Federal Legislative Wins

2017 was a year of important wins for health care policy. With health care reform again at the forefront of political debates on Capitol Hill, the AAOS Office of Government Relations worked hard to continue to ensure physician priorities – including medical liability reform, ownership issues, and IPAB repeal – were heard and advanced. Below is a list of some accomplishments achieved during 2017 and 2018.

Sports Medicine Licensure Clarity Act and the Medical Controlled Substances Transportation Act

The Sports Medicine Licensure Clarity Act, designed to ensure team providers are properly covered by their professional liability insurance when traveling with athletic teams, passed in the House of Representatives by voice vote. Read more online here. A Senate companion bill was introduced in April and has 22 cosponsors.

From high school to college to professional levels, it is important that the men and women who are trained to protect and care for athletes and who best know the players’ medical histories are able to engage in the treatment of injured athletes.

On July 12, 2017, the House of Representatives passed the Medical Controlled Substances Transportation Act of 2017. The bill would update the Drug Enforcement Administration (DEA) registration process for mobile medical practitioners and team physicians to ensure they can administer controlled substances at locations other than their principal place of business while complying with new limitations on timing of transport and related recordkeeping requirements.

For more on these issues, visit: www.aaos.org/advocacy/mlr/ 

Antitrust Reform

On March 22, 2017, the House easily approved a bill that makes needed reforms to the McCarran-Ferguson Act to reduce health care costs for consumers by ensuring competition. AAOS has raised the issue of the current exemption for health insurers, commenting that the antitrust exemption, “together with the recent health care industry consolidations,” has enabled a select few health plans to dominate the health care market. As a result, physicians are frequently placed in positions of diminished bargaining strength, and health plans can impose unilateral, non-negotiable contracts.

On February 14, 2018, AAOS released a statement related to a House Energy and Commerce Subcommittee hearing on health care consolidation, which urged Congress to secure passage of this legislation as soon as possible. Read the statement online here.

For more on the issue of antitrust, visit: www.aaos.org/advocacy/antitrust/ 

Medical Liability Reform

The House of Representatives passed the Protecting Access to Care Act. This legislation—which contains important reforms such as a cap on noneconomic damages, limits on attorney fees, and a 3-year statute of limitation—was one of the issues discussed by nearly 400 orthopaedic surgeons who attended the National Orthopaedic Leadership Conference in Washington, D.C., in April. Currently, there is no Senate companion, but the nonpartisan Congressional Budget Office estimates the legislation would save the government approximately $1.5 billion, an important first step in passing legislation into law.

“These reforms will ensure negligently injured patients are compensated promptly and equitably, and they will, importantly, improve our overall health care system even before the filing of a lawsuit, by lowering health care costs, improving patient safety, and preserving the patient-physician relationship.” – AAOS President William J. Maloney, MD

Additionally, AAOS continued to build support for the Good Samaritan Health Professionals Act. On February 14, the House Energy and Commerce Committee approved the legislation, which helps protect health care professionals who volunteer their services when a major emergency arises. Specifically, H.R. 1876 provides clear liability protections to licensed health care professionals who volunteer health care services to victims during a declared national disaster. Notably, the legislation respects existing medical liability laws and does not protect providers in cases of willful or criminal misconduct, gross negligence, or reckless misconduct. Read a Feb. 14, 2018 letter sent by AAOS and the Orthopaedic Trauma Association on this issue online here.

For more on the issue of medical liability reform, visit: www.aaos.org/advocacy/mlr/ 

CHIP, NIH, and Defense Department Medical Research Funding

On February 9, 2018, Congress passed legislation that includes an additional $2 billion in funding for the National Institutes of Health (NIH) requested by AAOS (read more online here and here), another extension of the Children’s Health Insurance Program (CHIP) funding, and further funding to address the opioid epidemic.

After CHIP authorization expired, AAOS, SRS, and POSNA combined forces in advocating for the nearly 9 million children enrolled in the program. “The POSNA leadership would like to thank its membership for their involvement in the process, particularly the many members who participated in the grassroots effort. We feel that the combined voice of POSNA members had a profound effect on energizing the process, and we are proud of our organization's history of advocating for our patients.”

The Senate on Nov. 16, 2017 approved the final version of the National Defense Authorization Act (NDAA), which removed harmful language that would have impeded vital defense health research. Specifically, the language would have instituted a prohibition on conduct of certain medical research and deployment projects like the Peer Reviewed Orthopaedic Research Program (PRORP). The PRORP, championed by AAOS, works to help military surgeons find new limb-sparing techniques to save injured extremities, avoid amputations, and preserve and restore the function of injured extremities.

AAOS successfully advocated for $30 million in funding for the Peer Reviewed Orthopaedic Research Program through the Department of Defense Congressionally Directed Medical Research Program. Once the FY2018 defense appropriations money is allocated, this program will have received more than $330 million in funding since its inception in 2009.

For more on these issues, visit: www.aaos.org/advocacy/researchappropriations/ 

The Medicare Access and CHIP Reauthorization Act (MACRA)

Legislation signed into law Feb. 9, 2018 included a number of encouraging updates to MACRA requested by AAOS. For example, the legislation excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination; eliminates improvement scoring for the cost performance category for the third, fourth, and fifth years of MIPS; allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS; and allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year. The legislation also permanently repeals the outpatient therapy caps beginning on Jan. 1, 2018 and removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

For more on the issue of MACRA, visit: www.aaos.org/macra/ 

Independent Payment Advisory Board (IPAB)

While no members had been appointed to the IPAB yet, repealing this board – which was charged with making recommendations to cut Medicare expenditures if spending growth reaches a certain level – has been a top priority for AAOS over the years. Even without board members, the Secretary would be directed to develop and implement proposals automatically if the IPAB protocol was triggered. Further, not only did the IPAB limit congressional authority with little accountability and preclude meaningful opportunity for stakeholder input, but AAOS had deep concerns about the specific impact that IPAB-directed cuts would have on patient access to quality musculoskeletal care.

