May 26, 2020
All fifty states have either completely or partially relaxed their rules prohibiting “nonessential” surgery. Some states, including Louisiana, have even declared that no type of orthopaedic surgery qualifies as “elective” surgery. As our surgical cases increase in volume and complexity, we continue to actively monitor our communities’ COVID-19 burden and resource availability. I am happy to report that, so far, there has been no increase in COVID-19 cases corresponding to the increase in surgery. However, all experts agree that, at some point, our country is likely to experience an uptick in COVID-19 cases. If and when this occurs, we must be ready to respond.
Last week, I discussed the Provider Relief Fund grant program administered by a branch of Health and Human Services (HHS) called the Health Resources and Services Administration (HRSA). I am pleased to report that, since our analysis last week, we have discovered that an additional $30,677,977 has been provided to orthopaedic practices. This means that a grand total of $238,286,593 has been distributed to more than 1,440 practices. Florida has received the greatest amount of funding ($18,434,723), with California and Texas coming in at second and third, respectively.
HHS is reminding eligible providers that they must accept the terms and conditions of the Provider Relief Fund and submit their revenue information by June 3, 2020, to support receiving an additional payment from the fund’s $50 billion general distribution. HHS distributed $30 billion immediately on passage of the CARES Act, based on providers' share of Medicare fee-for-service reimbursements in 2019. Then, beginning on April 24th, the department began distributing an additional $20 billion to providers based on their share of net patient revenue. Eligible providers now have 45 days from the date they receive a payment to attest and accept the terms and conditions or return the funds. If they do not do so, they will be deemed to have accepted. So far, the vast majority of practices have accepted the terms, which I believe are relatively benign by federal standards. I urge those of you who have received grants to look at the conditions and make an informed decision whether you will accept the funds within the allotted 45 days. Again, let me reiterate that this payment is not a “gift,” but represents a portion of the Medicare fees we would have collected if the government had permitted us to work.
The Office of Government Relations (OGR) continues to work to ensure that each of the Academy’s Fellows receives a fair share of the $3.3 trillion CARES Act. While the Provider Relief Fund distributions are a WIN for the OGR, our advocacy team is far from finished. Efforts continue to change the way practices can spend funds provided under the Paycheck Protection Program, and to lengthen and relax the payback terms for loans from the Small Business Administration. Equally as important, the OGR is partnering with state orthopaedic societies to address state-level issues, including the return to surgery and the permanent relaxation of Certificate of Need requirements for physician-owned ambulatory surgery centers and hospitals.
On another positive note, we have rolled out the patient-centered FAQs for undergoing orthopaedic surgery during the COVID-19 pandemic. The Academy partnered with the orthopaedic subspecialty societies to create this informative and easy-to-understand resource, which is available on OrthoInfo.org, the AAOS patient education website, at Questions and Answers for Patients Regarding Elective Surgery and COVID-19. A Spanish translation will soon be available.
First Vice President Daniel Guy MD, FAAOS, is busy leading a work group that is organizing in-district visits with members of Congress. This event will take place over a two-week period in August. It will include a virtual symposia day that will highlight topics that are typically part of the NOLC. The planning team will be hosting educational webinars and will be distributing the background information you will need to prepare for this year’s in-district events. Please be on the lookout for more details from the Academy and your state orthopaedic society leadership over the next few weeks.
Lastly, I hope you had a peaceful Memorial Day weekend that included a socially distanced barbeque, beach day, or some other activity that you enjoy. I know you will agree with me that, while taking part in these activities, it was important to reflect on the meaning of Memorial Day and remember those who sacrificed so that we could enjoy such days.
Joseph A. Bosco III, MD, FAAOS