It sometimes appears that every bit of good news in Washington, D.C., is accompanied by an equivalent amount of bad news. That’s certainly the case with regard to the prospects for repeal of the Medicare sustainable growth rate (SGR) formula and the potential impact of that repeal on the in-office ancillary services (IOAS) exception.

Thanks in part to efforts by the American Association of Orthopaedic Surgeons’ (AAOS) office of government relations, legislation to repeal the SGR formula passed the House Energy and Commerce Committee this summer without opposition. The framework now lies with the House Ways and Means Committee, which must determine how to pay for the legislation.

The AAOS was heavily involved in crafting the SGR repeal legislation and is committed to continuing reform efforts. At the same time, the AAOS is concerned that the spending offsets needed to pay for the SGR repeal may result in cuts to other areas. The AAOS legislative team and AAOS members across the country are working aggressively to ensure that the offsets do not result in a narrowing or closure of the IOAS exception.

Grassroots outreach
AAOS fellows and orthopaedic state societies used the August Congressional recess as an opportunity to meet with their representatives and key legislators. The goal was to educate them on the importance of advanced imaging and physical therapy services in delivering high-quality, coordinated care. Matthew J. Weresh, MD, of Des Moines Orthopaedic Surgeons, met with Iowa Senator Chuck Grassley, a senior member of the Senate Finance Committee, at a local fundraising event.

“I was able to share with him real examples of how in-office ancillary services advance our ability to get timely information to our patients and make treatment-based decisions much more quickly than we otherwise could,” said Dr. Weresh.

Dr. Weresh realizes the importance of educating policymakers on the IOAS issue. “The only way we can continue to combat these threats is to share tangible evidence of how these services are integrated into our practices and care models, as well as other reviews that suggest utilization of these services is actually on the decline. We have to tell our patients’ stories,” he said.

The role of the PAC
In addition to grassroots outreach, the Orthopaedic Political Action Committee (PAC) is a powerful tool in the fight to preserve the IOAS exception by providing critical access to key decision makers in Washington. Leveraging the PAC’s ability to access and facilitate relationships with policymakers is essential in efforts to combat opposition to this issue.

The size and strength of the Orthopaedic PAC sets the AAOS apart from other medical societies with a presence inside the Beltway and helps the orthopaedic message resonate with top-level staff and Congressional leaders. Unilateral access to the key players is only attainable through strong grassroots efforts and a solid political presence.

More than 2,850 AAOS members have donated to the Orthopaedic PAC in 2013, raising $802,339.98 in personal dollar receipts through Sept. 3. Although this is a robust start, PACs sponsored by organizations that oppose the IOAS exception are raising even more funds.

RADPAC, the American College of Radiology’s political action committee outraised the Orthopaedic PAC by more than $100,000 in the first half of 2013 (Table 1). RADPAC and its allies have launched an aggressive lobbying effort, making it essential that the Orthopaedic PAC keep pace by maintaining its standing as the largest medical PAC in Washington, D.C.

Internal reports confirm the Orthopaedic PAC’s total receipts (personal and corporate contributions) total $1,152,664.84. All contributions to the Orthopaedic PAC—whether written on a personal or business (corporate) check—are welcome. However, corporate contributions can only be used for PAC-related administrative expenses. Only those contributions written on a personal check can be used to support political candidates—and it is these contributions that help make the Orthopaedic PAC powerful.

The Orthopaedic PAC is a strong tool in deterring the threat of narrowing or closing the IOAS exception but this effort requires ever-expanded and stronger PAC participation by AAOS members. Last election cycle, 28 percent of AAOS members contributed to the Orthopaedic PAC; so far this year, 16 percent of AAOS members have contributed.

Join the fight
Although orthopaedic practice settings vary, preserving ownership of IOAS is about protecting autonomy of orthopaedic surgeons to provide the highest quality, most efficient orthopaedic care for their patients. AAOS members can get involved by attending in-district meetings and events for members of Congress or hosting fundraising events for key champions on the issue, such as the fundraiser for Rep. Phil Gingrey hosted by Resurgens Orthopaedics in Atlanta.

AAOS staff in the office of government relations can help facilitate a fundraising event or a visit with your Congressional legislators. Both are very manageable undertakings by simply following a few easy steps. In addition to local outreach, the online AAOS Legislative Action Center (http://capwiz.com/aaos/home/) is an easy way to contact your legislator about preserving IOAS access for patients.

This IOAS issue is critical to delivering high-quality, coordinated, orthopaedic care; your increased involvement is key to affecting the legislative discussion. For more information on how to get involved in IOAS advocacy efforts, contact the AAOS office of government relations at dc@aaos.org or call 202-546-4430.

Kristin Leighty is the PAC manager in the AAOS office of government relations; she can be reached at leighty@aaos.org

The AAOS on IOAS
The in-office ancillary services (IOAS) exception to the Stark Law allows physicians to own in-office ancillary services, such as imaging services and physical therapy services. The purpose of the IOAS exception is to improve patient care through better physician oversight of the quality of care, improved coordination among providers, and greater patient adherence to treatment plans recommended by physicians due to convenience for patients.

The American Association of Orthoapedic Surgeons (AAOS) has recommended the following actions with regard to in-office ancillary services:

• Congress should enact public policies that encourage the integration of clinical services to achieve a more efficient healthcare delivery system.
• The Centers for Medicare & Medicaid Services should work with the AAOS to address concerns about utilization increases through the development of appropriate use criteria and quality measures.