During a presentation at the AAOS 2019 National Orthopaedic Leadership Conference, Wilford K. Gibson, MD; Stacie Monroe (on behalf of John T. Gill, MD); and M. Bradford Henley, MD, MBA, FACS, shared the latest updates regarding the Association’s advocacy efforts.
Dr. Gibson, chair of the AAOS Council on Advocacy, began with an overview of AAOS-supported legislation.
The Seniors’ Timely Access to Care Act of 2019, supported by Representatives Roger Marshall, MD (R-Kan.); Ami Bera, MD (D-Calif.); Mike Kelly (R-Pa.); and Suzan DelBene (D-Wash.), would help protect patients from unnecessary delays in care by standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors.
At the time this presentation was given, the Senate Committee on Health, Education, Labor, and Pensions (HELP) had been working on a series of legislative initiatives aimed at lowering the cost of health care while increasing value, including topics such as surprise billing, price transparency, a gag clause between providers and health plans, and anticompetitive behavior. Since then, the HELP Committee has passed a legislative package out of committee that would benchmark out-of-network bills to the median in-network rate. The House Energy and Commerce Committee passed similar legislation but included an arbitration mechanism for bills over $1,250. AAOS does not expect further action in either chamber until September.
In addition, several bills have been introduced to expand the role of public programs in health care—“Medicare for All.” Dr. Gibson noted that AAOS “strongly oppose[s] proposals that create a federal healthcare authority or move health care further in the direction of a single-payer healthcare system.” AAOS is looking to produce guiding principles for the expansion of the role of public healthcare programs.
OrthoPAC’s banner year
Ms. Monroe, senior manager of political affairs in the AAOS Office of Government Relations, spoke on behalf of Dr. Gill and gave an update on the Orthopaedic Political Action Committee (OrthoPAC). The PAC celebrated its 20th anniversary in February, following a record-breaking 2017–2018 election cycle that raked in more than $4 million in donations, representing a 15 percent increase from the previous election cycle. It was the best in the PAC’s history and resulted in $2.7 million being invested in congressional candidates. OrthoPAC has a goal to reach $4.2 million in donations during the next election cycle. She also noted that the PAC team won the 2019 National Outstanding Association PAC Award by the Public Affairs Council.
Ms. Monroe also introduced the OrthoPAC Squad—a recent campaign designed to boost interest in OrthoPAC and its initiatives, featuring a cast of superheroes dedicated to protecting orthopaedists and their patients.
“The campaign is light-hearted and fun,” Ms. Monroe said. “Some people don’t like politics. They don’t want to be pushed to give money, so let’s give them an educational campaign. … We really go back to the basics—explaining hard and soft dollars and some of our victories.”
Getting involved in the RUC
Dr. Henley, chair of the coding coverage and reimbursement committee, discussed the Resource-based Relative Value Scale (RVS), in which physician services are “in theory” ranked according to the relative costs of resources required to provide them. These are divided into three categories: physician work, practice expense, and professional liability insurance. The formula for calculating payment schedule amounts entails adjusting relative value units (RVUs), which correspond to services, by the budget neutrality work adjuster and by the geographic practice cost indexes, which correspond to payment localities.
He then discussed how RVUs are generally calculated for Medicare payments across the United States. AAOS member R. Dale Blasier, MD, is on the RVS Update Committee (RUC), which meets three times per year to consider coding changes for the following year.
RUC’s cycle for developing recommendations is closely coordinated with both the Current Procedural Terminology Editorial Panel’s schedule for annual code revisions and the Centers for Medicare & Medicaid Services’ (CMS) schedule for annual updates in the Medicare payment schedule. CMS publishes the annual update to the Medicare RVS in the Federal Register every year.
Specialty societies that have a seat at the American Medical Association’s House of Delegates actively participate in the RUC, and, according to Dr. Henley, AAOS members are able to influence Medicare reimbursement through the RUC survey process. He encouraged the audience: “If you receive a survey, please participate, because your input is critical to the values that are eventually published and accepted. When you don’t participate, we only have ourselves to blame for the lower reimbursement.”
Dr. Henley discussed CMS’ decision to remove total knee arthroplasty from the inpatient-only list, effective Jan. 1, 2018. This caused confusion within the specialty and could impact reimbursement for those procedures. AAOS was successful in getting CMS to issue an unprecedented guidance on the new policy and is still working with the agency to address the concern. AAOS is also developing a toolkit to help members work through policy implementation.
Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at firstname.lastname@example.org.