AAOS Advocacy Efforts Address the BPCI Advanced Model

Shreyasi Deb, PhD, MBA

Almost a year ago, the Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payments for Care Improvement (BPCI) Advanced model as part of its ongoing bundled payment initiative through the Center for Medicare & Medicaid Innovation (CMMI). The voluntary, episode-based program ties payments to quality performance and requires that participants bear financial risk and use certified electronic health record technology.

Former Orthopaedic Hand Surgeon Turned State Senator Talks Politics

Douglas W. Lundy, MD, MBA

I am in the unique position to interview my former partner and practice copresident, Georgia state Senator D. Kay Kirkpatrick, MD. She provides insights on how and why a successful orthopaedic surgeon would leave the familiarity of orthopaedic surgery and enter the world of public service and politics. When I joined Resurgens Orthopaedics in 2006, Dr. Kirkpatrick and Steve B. Wertheim, MD, served as the practice’s copresidents. In 2014, Dr.

PAC Corner

The Orthopaedic Political Action Committee (OrthoPAC) supports candidates for federal office who champion orthopaedic issues and help advance the legislative agenda of AAOS. OrthoPAC is rebuilding its war chest to be well positioned for the 2020 election and is thrilled by not only individual members’ participation in the PAC but also the success of corporate-level fundraising through the Advisor’s Circle. (See below for more information on individual/personal and corporate donations.

A Renewed Push for Stark Law and Anti-kickback Reform

Rory Wright, MD

Despite the drastic changes to the healthcare system, particularly the move from volume- to value-based reimbursement, certain laws and regulations governing physician referrals remain the same. Some of the laws create barriers to the coordination of care needed to lower costs and improve quality. One prominent example is the federal Stark Law, enacted in 1989 and expanded in 1992.

Advocacy in Action

How the AAOS Office of Government Relations (OGR) is working for you … Conveyed AAOS’ support for the House and Senate versions of the Medicare Care Coordination Improvement Act of 2019. The legislation would substantially improve care coordination for patients, improve health outcomes, and restrain costs by reforming the Stark Law for alternative payment models.

Second Look – Advocacy

According to a report from the Government Accountability Office (GAO), just a few health insurance issuers held the majority of the market in 2015 and 2016. In at least 37 states, the three largest issuers dominated more than 80 percent of the market. In individual market exchanges, three or fewer issuers controlled at least 80 percent of the market in 46 of the 49 states for which GAO had data.

State and Federal Solutions to ‘Surprise Billing’

Rory Wright, MD

AAOS Now has covered out-of-network (OoN) billing in several previous articles, but the subject remains active in many state and federal legislative bodies. This article focuses on pending legislation and other potential solutions to address OoN billing as of May 1. (See the sidebar for a more recent legislative update.) Since the passage of the Affordable Care Act, insurers have increasingly offered products with narrow, inadequate, and nontransparent networks.