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

June 8, 2020

This week, First Vice-President Daniel Guy, MD, FAAOS, sent more information to AAOS leadership, specialty, and state societies, on our plans to make August the month for advocacy. Our goal is to meet with every member of the U.S. House of Representatives and the Senate, either in our homes, at our practices, or at their district and regional offices. This In-District Advocacy Event will be a nationwide effort, so we look forward to the participation of the full AAOS membership. You will each soon receive details on how you can get involved and promote advocacy for our patients’ access to quality orthopaedic care. This is an example of your Academy turning a negative -- the cancellation of the National Orthopaedic Leadership Conference (NOLC) -- into a positive. Much appreciation to Danny, his work group, and the Office of Government Relations (OGR) team for their efforts.

On June 3, the Senate approved the Paycheck Protection Program Flexibility Act which will give recipients more flexibility to use the program funds. Specifically, recipients will now have 24 weeks to spend the funds as opposed to eight weeks, and more flexibility with how funds are used because the ratio required for payroll costs has been changed from 75% to 60%. This legislation was signed into law by the President on Friday.

Many of us who received payments from the Department of Health and Human Services’ (HHS) Provider Relief Fund were justifiably concerned about how these monies could be spent. On June 2, the HHS updated the Provider Relief Fund FAQs to clarify the definition of “healthcare-related expenses attributable to coronavirus” specifying them as a range of items and services purchased to prevent, prepare for, and respond to coronavirus. These expenses may include supplies and equipment used to provide healthcare services for possible or actual COVID-19 patients, workforce training, as well as acquiring additional resources, including facilities, equipment, supplies, healthcare practices, staffing, and technology to expand or preserve care delivery. HHS expects that it would be highly unusual for providers to have incurred eligible expenses prior to January 1, 2020.

HHS defines “lost revenues that are attributable to coronavirus” as any revenue that you as a healthcare provider lost due to coronavirus. These may include revenue losses associated with fewer outpatient visits, canceled elective procedures or services, or increased uncompensated care. Note that these lost revenues do not need to be specific to providing care for possible or actual coronavirus patients.

Since March, AAOS has been advocating for flexibility in the Centers for Medicare & Medicaid Services’ (CMS) alternative payment model programs during the public health emergency. In response, the agency’s Innovation Center has issued COVID-19 related adjustments and plans to issue more information regarding the implementation of these changes as the pandemic evolves.

  • For the Bundled Payments for Care Improvement (BPCI) Advanced model, financial methodology changes include an option for participants to eliminate upside and downside risk by excluding clinical episodes from reconciliation for Model Year 3 (2020). For BPCI-Advanced participants that choose to remain in two-sided risk, certain clinical episodes with a COVID-19 diagnosis during the episode will be excluded from reconciliation. The CMS has not yet made any changes in quality reporting requirements and model timelines, but AAOS is continuing to advocate for the flexibilities in this program to match those in the Comprehensive Care for Joint Replacement model listed below.
  • For the partially mandatory Comprehensive Care for Joint Replacement (CJR) model, changes include the removal of downside risk by capping actual episode payments at the target price for episodes with a date of admission to the anchor hospitalization between January 31, 2020 and the termination of the public health emergency (as described in the interim final rule CMS1744-IFC). The appeals timeline has been extended for Performance Year (PY) 3 and PY 4 from 45 days to 120 days. There are no changes to quality reporting, but PY 5 has been extended through March 2021.

The AAOS is nowhere near done advocating on behalf of our members and our patients. For example, we continue to work on obtaining financial relief for those who serve populations that are predominantly covered by Medicaid. These providers have been largely left out of funding distributions and proportionally disadvantaged by the payment formulas. Our pediatric orthopaedic colleagues have been especially affected by this. Members of Congress have recently signed a letter expressing concern about the delay in sending funds to Medicaid providers. Senate Finance Committee Chair Chuck Grassley (R-Iowa), Senate Finance Committee Ranking Member Ron Wyden (D-Ore.), House Energy & Commerce Committee Chair Frank Pallone (D-N.J.), and House Energy & Commerce Committee Ranking Member Greg Walden (R-Ore.) all signed the letter. AAOS supports this effort.

Thanks, and stay well,

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