ICD-10, Electronic Health Records, AMA Meeting, and Other Developments

Physicians and other eligible professionals are expected to be in compliance with the newly government mandated ICD-10 diagnostic coding system by October, which would increase codes to 68,000 from the 13,000 ICD-9 diagnostic codes currently in place. Many in the physician community, including AAOS, have stressed a number of difficulties in moving to the more complex ICD-10 coding system, and several members of Congress have introduced different bills to address this concern.

Congressman Ted Poe (R-TX) introduced H.R. 2126, the Cutting Costly Codes Act of 2015, which would prohibit the Secretary of Health and Human Services (HHS) from replacing ICD-9 with ICD-10 entirely. The bill has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means. According to Poe, “big government must get out of the way and let doctors do what they were trained to do – help people.” Similar legislation was introduced in 2013, which the AAOS supported.

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AAOS delegate members met in Chicago, Illinois in early June for the American Medical Association (AMA) House of Delegates (HOD) Interim meeting. The HOD is the legislative and policy-making body of the AMA and is composed of elected representatives and others. Numerous advocacy focused resolutions were considered during the meeting. For example, the HOD reevaluated current ICD-10 policy and passed a new policy calling on the Centers for Medicare & Medicaid Services (CMS) not to withhold claim payments based on coding errors, mistakes or malfunctions in the system for two years directly following implementation. This two year grace period would allow for a smoother transition.

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Following their successful and productive Annual Meeting, the North Dakota Orthopaedic Society took direct action to advance their advocacy efforts. They invited U.S. Congressman Kevin Cramer (R-ND), who serves on the influential Energy and Commerce Committee, to visit the Bismarck Bone and Joint Center for a tour and lunch. While there, Rep. Cramer had the opportunity to observe while Dr. Tim Juelson saw three patients. The congressman also toured the Ambulatory Surgery Center (Bismarck Surgical Associates), where he met with physicians and staff. Rep. Cramer was provided a real look at the inside workings of the clinic and surgery center and heard the physician’s concerns about billing and documentation issues.

Dr. Juelson, Courtney Koebele, and others also discussed with Rep. Cramer issues including delaying the implementation of ICD-10, the Sports Medicine Licensure Clarity Act (H.R. 921), and future implications of the King v. Burwell Supreme Court case and the Affordable Care Act. Through this invitation, the North Dakota Orthopaedic Society created an opportunity to clearly communicate with their member of Congress, and in so doing, strengthened their relationship with him, which is the key to effective advocacy.

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The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program, recently released its June 2015 Report to the Congress: Medicare and the Health Care Delivery System. The report examines a variety of Medicare payment system issues and provides suggestions on hospital short-stay policy issues, payment policies for Part B drugs, value-based incentives for Part B drugs, polypharmacy and opioid use, risk-sharing in Part D, synchronizing policy across Medicare’s payment models, next steps in measuring quality, and the next generation of Medicare beneficiaries.

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Last week, the AAOS joined eight orthopaedic specialty societies in sending a letter to the Acting Food and Drug Administration (FDA) Commissioner Stephen M. Ostroff, expressing concern over a nationwide shortage of phentolamine and asking FDA to post a letter on their drug shortages website stating that providers can seek out of country sources of this drug for their patients.

“It is imperative the phentolamine shortage is promptly addressed as it is integral to patient safety,” the letter stated. “Thank you for considering this request to allow health providers to have access to phentolamine from outside sources until U.S. manufactures restore supply. This will allow clinicians to provide the expected standard of care and preserve patient safety.”

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With many health policy challenges on the horizon, it is more important than ever that individuals who understand and care about the future of medicine are elected to public office. Fortunately, physician involvement in politics has grown considerably in recent years. In the 114th Congress there are 17 physician members serving in Congress, including two orthopaedic surgeons: Dr. Tom Price (R-GA-06) and Dr. John Barrasso (R-WY). Many more physicians are serving their communities through elected office at the state and local level.

The Orthopaedic PAC strives to educate and help elect AAOS members and other specialty physicians to political office at all levels. AAOS is co-hosting the 6th Annual Specialty Physician and Dentist Candidate Workshop on Saturday, July 11 in Washington, DC along with the American Congress of Obstetricians and Gynecologists, American Society of Anesthesiologists, American College of Radiology and the American Dental Association.

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The BOS Quality and Patient Safety Action Fund’s (Action Fund) purpose is to support BOS member organizations’ involvement in developing and implementing quality and patient safety initiatives, and related advocacy efforts.  Projects that meet prescribed criteria are eligible for AAOS matching funds up to $50,000.  The Action Fund started accepting applications on March 30, 2015, and the first deadline is July 1, 2015.  We expect demand for funds to exceed supply, so please be sure to submit thorough and complete applications.

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Orthopaedic PAC resident member participation thus far in 2015 has already surpassed resident involvement levels in 2014 under the PAC’s increased resident outreach initiative.  Congratulations to Cooper University Hospital Program for being the first residency program to achieve 100 percent participation in the PAC in 2015!

Residents from the following programs have joined the PAC thus far in 2015:

To learn more about the importance of residency involvement in the PAC or for resources you can use to encourage your program to become involved, please visit the Orthopaedic PAC Resident Toolkit or contact Kristin Brackemyre at pac@aaos.org or 202.546.4430.