Federal Legislative Accomplishments

The AAOS Office of Government Relations monitors a wide variety of issues related to advancing the highest quality musculoskeletal health. Below is a list of some accomplishments achieved during 2015 and 2016.

SGR Repeal (MACRA)

On April 16, 2015, President Obama officially signed H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, into law, repealing the SGR and ending the threat of substantial payment cuts in physicians’ Medicare reimbursement. AAOS worked with Senate Finance, House Energy and Commerce, and House Ways and Means Committees on the legislation, which included a number of AAOS championed provisions, such as the Standard of Care Protection Act, reversal of the harmful global payments policy, and expansion availability of Medicare data. In February, AAOS hosted a virtual fly-in with several other specialties to urge passage of the SGR before the current patch expires on March 31.  It was very successful and included 53 individual meetings, thousands of e-mails, 350 twitter posts that reached over 134,000 unique users and had nearly 900,000 total impressions.

Meaningful Use Exemption

In December 2015, Congress passed S. 2425, The Patient Access and Medicare Protection Act, which includes a provision addressing relief from EHR and meaningful use. Importantly, the legislation requires that the Centers for Medicare and Medicaid Services (CMS) provide a blanket hardship exemption from 2015 meaningful use penalties to all providers who ask for it. The penalties would have been assessed in 2017. AAOS had expressed repeated concern to CMS about the program (read more in a previous Advocacy Now article online here) and supported similar legislation proposed by Representative Tom Price, MD (R-GA), in November. AAOS leadership asked orthopaedic surgeons last month to contact their legislators about the issue and send a strong message that physicians need relief from this highly burdensome program (read more in a previous Advocacy Now article online here).

Medical Liability

On medical liability issues, the AAOS worked closely with Senators Thune (R-SD) and Klobuchar (D-MN) to introduce S. 689, that would protect physicians who travel across state lines with sports teams. AAOS worked with AOSSM in developing the bill. AAOS also continued to build co-sponsors for the House companion bill, H.R. 921, and in December, the House Energy and Commerce Subcommittee on Health held a hearing on the legislation. AAOS submitted a statement for the record in support of H.R. 921. AAOS also continued to build a list of co-sponsors for the Good Samaritan Health Professionals Act, the Provider Shield Act, the Emergency Medical Treatment and Active Labor Act, and the Quality Health Care Coalition Act; and elevated the importance of the Standard of Care Act.

IOASE

AAOS prevented the in-office ancillary services exception (IOASE) from being used as a pay-for in any legislation, despite legislative threats like H.R. 2914 and the President’s Budget. AAOS also established an IOASE Working Group to pursue aggressive legislative strategy, which resulted in a Congressional Doctors Caucus letter, meetings with targeted Hill staff, and a physician fly-in in February. Further, the AAOS successfully rolled-out an IOASE study, which has armed AAOS with positive data for efforts to preserve the IOASE exception. The AAOS also worked with the Government Accountability Office (GAO) on its physical therapy self-referral report, recruiting physicians to review the document prior to publication and offer comments. 

IPAB

On May 1, 2015, AAOS – together with over fifteen orthopaedic specialty and regional societies and more than 500 other physician groups – sent a letter to Congress urging support to repeal the IPAB. Earlier this year, Reps. Phil Roe, M.D. (R-TN) and Linda Sánchez (D-CA) announced their legislation to repeal the IPAB – H.R. 1190, the Protecting Seniors’ Access to Medicare Act of 2015 – surpassed 220 cosponsors, a critical milestone necessary to ensure House passage should the legislation receive a floor vote. On June 2, 2015, the House Ways and Means Committee approved the legislation. On June 23, the full House of Representatives passed the bill. Finally, IPAB operational funding was cut by $15 billion in the FY2016 omnibus appropriations legislation passed by Congress in December 2015.

Extremity War Injuries

AAOS efforts helped secure $30 million in funding for the Department of Defense Peer Reviewed Orthopaedic Research Program (PRORP) in the 2015 Defense Appropriations Bill, which was signed into law by President Obama in December. The House Appropriations Committee included $30 million in funding in the 2016 Defense Appropriations Bill and the full $30 million was included in a final omnibus measure passed in December 2015. AAOS worked with Representatives Tammy Duckworth (D-IL) and Duncan Hunter (R-CA), who led a bipartisan letter to the Subcommittee on Defense of the House Committee on Appropriations requesting inclusion of $30 million for the PRORP in the FY 2016 Defense Appropriations legislation.

Trauma Care

AAOS has worked with Representative Burgess (R-TX) and Representative Green (D-TX) to introduce two trauma care bills to ensure that Americans have access to necessary medical services. The bills passed the House of Representatives unanimously. AAOS is now working with appropriators to fund the programs. OTA is supportive of the bills.

