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

June 22, 2020

I hope you have all been well and working hard since my last message. A survey of our country at this time reveals two distinctly different narratives. Those areas that initially faced high COVID-19 burdens are opening up and relaxing restrictions on businesses and social gatherings. On the other hand, those areas of the country that were initially spared are now experiencing increases in COVID-19. This may result in some sort of regulatory restrictions, but certainly nothing as draconian as what we experienced in March and April. All signs point to a continued return of our clinical activities; however, there is still much to be done on the legislative and regulatory fronts to ensure that we receive the support we deserve to continue providing high-value patient care.

On June 15th, the Federal Reserve’s long-awaited Main Street Lending Program finally opened for registration. The program is designed for small- and medium-sized businesses facing cash flow issues resulting from the pandemic. With loans ranging from $250,000 to $300 million, the program offers businesses five-year loans with floating rates, principal payments deferred for two years, and interest payments deferred for one year. To learn more about all of the COVID-19 loan and grant programs available to physicians, visit the AAOS COVID-19 Member Resource Center.

In addition to creating the need for financial support, the COVID-19 pandemic has also illuminated ongoing issues in our healthcare system, including the burden of prior authorization, which creates delays for our practices and our patients. Thankfully, a House bill designed to alleviate this problem is gaining momentum. The Improving Seniors’ Timely Access to Care Act (H.R. 3107) hit a new milestone this week, gaining 220 co-sponsors or a majority of support from the House of Representatives. The bill would work to reform prior authorization processes for Medicare Advantage Plans by streamlining submission processes, increasing transparency, and creating exceptions to keep patients safe. The bill could be considered before the Committee on Ways and Means as early as August. AAOS continues to push for these and broader prior authorization reforms to reduce administrative burdens for providers and to minimize delays for patients.

The Academy also continue to work to address surprise medical billing. As I said in my recent presidential address, no patient should be subject to predatory out-of-network billing when seeking emergency care. Thus, we support efforts to curtail this bad practice. However, some in Congress are trying to use the COVID-19 crisis as cover for a harmful reduction of physician negotiating power with insurers. A “benchmark” fix for surprise medical billing would slash physician reimbursement by allowing insurers to dictate a median in-network rate and forcing physicians underneath it. AAOS is determined to stop this unacceptable giveaway to insurers and solve this problem with a fair negotiation standard centered on independent dispute resolution, which has been successful in New York State and other states. In fact, legislative activity surrounding the issue is not confined to the halls of Congress; state governments continuing to grapple with it as well.

On June 17th, the Georgia legislature passed House Bill 888, which prevents patients from finding themselves in the middle of disputes by creating a “baseball style” independent dispute resolution process. If approved by Gov. Brian Kemp, Georgia will join the Commonwealth of Virginia in being among the most recent states to pass legislation targeting balance billing.

Last Friday was Juneteenth. It commemorates the ending of slavery in Texas on June 19, 1865. This date was more than two years after President Lincoln signed the Emancipation Proclamation and one month after General Lee’s May 13th surrender at Appomattox. That is how long it took for news of the emancipation of those who had been enslaved to reach Texas. It is an official Texas state holiday.

Two years ago, the Academy enacted a Strategic Plan that spotlights three specific areas: membership, quality, and culture. One area detailed within culture is the need to evolve the Academy’s Board and volunteer structure to become more strategic, innovative, and diverse. Recent national events have made it clear that racism and racial inequalities continue to exist. Orthopaedic surgeons are leaders. I believe in the concept of noblesse oblige. Our wonderful profession has blessed us with many privileges. I believe that, with these privileges, comes a duty to act in a socially responsible manner. That is why we continue to focus our efforts on diversifying our profession. As I have said before, it will benefit our specialty and the care we provide to our patients.

Thank you and stay well,

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