Last Week of In-District Advocacy Event

Last Week of In-District Advocacy Event

We are nearing the end of our nationwide campaign to engage with members of Congress “in-district.” We have received positive feedback on the meetings and conversations that have taken place so far, as lawmakers get a better sense of the hardships that the orthopaedic community has faced during this unprecedented national public health emergency.

On September 3, from 7:15 – 8:15 pm CT, Brad Henley, MD, will lead the first webinar in a two-part series offering an in-depth analysis of the changes occurring to the 2021 Evaluation and Management (E/M) services (register here). Part I will touch upon the history of the E/M guidelines, identify the new requirements, and explain the significant changes to how time and medical decision-making (MDM) are used to determine the level of service. Attendees will become familiar with the amount and/or complexity of data that must be reviewed and analyzed, as well as the risk of complications of patient management for MDM. Finally, Part I will cover how to report the correct level of E/M service in accordance with the new reporting guidelines.

Anthem Clarifies New Setting of Care Policy 

In working with Anthem to seek clarification on its new policy around setting of care for certain musculoskeletal procedures, the Office of Government Relations recently learned that four spine codes (22633, 22634, 63265 and 63267) and two knee arthroscopy codes (29871 and 29892) will be incorporated into the AIM Level of Care Guidelines for Musculoskeletal Surgery and Procedures effective October 1. Anthem will review requests for inpatient admission and will require providers to substantiate the medical necessity of the inpatient setting with medical documentation that demonstrated one of the following: 1. Current postoperative care requirements are of such an intensity and/or duration that they cannot be met in an observation or outpatient surgical setting. OR 2. Anticipated postoperative care requirements cannot be met, even initially, in an observational surgical setting due to the complexity, duration, or extent of the planned procedure and/or substantial preoperative patient risk.

HHS Reveals 10-Year Plan to Tackle Nation’s Public Health

Last week, the Department of Health and Human Services (HHS) released the Healthy People 2030 plan for addressing the nation’s most critical public health challenges and priorities. Led by the HHS Office of Disease Prevention and Health Promotion, the Healthy People initiative sets decade-long objectives—including those related to opioid use disorder and preventing fractures related to osteoporosis—using data-driven methods for priority assessment. The goals focus on improving health literacy on both the individual and organizational level, and addressing five categories of social determinants of health: economic stability, health care access and quality, social and community context, education access and quality, and neighborhood and built environment. This fifth edition of the Healthy People initiative is comprised of goals and methods set by a federal advisory committee of 13 external thought leaders and a workgroup of experts from 20 federal agencies, as well as the contribution of public comments received during the development process.

Deadline Friday to Apply for Provider Relief Funds

Providers who missed the June 3 deadline to apply for additional Provider Relief Fund payments—equal to 2% of their total patient care revenue—have until Friday, August 28 to submit applications. This includes Medicaid and Children’s Health Insurance Program providers with low Medicare revenues, or those who experienced a change in ownership and were previously ineligible for Phase 1 funding. As a reminder, this program is a grant not a loan and does not need to be repaid. The agency is still working to address relief payments to new providers in 2020 along with those that have yet to receive any funding for a variety of reasons, including the fact that they may only bill commercially, or do not directly bill for the services they provide under the Medicare and Medicaid programs. AAOS members can learn more about the loan and grant programs that have been created to help counter the economic challenges related to the COVID-19 pandemic at aaos.org/covid-19-financial-relief-information

AAOS Leadership Gets Election Forecast From Top Pollster
On Saturday, August 22, as part of the August In-District Advocacy Event, members of the AAOS Board of Councilors and Board of Specialty Societies heard from David Wasserman, house editor for the Cook Political Report and one of the nation’s top election forecasters and pollsters. Wasserman presented an engaging, in-depth overview of the 2020 election landscape while focusing on key House and Senate races, how mail-in/absentee ballots will play a role in this historic election, and his predictions on the presidential race. Wasserman also highlighted physicians running for federal office including Roger Marshall, MD, for Kansas’ open Senate seat race and Al Gross, MD, FAAOS, who is challenging Senator Dan Sullivan in Alaska. During the Q&A period of the program, members asked about third-party presidential candidates and Manny Sethi’s, MD, FAAOS, Tennessee Senate primary, among other topics.

·         Proposed cuts to Medicare will be devastating to surgeons and their patients (CNN, 8/20)

·         The pandemic has created an opportunity to innovate delivery of telehealth services (The Hill, 8/18)

·         Is the Medicare ‘Inpatient Only’ List History? (Medpage Today, 8/13)

·         Senate Bill 1264: Six-month preliminary report (Texas Department of Insurance)