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

June 2, 2020

Our patients are finally getting the high-quality care they deserve as state and local governments continue to relax restrictions on surgical practices. Most importantly, this care is being provided in an environment that is safe for patients, staff, and society. All those involved in patient care—including the patients themselves—understand that certain aspects of our practices have changed. The need for social distancing requires that we see fewer patients and utilize telemedicine whenever possible. We are becoming accustomed to wearing masks during office hours and our patients welcome symptom screening before being seen. COVID-19 antigen testing is being required by many institutions prior to surgery and this has been well received by patients. Despite the inconvenience, they understand and appreciate the steps we are taking to protect them. In short, we are all getting used to the “new normal.”

As I mentioned in last week’s update, the Academy has developed a helpful resource for you and your patients around the return to orthopaedic surgery. “Questions and Answers for Patients Regarding Elective Surgery and COVID-19” is now available in both English and Spanish on OrthoInfo.org, the Academy’s patient education website.

Last Thursday, the U.S. House of Representatives passed legislation allowing healthcare providers that received funding under the Paycheck Protection Program (PPP) to have greater flexibility in how they utilize the funds. You will recall that, originally, 75% of the funding had to be spent on payroll costs. This has now been reduced to 60%. The issue is that businesses need the funds to stay open before they can hire back their employees. If your practice cannot pay rent and other expenses, it does no good to be able to rehire your staff. Additionally, the House bill gives borrowers 24 weeks to spend the funds instead of eight weeks. The eight-week deadline to spend the funds is approaching for those who received PPP loans early on, and practices that have furloughed staff cannot hire them back if regulations prevent them from operating and seeing patients.

The Academy fought hard to get these two issues addressed, so this is a big win for our advocacy efforts. The current version of the House bill maintains the payroll percentage spend at 75%, but it does extend the spend period to 24 weeks. We all need to contact our senators and tell them to reduce the payroll spend to 60%. The Office of Government Relations (OGR) can assist you in this process and can be contacted via dc@aaos.org. It really does make an impact when our legislators hear from us.

On May 4th, the Academy sent a letter to CMS requesting several changes to the COVID-19 Accelerated and Advance Payment (CAAP) program. The CAAP program provided advances on our Medicare payments in the form of a loan. The Academy asked that the program be reinstated, the loan repayment period be extended for two years, and the loans be interest free. CMS replied on May 21st. The agency did not reinstate the program but, instead, replaced it with an extension of the Provider Protection Act, which gives practices grants (non-repayable) based on Medicare billing. A win! They allowed a one-year payback period for hospitals and 210 days for practices before a demand for repayment of the remaining balance is made.

Last Friday, Reps. Phil Roe, MD (R-Tenn), and Lou Correa (D-Calif) introduced the Coronavirus Provider Protection Act, which would provide healthcare professionals and the facilities in which they work with protections from COVID-19-related lawsuits. This bill is meant to be narrow and would only apply during the declared COVID-19 public health emergency or for 60 days after it ends. In addition, it would apply only when the services were within the provider’s scope of licensure/certification, without regard to whether the service fell within the usual scope of practice, and the services were provided in good faith. Finally, the bill covers actions taken based on any direction or guidance from federal, state, or local agencies, or those taken due to a lack of resources that can be attributed to the declared emergency.

None of these advocacy and regulatory wins would have been possible without the sustained efforts of the OGR and the alignment of the “House of Orthopaedics.” The OGR gets its traction through a combination of hard work and relationships with lawmakers. The hard work we supply; the relationships are powered by financial support. This financial support comes from our Orthopaedic Political Action Committee commonly known as the OrthoPAC (learn more in this recent episode of The Bone Beat podcast). As you know, OrthoPAC is considered one of healthcare’s best and is wholly funded by support from our members. I understand that this is a difficult time for all of us, but this is also a crucial time for our OrthoPAC. Now, more than ever, our advocacy efforts are paying dividends. For this reason, I am asking you to continue to support the OrthoPAC so that it can continue to support our patients and our profession.

Thanks and stay well,

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