ICD-10

Congressman Ted Poe (R-TX) recently 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. The bill has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means. AAOS sent a letter of support to Congressman Poe and also submitted testimony to the Energy and Commerce Committee for a hearing on February 11 arguing for elimination or, if necessary, a two year delay. Congresswoman Diane Black has also introduced H.R. 2247, the ICD-TEN Act which requires CMS to conduct end-to-end testing, meet a 98% threshold to indicate the Medicare claims system is fully functioning and adds an 18-month “safe harbor” transitional period. Congressman Marsha Blackburn (R-TN) introduced H.R. 2652, the Protecting Patients and Physicians Against Coding Act which would provide a 2 year grace period for physicians and other healthcare providers in transitioning from ICD-9 to ICD-10. Finally Congressman Palmer (R-AL) introduced H.R. 3018, the Coding Flexibility in Healthcare Act which would establish a transition period for physician practices to submit healthcare claims using either ICD-9 or ICD-10 codes.

Other ICD-10 wins:

  • For the first year, Medicare claims will not be denied solely based on specificity – just as long as they are in the appropriate “family” of ICD-10 codes
  • CMS will not subject physicians to quality reporting penalties for the same reasoning above
  • If Medicare is unable to process claims with ICD-10, CMS will authorize advance payment for physicians
  • A communication center will be established to monitor issues which will include an “ICD-10 Ombudsman”

Research Funding

AAOS is working with the NIAMS coalition to secure additional research funding for musculoskeletal health. The Ruth Jackson Society and the Gladden Society have been involved. Further, the Agency for Healthcare Research and Quality (AHRQ) funding was cut by just $30 million after the House passed legislation to defund the program entirely.

Physician-Owned Hospitals

The AAOS is aggressively supporting legislation to repeal the provisions in the ACA relating to physician-owned hospitals. Section 6001 specifically prohibits the construction or expansion of hospitals owned in part or in full by physicians. Repeal would provide patients greater access to quality health care, more provider options and lower costs. The House Ways and Means Subcommittee on Health, led by Rep. Kevin Brady (R-TX), held a hearing May 19 where the issue of physician-owned hospitals was highlighted. In light of the importance of the issue, AAOS submitted a statement for the record.

21st Century Cures

21st Century Cures (HR 6) is a legislative proposal that originated in the House which seeks to provide better, faster, safer and more innovative approaches to treat diseases. It passed the House in June by an overwhelming vote of 344-77. AAOS is supportive of the proposal and has worked with the committee of jurisdiction on several of the provisions in the bill and submitted a support letter which included the signatures of 13 specialties. The bill includes, among other things, increased funding for the NIH, expedited device approval, a centralized IRB, interoperability language, telehealth provisions, improvements in LCD’s, a national pediatric research network. AAOS is now working with the Senate and a companion proposal is expected to be similar but with more of a focus on interoperability.  Senate floor action is likely after the first of the year. 

PAC

The Orthopaedic PAC saw a number of huge successes in 2014. Most importantly, the PAC raised over $3.5 million from 30 percent of AAOS fellows in the 2014 election cycle. This support allowed AAOS to help re-elect over 150 House and 8 Senate members who will continue to be champions for the orthopaedic and physician community. AAOS also helped elect over 25 House and Senate pro-physician candidates. Additionally, during 2013-2014, the PAC dispersed $2.7 million to pro-physician members of Congress and candidate committees, making it the 10th largest association PAC in federal candidate committee contributions. Finally, throughout the 2014 election cycle, AAOS fellows hosted or attended 155 political events in their local communities extending AAOS’ grassroots reach and strengthening key relationships in district.

Regulatory

On the regulatory front, advocacy initiatives resulted in HHS Office of Human Research Protection (OHRP) posting guidance documents on their website clarifying applicability of the Common Rule to clinical data registries. AAOS also obtained language in House Energy & Commerce legislation directing the HHS OHRP to post guidance on applicability of the Common Rule to clinical data registries. Further, AAOS obtained language in House Ways and Means Committee legislation granting expanded access to Medicare claims data for medical specialties, qualified registries, and qualified clinical data registries. Finally, AAOS secured representation on the AMA Task Force to Reduce Opioid Abuse and continues to develop opioid positions and advocacy efforts.

The Orthopaedic Device Forum continues to serve as an essential communication hub where industry, the Federal Drug Administration and AAOS convene to settle mutual issues which include the operationalization of the unique device identifier (UDI), custom device policies, and post market surveillance.

CMS

AAOS also submitted comment letters to the Centers for Medicare & Medicaid Services (CMS) on issues including the proposed rules: the 2016 Medicare Physician Fee Schedule proposed and 2015 final rule; Hospital Outpatient Prospective Payment System (OPPS); , Comprehensive Care for Joint Replacement Model;  Ambulatory Surgery Center (ASC) Payment System; and the Sunshine Act exemption for accredited continued medical education (CME) and educational materials, books and reprints. Additionally, AAOS met with CMS to discuss Physician Quality Reporting System (PQRS) and clinical data registry issues. Recently, AAOS and 12 specialty societies submitted a comment letter to CMS on the proposed Meaningful Use (MU) stage 3 regulations, which is the concluding phase of the CMS electronic health records (EHR) incentive program.

International

AAOS also monitors international policy that would affect the way our members practice. Earlier this year, AAOS composed a letter to address Chinese regulations that would affect our ability to bring Chinese scholars to our meetings. 


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