In November 2017 and as a result of AAOS efforts, the U.S. House passed a bipartisan measure introduced by Reps. Phil Roe, M.D. (R-TN) and Raul Ruiz, M.D. (D-CA). In February 2018, IPAB repeal was included in a bipartisan budget deal that was signed into law by President Trump. Read more about the changes online here.

“IPAB repeal has been a topic at the NOLC as well as the subject of the grassroots efforts that many of you supported. Hundreds of orthopaedic surgeons have gone to Capitol Hill and/or talked to their elected representatives about this issue, and we are happy to see our voices heard.” – AAOS President William J. Maloney, MD

Physician-Owned Hospitals

Important progress was also made this year toward lifting the moratorium on new or expanded physician-owned hospitals. The House bill, sponsored by Rep. Sam Johnson (R-Texas), has received 64 cosponsors, more than double what it received in past years. Moreover, for the first time, the legislation has a Senate companion, which was introduced by Sen. James Lankford (R-Okla).  

For more on the issue of physician-owned hospitals, visit: www.aaos.org/advocacy/ioas/ 

In-Office Ancillary Services and Stark Law Reform

AAOS prevented the in-office ancillary services exception from being used as a pay-for in any legislation, despite legislative threats, and continued work with the IOAS Working Group to pursue an aggressive legislative strategy. Further, AAOS also worked on Stark law reform efforts, including support of the Stark Administrative Simplification Act and the Medicare Care Coordination Improvement Act of 2017. The Stark Administrative Simplification Act, H.R. 3173, would limit the penalties for technical violations of the Stark law and create an expedited process for their resolution. The Medicare Care Coordination Improvement Act, H.R. 4206, creates new flexibilities, waivers, and exceptions to the Stark law to accommodate alternative payment models. The President’s 2019 budget reinforced the need for these modifications, recommending reform of the Stark self-referral law to better support and align with alternative payment models. Additionally, in the 2018 budget agreement, language was included to modernize application of the Stark law under Medicare, codifying changes made in CMS rulemaking to “streamline and clarify” certain rules for providers.

For more on the issue of in-office ancillary services and Stark law, visit: www.aaos.org/advocacy/ioas/

Opioids and FDA

AAOS has worked with Congress on a number of opioid-related measures, ensuring the primacy of the doctor-patient relationship is protected. Read a Feb. 16, 2018 letter sent to the Senate Finance Committee online here. Additionally, AAOS supported introduction of H.R. 4236, the Monitoring and Obtaining Needed Information to Track Opioids Responsibly Act of 2017, which would aid orthopaedic surgeons in addressing this issue by establishing minimum standards that Prescription Drug Monitoring Programs (PDMPs) must meet in order to receive funding from the Account for State Response to the Opioid Crisis.  

On August 18, 2017, President Trump signed H.R. 2430, the FDA Reauthorization Act of 2017, into law. H.R. 2430 reauthorizes the FDA’s critical medical product user fee programs, ensuring the agency has the tools it needs to more efficiently deliver safe and effective drugs, devices, and treatments to patients.

To read more about the issues of opioids and the FDA, visit: https://www.aaos.org/advocacy/fda/ 

Trauma Care

AAOS worked with Representative Burgess (R-TX) to introduce H.R. 880, the Mission Zero Act, and the legislation was passed by the U.S. House of Representatives on February 26, 2018. This bill will provide grants and allow Department of Defense trauma surgeons to be assigned to civilian trauma centers. The legislation is intended to help fill gaps in care and ensure that advances in military trauma care are brought home for civilian patients. AAOS, working with the Orthopaedic Trauma Association (OTA), participates in the Trauma Coalition, which worked to formulate and advance this legislation.

VA Provider Equity Act

AAOS successfully amended legislation that would have included language elevating podiatrists to the same status as physicians under the Veterans Health Administration (VA). Related, on Tuesday, May 2, 2017, orthopaedic surgeon Col. James Ficke, MD (ret.) testified on behalf of AAOS and the American Orthopaedic Foot and Ankle Society (AOFAS) before the House Veterans’ Affairs Subcommittee on Health on the issue of lower extremity injuries among veteran patients. Read more on this testimony online here.

Emergency Medical Services (EMS)

The Protecting Patient Access to Emergency Medications Act was signed into law on November 17, 2017. Introduced by Reps. Richard Hudson (R-NC) and G.K. Butterfield (D-NC), the AAOS-supported legislation provides a statutory framework to allow EMS agencies, professionals, and medical directors to fulfill their mission to save lives and alleviate pain, while also enabling the DEA to continue with appropriate oversight to prevent drug diversion. 

Site Neutral Payments

AAOS provided comments to the House Energy & Commerce Committee on the Medicare site-neutral payments issue and mentioned the issue in a statement following a House Energy and Commerce Subcommittee on Oversight and Investigations hearing on health care consolidation. Read it online here.

Orthopaedic PAC

2017 was an exciting year for the Orthopaedic Political Action Committee (PAC). In addition to the growth of the Advisors’ Circle and record-breaking resident involvement, the Orthopaedic PAC had unprecedented access and representation at more than 600 political events, an increase of more than 30 percent from last election cycle. The strength of the PAC has allowed orthopaedists to have a seat at the table and educate members of Congress about the importance of musculoskeletal care. Visit the PAC website online here.