Published 9/1/2018
Wilford K. Gibson, MD; Stacie Monroe

The Power of Our Pillar: The Value of Advocacy for Our Profession and Patients

Have you noticed that in the AAOS logo the “O” has three arrows? They represent the pillars of our organization: research, education, and advocacy. Advocacy ranks highly among our members as one of the most valued membership services.

Whether you are in academia, an employed physician, or in private practice, we are advancing your issues. Although orthopaedics is comprehensive, with 24 subspecialties in all, the AAOS Office of Government Relations (OGR) advocates for the entire field.

AAOS is recognized as a political powerhouse in our nation’s capital. In a tumultuous political environment, you must have a presence to be heard, and our voice is the AAOS Orthopaedic Political Action Committee (Orthopaedic PAC).

Formed in 1999, our PAC is one of the largest in the nation. We have one of the highest participation rates across all PACs and raise $3.5 million per election cycle. The Orthopaedic PAC has already raised more than $3.5 million this cycle and is on track to achieve its best election cycle to date.

The Orthopaedic PAC opens doors and offers access to lawmakers. We invest heavily in candidates who support our causes, and the investments are based on a three-tiered system, weighted by members on committees of health jurisdiction, considered by the leadership, and determined as issues of importance by the AAOS Council on Advocacy. We only deliver support in person based on causes relevant to our specialty. During the midterm election cycle, we are attending more than 1,000 events in Washington, D.C., going to more than 85 events in the Congressional district, and hosting more than 100 events for our orthopaedic champions.

Although the Orthopaedic PAC is federal, we also recognize the state-specific battles. We work to increase our political footprint and have invested through gubernatorial committees, as well as state party committees, which is a new endeavor this year.

Access to and affordability of health care continue to be at the top of our concerns. Everyone has a stake in the healthcare system, and with a system as complex as ours, billions of dollars are being spent on healthcare consulting. The OGR consistently monitors and fights for issues related to advancing the highest-quality musculoskeletal health, guided by the Council on Advocacy’s Unified Legislative and Regulatory Agenda. The primary objective is to enhance access to and quality of orthopaedic care for our patients. Major legislative and regulatory initiatives include Medicare reimbursement reform, addressing health information technology, increasing research funding, protecting in-office ancillary services, and increasing Congressional awareness of the large and growing prevalence of musculoskeletal diseases.

Recent legislative wins

Perhaps the most notable AAOS-specific win has been the repeal of the Independent Payment Advisory Board, which was charged with making recommendations to cut Medicare expenditures if spending growth reaches a certain level. This has been a top priority for AAOS over the years, and the repeal is a great example of our successful advocacy efforts.

This year, there were technical fixes, which AAOS requested, to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), improvements to the cost performance category of the Merit-based Incentive Payment System, additional flexibility related to the performance threshold, and removal of the meaningful use standards mandate that became more stringent over time.

Medical liability reform continues to be a high-profile issue for AAOS, and we have seen some movement in this area.

First, our Sports Medicine Licensure Clarity Act—a bipartisan, bicameral bill—would clarify medical liability rules to ensure that team providers are properly covered by their professional liability insurance while traveling with athletic teams out of state. The House of Representatives’ version passed on suspension in early 2017 and has since passed the Senate Health Education Labor and Pension Committee, setting the stage for this bill to become federal law. Second, the Protecting Access to Care Act has passed the House, placing a $250,000 cap on noneconomic damages.

Additionally, we work tirelessly to repeal the provisions of the Affordable Care Act related to physician-owned hospitals. Section 6001 specifically prohibits the construction or expansion of hospitals owned in part or full by physicians. A repeal of this section would provide patients greater access to high-quality health care, allow more provider options, and lower costs. AAOS stressed the importance of the repeal with help from physician fly-ins; as a result, Reps. Sam Johnson (R-Texas) and Sheila Jackson-Lee (D-Texas) and Sen. James Lankford (R-Okla.) introduced the Patient Access to Higher Quality Health Care Act of 2017, which, if enacted, would repeal Section 6001.

Other legislative wins for orthopaedics include the Veterans Affairs Prompt Payment, $30 million in Department of Defense (DoD) annual funding for musculoskeletal extremity war injury research, in-office ancillary services protection, $2 billion in funding for the National Institutes of Health, and 10 years of CHIP funding and additional funding to combat the opioid crisis. These successes are in addition to other AAOS-led bills, such as advancing Stark Law reforms to allow for coordinated care; antitrust reforms to level the playing field between physicians and providers; Mission Zero, which provides grants and allows DoD trauma surgeons to be assigned to civilian trauma centers; and the Good Samaritan Act, which would provide protections for physicians traveling to disaster areas.

Our work extends into the regulatory agencies. Increasingly, we have seen regulations and physician burden rise, and with this, we have taken a multipronged approach to cut the red tape and help provide regulatory relief.

Our efforts ensure that orthopaedic concerns are addressed, even after the conclusion of the legislative process and throughout agency rulemaking and implementation. The regulatory staff works closely with Department of Health and Human Services’ agencies, including the Food & Drug Administration, Centers for Medicare & Medicaid Services (CMS), Agency for Healthcare Research and Quality, and Centers for Disease Control and Prevention. In addition, expertise in coding, reimbursement, and payment policy is shared across the Academy and with our members. The OGR also houses AAOS’ practice management information and educational efforts, which are key services to our fellowship and members.

A recent substantial win was part of the 2017 Medicare Physician Fee Schedule proposed rule, in which CMS proposed eliminating its 10- and 90-day global codes and instituting eight G codes that providers would report in 10-minute intervals. AAOS successfully argued that this proposal was a great burden on physicians, would compromise care, and exceeds Congressional intent in MACRA, noting that CMS should review and revise the proposal.

Additional regulatory actions for which AAOS advocated include the following:

  • The 2017 inpatient final rule included a code change from musculoskeletal diagnosis-related group (MS-DRG) 470 to MS-DRG 469 for total ankle replacement, recognizing the increased complexity and increasing diagnosis-related group reimbursement.
  • A 2017 final rule addressed significant concerns raised by AAOS related to mandatory bundled payment programs (downsizing the Comprehensive Care for Joint Replacement [CJR] model and canceling the Surgical Hip and Femur Fracture Treatment model).
  • Increased protection for small, solo, and rural practices under the Quality Payment Program and the creation of more Advanced Alternative Payment models beginning in 2018, through CJR and Medicare Advantage.

In July, the OGR secured report language that clarifies that the CMS Innovation Center (CMMI) may use funds to support the
development and utilization of Qualified Clinical Data Registries as part of CMMI’s initiative to test innovative payment and service-delivery models. This clarification will assist AAOS in securing federal CMMI funding to support demonstration and research projects that include the American Joint Replacement Registry and other AAOS orthopaedic specialty registries.

To renew your support of the Orthopaedic PAC, visit www.aaos.org/PAC or text aaos to 41444.

Wilford K. Gibson, MD, is chair of the AAOS Council on Advocacy and a member of the AAOS Now Editorial Board.

Stacie Monroe is the senior manager of political affairs in the AAOS OGR.