Member Poll: Alternative Payment Models

August In-District Advocacy Event is Underway

AAOS members across the U.S are engaging with members of Congress this month as part of the In-District Advocacy Event. Their objective is to carry the unified asks of legislators on behalf of the musculoskeletal profession and its patients on four issues: the potential cuts brought on by the recently proposed 2021 Medicare Physician Fee Schedule, medical liability reform, prior authorization reform, and lifting restrictions on physician-owned hospitals. State executive directors and members of the AAOS Board of Councilors as well as the Board of Specialty Societies have been setting up meetings with their representatives in-district for you to join.

AAOS President Joseph A. Bosco III, MD, FAAOS, issued two statements last week in response to the Centers for Medicare & Medicaid Services’ (CMS) newly released Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) and CY 2021 Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC) Proposed Rules. The MPFS statement highlights AAOS’ disappointment in CMS’ proposal to reduce the value of orthopaedic surgical services by 5% and further reduce the work relative value units for hip and knee arthroplasty by an additional 5.4%. Dr. Bosco urged CMS to reconsider these punitive cuts. In the statement on the OPPS/ASC proposed rule, AAOS expressed concern with CMS’ proposal to eliminate the Inpatient Only List over the next three years, beginning with 266 musculoskeletal procedures and services. Dr. Bosco noted AAOS’ support for flexibility in site-of-service, but cautioned that these decisions are best made by physicians in partnership with their patients.

AAOS Expresses Priorities for Next Covid Relief Package

The AAOS recently wrote a letter to congressional leadership expressing our priorities for the next Covid-related relief package. We re-emphasized the importance of keeping the eligibility of the Provider Relief Fund open to all physicians, since all practices have been negatively impacted by the effects of the pandemic. We urged Congress to legislate improvements to the Medicare Accelerated and Advance Payment Program, including reducing the high interest rate and extending the repayment deadlines. We also applauded Congress for its role in extending flexibilities and equal reimbursements for telehealth. Finally, we advocated for medical liability protections for health care professionals who were forced to delay surgeries due to state and local guidance, as well as those who worked outside of their normal work practices in order to care for Covid positive patients. Although negotiations between the House and the Senate on the next relief package have stalled, the AAOS is committed to ensuring these and other priorities are addressed in a timely fashion.

Cuts Proposed to Surgical Services in 2021 Medicare Physician Fee Schedule

Last week, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. In the months prior to the release of the rule, AAOS had advocated against the proposed 5.4% cut to the work relative value units for hip and knee arthroplasty, as well as changes to the Evaluation and Management Office/Outpatient visit codes that were not extended to global surgical codes–which would lead to an overall 5% reduction to all orthopaedic surgical services. CMS has formally proposed these changes in the rule, and AAOS will continue to advocate against them through the rule’s comment period. Other changes proposed include making permanent some of the telehealth provisions implemented during the Covid-19 public health emergency, broadening the scope of practice for non-physician practitioners, pharmacists, and physical therapy assistants, as well as the introduction of the Alternative Payment Model Performance Pathway for the 2021 performance year. Members should be on the lookout for a grassroots opportunity soon to engage on this issue.

Elimination of Inpatient Only List Proposed in 2021 Outpatient Payment Rule

The Centers for Medicare & Medicaid Services (CMS) also released the Calendar Year (CY) 2021 Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC) Proposed Rule last week. The agency proposed to drastically shift the landscape of the outpatient setting by eliminating the entire Inpatient Only List over the next three years. The removal of procedures would begin with 266 musculoskeletal services effective in 2021, if finalized. CMS is also proposing to add total hip arthroplasty to the ASC Covered Procedures List, change the process for adding procedures, and require prior authorization for two groups of spine codes. In a win for AAOS advocacy, CMS is proposing to lift restrictions on physician-owned hospitals that are high Medicaid facilities. This proposal would be a step toward our long advocated for expansion of these high-value centers of care.

Medicare Providers Get Second Chance at Relief Funds

The Department of Health and Human Services (HHS) recently announced its plan to allow Medicare providers who experienced challenges in the Phase 1 Medicare General Distribution application period a second opportunity to receive funding. The agency also extended the deadline for Medicaid, Medicaid managed care, and Children’s Health Insurance Program providers to apply for aid from the Provider Relief Fund. HHS noted in its announcement that it wants to ensure fairness for the program. In April, it expedited $30 billion directly to Medicare providers proportionate to their share of the 2019 Medicare fee-for-service reimbursements. Then it asked p roviders that do not submit comprehensive cost reports with CMS to submit revenue information to a portal to receive the remaining balance of their funds. Providers now have until August 28 to complete the application and be considered for their additional funding up to 2 percent of their annual patient revenues.

Trump Issues Executive Order on Rural Health

On August 3, the Trump Administration issued an Executive Order on Improving Rural Health and Telehealth Access. The order sets forth recommendations for building on the rapid expansion of telehealth precipitated by the Covid-19 public health emergency (PHE) and improving the overall quality of rural health care. The Executive Order offers the following directives: the launch of a new, innovative payment model to test the efficacy of payment mechanisms aimed at increasing the access to, and quality of rural health care; a partnership between the Secretaries of the Department of Health and Human Services (HHS) and the Department of Agriculture, in coordination with the Federal Communications Commission, to advance the communications and physical infrastructure of rural health care; and the creation of a report by the Offices of the Domestic and Economic Policy proposing health policy initiatives to improve mental health, reduce maternal morbidity, and decrease regulatory burdens to rural health care. The order also directs the HHS Secretary to review and propose the extension of telehealth benefits beyond the PHE.

2020 Election Update: Too Much is at Stake
While the 2020 general election is still months away, the Orthopaedic PAC has been working overtime to ensure that supported candidates are well-positioned in their primary races. On August 4, Roger Marshall, MD, won his primary for the open Kansas Senate seat. He has been one of our biggest champions in the House of Representatives, so we are excited about him potentially joining the US. Senate. During that same week, OrthoPAC-endorsed candidate and orthopaedic surgeon, Manny Sethi, MD, FAAOS, lost his primary. Dr. Sethi ran an incredible grassroots campaign in Tennessee, and the OrthoPAC was pleased to see much of the orthopaedic community rally behind him. The 2020 election cycle has a record number of physicians running for federal office. Orthopaedic surgeons now more than ever need to get involved in the political process, both by showing up to the polls and by becoming a member of the OrthoPAC during a time when our resources carry more weight. If you have any questions about voting in your state or the OrthoPAC, please reach out to our political team at pac@aaos.org.

·         Washington, Colorado, Nevada, Oregon collaborate on telehealth framework (Becker’s Hospital Review, 8/6)

·         Providers Look To Congress To Avert Physician Pay Cuts (Inside Health Policy, 8/5)