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

May 18, 2020

Another week has passed, and we continue to see a gradual, phased reopening of elective orthopaedic surgery. Fortunately, there are no reports of unexpected events linked to the relaxation of surgery restrictions. The other positive news from this hiatus is that the care we provide is appreciated now more than ever—by patients, colleagues, hospitals, and governmental authorities. Absence, in this case, does make the heart grow fonder!

More good news: This week, the Department of Health and Human Services (HHS) published a list of provider organizations that received payments from the CARES Act Provider Relief Fund general distribution. AAOS analyzed this data and found that $207,608,616 has been delivered to 1,235 orthopaedic practices across the U.S. This money is a grant that was automatically sent to practices that treat Medicare patients. It was calculated as roughly one-twelfth of the individual practices’ 2019 Medicare payments and represents the reimbursement we would have collected from Medicare if we were allowed to treat patients. This is considered budget neutral as the federal government is still collecting Medicare premiums, but the patients are not accessing care. 

These grants were initially earmarked for “COVID-19 providers” and there was confusion as to whether orthopaedic surgeons would qualify. The American Association of Hip and Knee Surgeons (AAHKS) arranged a meeting with Eric Hargan, Deputy Secretary of HHS, and, together, we explained to him that all orthopaedic surgeons were delivering care to COVID-19 patients. The following week, the payments were deposited into many of our practice accounts. This was a clear demonstration of the effectiveness of aligned advocacy efforts with our subspecialty partners, and we thank AAHKS for arranging the meeting.

On May 15th, the U.S. House of Representatives voted to pass the HEROES Act (see AAOS summary), opening debate on the next phase of coronavirus relief efforts from Congress. The legislation includes over $3 trillion in funding for state and local governments, hospitals and physicians, payments to individuals, and other assistance. Most relevant to orthopaedics is that the bill includes an additional $100 billion in grants for healthcare providers as a fix for the currently suspended Medicare Accelerated and Advance Payment Program, as well as adjustments to repayment timelines for Paycheck Protection Program (PPP) loans. The HEROES Act has been criticized as being too expansive and overreaching and is unlikely to see quick consideration in the Senate as currently written. That being said, formal negotiations on the next phase with the White House and Congress are not expected to begin until June, so this process will be significantly slower than the CARES Act and previous stimulus bills. The AAOS Office of Government Relations continues to advocate for our priorities, including support for physician practices, preservation of reimbursement levels, reduced administrative burden, and protection from infection and other baseless liability claims.

At this point, most states have eased directives delaying non-emergent medical care that were aimed at conserving personal protective equipment and freeing up facilities for COVID-19 patients. However, even in states that have reined in limitations, many state health departments have outlined a variety of guidelines that could still limit procedures. As previously mentioned, AAOS recently joined the New York State Society of Orthopaedic Surgeons in urging the state to allow ambulatory surgical centers (ASCs) to resume performing medically necessary care. A positive step in this direction was made last week when Gov. Andrew Cuomo announced the resumption of elective surgery in 47 counties without significant risk of COVID-19 surge, including within ASCs. We are involved in similar efforts in Massachusetts and stand ready to assist other states.

Another notable development resulting from the pandemic is that there have been actions to suspend Certificate of Need (CON) requirements. Of the 35 states that still have formal CON laws on their books, 22 have suspended some portion of their programs in response to COVID-19, according to a report published by the Pacific Legal Foundation. This represents further support for the Academy’s long-held position that archaic CON laws must be repealed in order to improve the patient access and quality of care that is fostered by healthy competition among healthcare facilities, including specialty hospitals. In addition to enshrining new advancements and flexibilities within telemedicine beyond this public health emergency, state governments would be well served to eliminate policies limiting the growth and expansion of healthcare infrastructure. Our efforts are currently focused on ensuring that the suspended CON requirements are permanent— thus allowing all patients access to the high-value care provided at surgeon-owned ASCs.

This week, the Academy, along with the subspecialty societies, will release a resource geared toward patients who are undergoing orthopaedic care during the pandemic. It will provide answers to questions they may have regarding how COVID-19 may impact their treatment or surgery. This is meant to be an adjunct to your discussions with patients who may be understandably anxious about in-office visits and surgery. It presents a reasoned, evidence-based approach. We hope that you will find this resource helpful in your discussions, and we appreciate the input of our subspecialty colleagues in developing the document.

Thanks to each of you who submitted responses to the survey and polls AAOS distributed in April. The results and analysis have been curated into a new report titled “Voice of the Orthopaedic Surgeon.” The report is available in the AAOS COVID-19 Member Resource Center and will be used by leadership and staff to address current and future member needs.

As always, if you have any questions or concerns, please email me at joseph.bosco@nyulangone.org, or at covid19@aaos.org.

Stay safe and healthy,

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