Adam J. Bruggeman, MD, MHA, FAAOS, FAOA


Published 12/20/2023
Adam J. Bruggeman, MD, MHA, FAAOS, FAOA

Final Chance to Prevent 2024 Pay Cuts

Help push Congress for a fix by Jan. 19 in absence of long-term structural changes

As we approach the end of the year, I want to reflect on AAOS’ advocacy efforts to reform Medicare payment policy and offer some insights on the path forward into 2024.

In 2023, the house of medicine found itself once again fighting payment cuts in the Medicare Physician Fee Schedule (MPFS). This seemingly endless cycle, in which the Centers for Medicare and Medicaid Services (CMS) is forced to propose cuts to the fee schedule due to the restraints of budget neutrality, leaves physicians running to Congress asking for relief. This is nothing new.

Since day one of the 118th Congress, AAOS has been working against an increasingly difficult landscape on Capitol Hill. Two separate, drawn-out battles over electing a Speaker left the House paralyzed for a total of 26 legislative days.

When Congress was functioning, it did so with a slim Republican majority in the House that gave considerable leverage to House Republican firebrands. This environment makes it especially difficult to advance any priorities, let alone crucial policies such as Medicare payment reform, which carries a significant price tag. Multiple threats of government shutdowns and brinkman-like funding battles have consumed most of the oxygen in the proverbial room this year, eventually leading Speaker Mike Johnson (R-La.) to take an unprecedented “laddered continuing resolution” approach to funding the government through early next year. As a result, competing priorities before Congress were deprived of the opportunities an end-of-year spending package can provide, which is commonly used to sign them into law.

Congress spent much of this year paralyzed, and as of mid-November, the 118th Congress had only passed a total of 21 bills into law. However, AAOS’s advocacy operation never slowed down in its work to promote policy priorities that advance musculoskeletal care.

This year, the Office of Government Relations (OGR) worked with our champions on Capitol Hill to introduce the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which is the first legislation to fully tie physician payment to the Medicare Economic Index. As of publication, the bill had a broad, bipartisan coalition of 72 cosponsors in the House of Representatives. Thanks in part to our efforts to raise awareness of the problems plaguing the Medicare payment system, the House Energy and Commerce Committee held its first hearing in several years to examine proposed reforms to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

In the past few weeks, there has been a growing sense on Capitol Hill that Congress must act on broader structural changes to Medicare payment policy. Our champions in Congress introduced legislation such as the Physician Fee Schedule Update and Improvements Act (H.R. 6545) and the Provider Reimbursement Stability Act (H.R. 6371) to provide stability in the annual conversion factor and address the budget neutrality requirements that contribute to the year-over-year cuts. These developments are encouraging signs that our advocacy is steering the narrative on Capitol Hill.

Unfortunately, the political challenges and time constraints of this Congress prevented these changes from materializing before the year’s end. Although the actual impact on our specialty and your practice may be different, the Medicare conversion factor is set to decrease by 3.37 percent on Jan. 1, 2024.. The immediate priority must be educating Congress on the impact this will have on our ability to provide patients with high-quality care.

However, there is still one more opportunity to stop this cut. Rep. Greg Murphy (R-N.C.) and five cosponsors introduced H.R. 6683, which would eliminate the full 3.37 percent cut. With a partial government funding lapse approaching on Jan. 19, 2024, Congress is facing a tight deadline to implement this fix. Should Congress act to stop the cut before Jan. 19, CMS would immediately direct its payment contractors to update payment calculations retroactively to Jan. 1 to pay the full adjusted rate. It’s no secret that Congress works best when it is backed up against a hard deadline, so it is crucial that we continue to put pressure on our members of Congress in the coming weeks.

I would be remiss if I didn’t reiterate the importance of supporting the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC) to give us the resources necessary to continue identifying and cultivating champions on Capitol Hill. Over the past few weeks, several of our key champions and physician members in Congress have announced their retirement in the coming year. Although their absences will be felt by us all, this also gives us an opportunity to unite around electing more physicians to Congress who understand our priorities and will lead the fight for the physician community and the patients we serve.

In closing, I extend my gratitude for your unwavering dedication to our profession, to your patients and communities, and to the field of musculoskeletal care. As we forge ahead into the new year, I look forward to working with you to ensure that whenever policy decisions that affect us and our patients are being made, orthopaedic surgeons have a seat at the table.

Wishing you a restful and rejuvenating holiday season.

Adam J. Bruggeman, MD, MHA, FAAOS, FAOA, is chair of the AAOS Advocacy Council.

AAOS advocacy in 2023 by the numbers

  • 723 total touchpoints with members of Congress and/or their staffs
  • 429 political fundraisers for members of Congress attended by AAOS staff in Washington, D.C.
  • 54 events attended by AAOS Fellows in Congress members’ districts
  • 11 Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC) fundraisers hosted in Washington, D.C., for members of Congress
  • 6 meetings with regulatory agency officials
  • 14 formal letters sent to agencies in response to proposed rules or requests for information