Orthopaedic Surgeons Discuss IPAB, Medical Liability, and Physician-Owned Hospital Issues with Congress
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Orthopaedic Surgeons in DC for National Orthopaedic Leadership Conference (NOLC) On Thursday, April 27, 2017, more than 300 orthopaedic surgeons from around the country took to Capitol Hill to meet with their congressional representatives as part of the American Association of Orthopaedic Surgeons (AAOS) National Orthopaedic Leadership Conference (NOLC). Attendees urged legislators to repeal the Independent Payment Advisory Board (IPAB) through legislation such as S. 260/H.R. 849, to reverse the restrictions on physician-owned hospitals via H.R. 1156, and to take meaningful steps towards medical liability reform with legislation including H.R. 1704. Orthopaedic surgeons also shared AAOS efforts to raise awareness of the importance of prescription safety and the dangers of opioid misuse, including a public service campaign with print and radio ads.

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CMS Addresses AAOS Concern on Total Ankle Arthroplasty Currently, the Centers for Medicare and Medicaid Services (CMS) includes total ankle arthroplasty (TAA) in the same Medicare Severity Diagnostic Related Group (MS-DRG) as total knee and total hip replacement (TKA/THA). There are significant differences between total ankle arthroplasty and other joint replacement procedures, both clinically and in procedural costs, which make this designation inappropriate. Many adjunctive procedures commonly performed at the time of the TAA lead to longer surgical times and differing anatomy makes TAA more susceptible to infection and wound complications. Additionally, there is usually an extended non-weight-bearing status in the post-operative period, which predicts longer inpatient length of stay and greater need for post-operative support and rehabilitation services. The additional resources required for TAA lead to higher costs, which is important to consider in the context of target pricing for the Comprehensive Joint Replacement (CJR) model procedures. Click here to read more.
HHS Secretary Price Discusses Opioid Strategy Reps. Jackie Speier (D-CA) and Dina Titus (D-NV), introduced legislation earlier this month that they say will “close a loophole in Medicare that wastes taxpayer dollars and in some cases harms patients.” H.R. 2066, The Promoting Integrity in Medicare Act (PIMA), would prevent physicians in certain specialties from referring patients to ancillary medical services in which they have an ownership interest and are offered in their offices. AAOS strongly opposes the legislation and believes that the in-office ancillary services (IOAS) exception to the Stark Law is essential to efficiently diagnosing and treating musculoskeletal conditions by allowing orthopaedic surgeons to provide imaging and physical therapy (PT) services in their offices. Congress should oppose any effort to remove the in-office ancillary services exception in the Stark Law.

AAOS 2017 PSA Postcard – Opioids

In the opioid grants announcement, HHS outlined five specific strategies the Department will take in confronting the challenge: strengthening public health surveillance, advancing the practice of pain management, improving access to treatment and recovery services, targeting availability and distribution of overdose-reversing drugs, and supporting cutting-edge research. In his letter to the governors, Secretary Price made clear that, though the initial grants would be released immediately, he intends to speak with each governor going forward “to identify best practices, lessons learned, and key strategies that produce measureable results.” Click here to read more.

Legislators Send Letter on PRORP Funding On April 4th, Reps. Duncan Hunter (R-CA) and Seth Moulton (D-MA), along with 52 other House members, sent a letter to Reps. Kay Granger (R-TX) and Pete Visclosky (D-IN) urging support of the peer-reviewed orthopaedic research program (PRORP) in the FY 2018 Defense Appropriations legislation. As part of the congressionally directed military research programs (CDMRPs), PRORP has received special funding in the defense appropriations bill over the past 10 years, totally almost $250 million. This money goes towards very important research that helps military surgeons address the leading burden of injury and loss of fitness for military duty by finding new limbsparing techniques to save injured extremities, avoid amputations, and preserve and restore the function of injured extremities. PRORP aims to provide all warriors affected by military orthopaedic injuries the opportunity for optimal recovery and restoration of function. Click here to read more.
State Corner: Physicians Advocate for States to Limit Maintenance of Certification Physicians are organizing state-based campaigns to minimize the role of maintenance of certification (MOC) in licensing, payment, employment or admitting privileges. These physicians have rebelled against compulsory MOC and have succeeded in getting the attention of their state legislatures. The state of Oklahoma passed a law in April, 2016 stating that nothing in its laws concerning medical practice shall be construed to make MOC “a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state.” Kentucky’s governor signed a more limited measure that forbids making MOC a condition of state licensure. Other states are considering joining Oklahoma as “Right to Care” states. Click here to read more.
What We’re Reading NIH to get a $2 billion funding boost as Congress rebuffs Trump’s call for cuts, Stat, 5/1/17 GOP Faces Make-or-Break Moment on Obamacare Repeal, Politico, 4/30/17 Trump Pushing for Vote on Health Bill, but Stumbling Blocks Remain, The Wall Street Journal, 4/30/17 Pence Floats End of 2017 as New Target for Replacing Obamacare, Bloomberg Politics, 4/30/17 GOP May Again Change Health Care Proposal As They Seek Votes, Roll Call, 4/28/17 Congress Averts Shutdown as Talks Continue on Broader Funding Package, Morning Consult, 4/28/17 House Will Not Vote on Affordable Care Act Rewrite, Smoothing Way for Government To Stay Open, The Washington Post, 4/27/17 Healthcare Groups Denounce Revised GOP Health Bill, The Hill, 4/27/17 GOP Health Care Bill Picks up “A Few” Moderate Supporters, Roll Call, 4/27/17 Senate Panel Advances Trump’s FDA Nominee, Morning Consult, 4/27/17 Doctors Look to Price for Tweaks in Medicare Rule, The Hill, 4/24/17
ICYMI: CMS Proposes 2018 Payment and Policy Updates The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update 2018 Medicare payment and policies when patients are admitted into hospitals. According to CMS, the proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.

“Through this proposed rule we want to reduce burdens for hospitals so they can focus on providing high quality care for patients,” said CMS Administrator Seema Verma. “Medicare is better able to support the work of dedicated hospitals and clinicians who provide the care that people need with these more flexible and simplified approaches.”

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