April 13, 2020

Much has transpired during the intervening week since my last correspondence. There is some good news on the COVID-19 pandemic front: as it appears that the curve is indeed flattening out. This is especially true in “hot spots” such as New York City and New Orleans. Other parts of the country are lagging behind and may still experience increases in cases.

The burning question is: when will we be able to perform “elective surgery” and get back to taking care of our patients? The short answer is no one knows. What we do know, is that timeline will likely be different for different parts of our country.  Additionally, the return will be staggered with ambulatory cases and less complex cases starting earlier. The key is that these decisions will be made locally, dependent on local conditions and resources. I am certain, that when we do get the “all clear”, we will all be happy to be back taking care of patients.

There is much activity on the regulatory and advocacy front. Thus far there have been three federal programs aimed at providing COVID-19 relief. The first package was $8.3 billion earmarked mostly for state and local programs to fight the virus. The second package called the Families First Coronavirus Response Act provided medical leave for employees with COVID-19 and also eliminated cost-sharing (co-pays) for COVID-19 testing and services related to testing for private health plans, Medicare, Medicare Advantage, Medicaid or CHIP plans. The third package was the Coronavirus Aid, Relief, and Economic Security (CARES) Act which was signed into law on March 27th. This was the legislation that appropriated $100 billion to Health and Human Services, the small business relief loans for businesses with fewer than 500 employees, and the exchange stabilization fund for businesses with 50-10,000 employees.

We just received more details Friday on how the initial $30 billion will be given to eligible Medicare providers--these are payments, not loans, and will not need to be repaid. We will be sharing more later this week but there’s a great chart we created to explain the financial relief currently available here.

Unbelievable as it may seem, $2.3 trillion is inadequate to provide the relief needed to keep our economy running and our patients safe. Thus, there is a Fourth Package which is being worked on now. Leaders from both the House and Senate, as well as the White House, are busy negotiating the details of this bipartisan bill. It is likely that this bill will double the $100 billion  for providers (including hospitals and physicians) in the CARES Act. We had hoped that extra funding would have been appropriated for the paycheck protection program last week, but unfortunately negotiations failed. As always, we will keep you informed of any developments.

I assembled a small task force of AAOS Board members which included Drs. Daniel Guy, Felix Savoie, James Ficke and Alex Vaccaro to work together, share information and create a comprehensive guide to help our members determine what constitutes elective surgery.  It is located on the AAOS COVID-19 Member Resource Center. The resource center also contains all the information you need to navigate through the regulatory challenges of telemedicine and many other federal and state programs. I urge you all to make the AAOS COVID-19 page your “go to” resource.

Although the curve may be flattening in some areas, this pandemic and its repercussions on our profession are far from over. We should all be proud of the service that we all are providing our communities in the COVID-19 fight. Rest assured, that as we devote our efforts to battle COVID-19 locally, our Academy is fighting equally as hard on a state and national level to assure that we get the relief we deserve. Join the conversation through #OrthoCOVID19 or send your questions directly to governance@aaos.org.

The Academy is completely aligned with all subspecialty societies in its advocacy efforts and our entire profession is speaking with one voice on Capitol Hill on behalf of our patients. For the latest updates, follow AAOS on social media through Facebook, Twitter, LinkedIn or Instagram.

Stay safe and healthy.

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