of French fries—while unsuccessfully trying to walk, ride a bike, or drive a pedicab. The segments conclude with the same individuals wielding real-size distractions while driving.

The final message is sobering: Distractions behind the wheel may not be as small as they seem.
No Such Thing as a Small Distraction

Click here to read more and view more videos.

Senate Committee Concludes Medical Innovation Work

On Wednesday, April 6, 2016 the Senate Health, Education, Labor and Pensions (HELP) Committee wrapped up work on their medical innovation package with a third and final markup, passing five bipartisan bills including two reform measures for the National Institutes of Health (NIH). The first bill passed by the committee (S. 2745) seeks to enhance NIH’s diversity in clinical research. According to reports, it also calls for the NIH to specify research priorities through the establishment of a 6-year strategy focused on discerning new scientific opportunities and assessing the nation’s disease burden. The second NIH-related bill, the Promoting Biomedical Research and Public Health for Patients Act (S. 2742), would streamline reporting requirements and increase accountability.

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GME Legislation Introduced in House

On March 17, 2016, just before the 2016 Match Day, Rep. Kathy Caster (D-FL) re-introduced the Training America’s Doctors Today Act (H.R. 4774). The bill comes at a time where the ever-looming shortage of physicians is very real – in fact, the nation will face a shortage of up to 90,000 physicians by 2025, according to a report released last March by the Association of American Medical Colleges (AAMC). The comprehensive study took into account demographics and recent changes to care delivery and payment models. The projected shortages were across the board, with specialty shortages particularly serious.

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Register for NOLC Capitol Hill Visit Training Webinar!

Register online by clicking here.

Register Now!
NOLC Capitol Hill Visit Training Webinar
Dates: April 12, 19 and 26 (Tuesdays)
Time: 8:15 am Eastern Time

Featuring: Thomas Barber, MD, Chairman, Council on Advocacy
Cost: Free

At the 2016 National Orthopedic Leadership Conference (NOLC)
you will have the opportunity to meet with many influential members of Congress.
This webinar will offer will offer tips and suggestions to make your visits as effective and productive as possible, including messaging on priority issues, responding to objections and the sucessful use of social media in advocacy.


What We’re Reading

House to Vote on Bills to Combat Opioid Abuse, The Washington Post, 4/7/16

Many Hospitals to Feel Pinch of New Joint Replacement Rule, MedPage Today, 4/7/16

Cancer Drugs Most Affected by Medicare Drug Payment Proposal, Morning Consult, 4/7/16

Senators Advance Medical Cures Bill, Push for More Funding, The Hill, 4/6/16

Pfizer, Allergan to Hunt for Deals of Their Own, The Wall Street Journal, 4/6/16

Many Americans Say Higher Prices Don’t Mean Better Healthcare, Reuters, 4/6/16

Senate Health Committee Faces Deadline for Medical Innovation, Morning Consult, 4/5/16

Brave New World: Medicare’s Advanced Payment Models, Health Affairs, 4/4/16

States Continue Push to Regulate Telemedicine, FierceHealthIT, 4/4/16

Medicare Advantage Payments to Rise Slightly, The Hill, 4/4/16

CMS Banks on Medicare Value-Based Insurance Test, Modern Healthcare, 3/30/16

Obama: Opioid Treatment Too Scant, ‘Underresourced,’ Roll Call, 3/29/16


Election 2016 Graphic of the Week

Click here to dowload graphic.


Pre-Certification Alert

On January 10, 2016, leaders of the AAOS, AAHKS, Hip Society, and Knee Society distributed a letter on new pre-certification procedures for total joint arthroplasty.

“We understand the goal of eliminating unnecessary health care costs, but these methods must be balanced with independent clinical judgment, patient preference, best levels of evidence and preservation of timely appropriate patient access to care,” the letter states. “We will continue to bring our combined resources and expertise to bear to address and resolve the problems associated with the activities of these insurance plans. If our constructive engagement falls short of achieving the necessary results, we are prepared to bring additional pressure to bear and seek alliances with other affected stakeholders such as patients and employers.”

Read the full letter online here and share your concerns with the pre-certification process with AAOS by emailing precert@aaos.org and AAHKS members can email aahksstaff@aahks.org.


2015 EHR “Meaningful Use” Hardship Exemption Information

Note: visit www.aaos.org/advocacy/HIT/ for all the latest updates on health information technology and meaningful use, including information on applying for a 2015 exemption.

In an effort to allow physicians to avoid a potential 3 percent meaningful use penalty in 2017, a law was passed by Congress that allows the Centers for Medicare & Medicaid Services (CMS) to consider hardship exceptions for categories of eligible professionals (EPs) and hospitals in a new, more streamlined process. Physician groups, including the American Association of Orthopaedic Surgeons (AAOS), lobbied for the legislation because the delayed release of modifications to the Stage 2 of the program left physicians with insufficient time to report under the modified requirements (read about the changes in an earlier Advocacy Now article here).

Read the full letter online here and share your concerns with the pre-certification process with AAOS by emailing precert@aaos.org and AAHKS members can email aahksstaff@aahks.org.

Click here to read more.