AAOS Now

Published 4/1/2019

How Does Advocacy Benefit AAOS Members?

As an orthopaedic surgeon, you expect the freedom to practice in the best interests of your patients as well as to be fairly compensated for care you provide. That’s why advocacy is essential—to promote relevant diagnostic and treatment procedures, advance reasonable reimbursement policies, and protect against unfair regulatory requirements.

AAOS is actively engaged in promoting and protecting the profession for members. We commit significant resources to serve as the voice of the profession and represent the interests and concerns of orthopaedic surgeons with regulatory agencies, payers, and the public. Most notably, the AAOS Office of Government Relations (OGR) pursues continuous activities to reduce regulatory burden and to protect physician reimbursement on federal, state, and local levels.

The OGR regulatory team works closely with the Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration, Agency for Healthcare Research and Quality, National Institutes of Health, and Centers for Disease Control and Prevention, as well as other agencies that influence regulation and policy for orthopaedic surgeons.

Currently, OGR regulatory advocacy activities include:

  • Continuously monitoring federal agency websites, announcements, and publications, such as the Federal Register, for release of proposed rules and policy changes
  • Analyzing proposed rules and policy changes to evaluate impact on AAOS members
  • Discussing proposed rule changes with AAOS committees, members, and leaders to solicit input on impact of new rules
  • Creating and submitting formal AAOS comment letters to express concerns and to propose alternate solutions
  • Arranging calls and in-person meetings with federal agency leaders to represent AAOS responses to rules and regulations
  • Gathering additional support for AAOS’ position by working with other groups and medical associations
  • Creating or joining existing coalitions to enhance the message
  • Meeting with congressional members and other entities, such as the White House Office of Management and Budget, to ask that they contact federal agency leaders in support of AAOS’ position
  • Initiating letter-writing campaigns and additional visits with federal agency staff to educate and influence agency rule-making
  • Serving on federal agency workgroups to lend clinical expertise

The OGR regulatory team’s expertise in coding, reimbursement, payment policy, and clinical quality and value is shared across the Academy and is available to its members.

Recent examples of AAOS regulatory achievements that enhance payment and provide regulatory relief include:

  1. Delayed changes to the evaluation and management (E/M) codes and prevented a collapse of payment levels 2 to 5 in the 2019 Medicare Physician Fee Schedule Final Rule
  • Background: In response to AAOS comments regarding proposed revisions to E/M services, CMS finalized documentation guidelines to reduce clinician burden. The new guidelines took effect on Jan. 1 and eliminate the need to redocument any part of the chief complaint or history recorded in the medical record. CMS also agreed to AAOS’ request to delay a collapse of E/M codes 99201–99215 until 2021.
  1. Secured additional guidance from CMS to help resolve confusion regarding the removal of total knee arthroplasty (TKA) from the Medicare inpatient-only (IPO) list
  • Background: On Jan. 8, CMS issued unprecedented guidance in response to AAOS advocacy to help resolve confusion regarding the removal of TKA from the Medicare IPO list. CMS also reiterated that the surgeon is the final arbiter of the setting of care and provided clinical case studies to guide how quality-improvement organizations will review claims based on the two-midnight rule.
  1. Secured language allowing funding to be used for qualified clinical data registries (QCDRs) in the fiscal year 2019 House Labor, Health and Human Services, Education, and Related Agencies appropriations bill
  • Background: Following a multi-year advocacy effort that included adding language to the Medicare Access and CHIP Reauthorization Act (MACRA) directing CMS to allow QCDRs access to Medicare claims data, AAOS was successful in obtaining Medicare datasets to conduct longitudinal studies on the 1.5 million hip and knee procedures in its registry database. Access to the Medicare claims data has significantly enhanced AAOS registry value to members and their patients.
  1. Prevented the elimination of the small-practice bonus
  • Background: In response to AAOS comments submitted on the proposed MACRA and 2019 Quality Payment Program (QPP), CMS not only agreed to AAOS’ request that the small-practice bonus not be eliminated or reduced but also raised the bonus from five to six points. This will continue to allow small and solo practices participating in the Merit-based Incentive Payment System to more easily meet the point threshold and avoid a negative payment adjustment.
  1. Helped develop the knee arthroplasty measure included among the eight episode-based cost measures in the QPP proposed rule
  • Background: AAOS was a part of the MACRA Episode-based Cost Measures Musculoskeletal Clinical Subcommittee and helped develop the knee arthroplasty measure included among the eight episode-based cost measures in the QPP Proposed Rule. Being a part of the team that developed this cost measure allowed AAOS to ensure that it adequately reflected member concerns and clinical expertise.
  1. Secured the Bundled Payment for Care Improvement (BPCI) Advanced payment model
  • Background: On Jan. 9, 2018, CMS announced a new voluntary bundled payment model—BPCI Advanced—that will qualify as an advanced alternative payment model (APM) under the QPP. This model creates opportunities for AAOS members to participate in advanced APMs and earn the incentive bonus associated with those payment models.

Protecting your ability to practice orthopaedic surgery in the best interest of patients is paramount to AAOS. Your Academy membership adds credence to our representation of the profession as we preserve and defend against regulatory policies that are contrary to the delivery of high-quality patient care. By being an Academy member, you also amplify our voice as we actively pursue reasonable compensation for orthopaedic surgery. That’s the true benefit of advocacy at AAOS.