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COVID-19 Presidential Update from Joseph A. Bosco III, MD, FAAOS

May 11, 2020

In the last week, we have seen the measured and incremental resumption of elective surgery across much of the country. Federal and state authorities are closely monitoring this situation to ensure that there is no increase in the COVID-19 burden as a result of this change. Thankfully, none has been observed. If this trend continues, we will be allowed to increase the number and complexity of our surgeries in accordance with local resource availability. On a personal note, it felt great to be back in the OR working with friends and colleagues and taking care of patients. I am sure I am not alone in this sentiment.

Our advocacy efforts continue unabated. Since March 16th, the AAOS Office of Government Relations (OGR) has met with more than 100 members of Congress, either by phone or video conference. Each meeting is a testament to the Academy’s strong Orthopaedic PAC and reputation as the premier voice of authority in health care. This voice affords us the opportunity to continue shaping the conversation around COVID-related policies. Since the inception of the fourth COVID-19 relief package two weeks ago, which provided additional funding for Small Business Administration loans and the Paycheck Protection Program (PPP), the news from Congress has been sparse. Meanwhile, the Centers for Medicare and Medicaid Services is continuing to implement these programs and recently announced its second round of regulatory changes. Importantly, the period for accepting and attesting PPP funds has been extended to 45 days with the same terms and conditions.

At the state level, policymakers have been grappling with a variety of issues impacting physicians and patients in the course of responding to the pandemic. These include:

  • Access to and costs associated with testing and treatment,
  • The personal protective equipment (PPE) supply chain,
  • Limitations on procedures considered elective,
  • Licensure portability,
  • Medicare/Medicaid flexibilities, and
  • Medical liability and telemedicine.

Of particular importance is the need for states to grant physicians immunity from civil liability for any harm caused while providing medical care in support of the states’ response to the pandemic, as well as harm resulting from federal, state or local directives to cancel, delay or deny care as a result of the public health emergency. The Academy is continuously monitoring these evolving developments and stands ready to support state orthopaedic societies working to navigate these uncharted waters.

In fact, AAOS is already working with several state orthopaedic societies to address these issues as states ease restrictions and outline a variety of recommendations that could still limit care. In my own hard-hit state, AAOS recently joined the New York State Society of Orthopaedic Surgeons in expressing concern to Gov. Andrew Cuomo about a recent executive order. This order left out a critical component of the healthcare system by denying free-standing ambulatory surgery centers (ASCs) the opportunity to provide medically necessary care. Soon we will be joining the Massachusetts Orthopaedic Association in encouraging Gov. Charlie Baker to allow the safe resumption of non-emergent surgical procedures in hospitals and ASCs.

The Academy continues to focus on COVID-19 even as it works on executing its Strategic Plan. For example, the pandemic has accelerated the trend towards distance-based, virtual learning. In response, we have ramped up our virtual education offerings. We are providing hybrid online and in-person Orthopaedic Learning Center (OLC) courses, including a successful outpatient total joint course. Our Board Prep and Review Course is completely digital and delivered through the Learning Management System, the Academy’s online learning platform. Most importantly, we have transformed much of our “canceled” 2020 Annual Meeting educational content into a virtual experience. To date, we have uploaded 587 (71%) of the podium presentations and 889 (88%) of the posters. These are available for viewing on AAOS.org. We are in the process of recording the Instructional Course Lectures and Symposia and are currently offering more than 100 hours of online CME for viewing these offerings. The Academy understands that education may never return to its pre-COVID state and is prepared to meet the changing educational needs of its members. 

Even the AAOS Registry Program has responded to the COVID-19 challenge. To date, we have captured 1.95 million total joint arthroplasties! All of our registries are now capturing COVID-19 status as a perioperative comorbidity. Additionally, we are now able to list COVID-19 as a reason for readmission. The new data allows us to understand the impact of COVID-19 outcomes. It will also help inform OGR staff in their efforts to roll back potential COVID-19-related penalties associated with CMS’s value-based payment models.   

It is important for all of us to realize that, along with our highly visible and successful COVID-related advocacy and policy efforts, we continue to execute on our Strategic Plan. Together, these combined efforts will help ensure that the Academy emerges from the pandemic as a strong and effective force for you and your patients.

I hope you will join me and the rest of the AAOS Presidential Line this Wednesday, May 13th, at 8 pm CT for another webinar to share new information and answer your questions. Registration is available online.

Stay safe and healthy,

Sincerely,
Joseph A. Bosco III, MD, FAAOS
AAOS President