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

April 6, 2020
These are unprecedented times and call for unprecedented actions. The purpose of this letter is to outline the actions the AAOS is taking to help us manage and emerge from this pandemic as strong as possible. As you know, last year we implemented a Strategic Plan and were busy executing this plan when the COVID-19 pandemic hit. We have temporarily pivoted off of the Strategic Plan and are devoting nearly 100% of our efforts to mitigating the ill effects the pandemic has on our practices and patients. The three pillars of the AAOS COVID-19 Action Plan are:
  • Communication
  • Advocacy
  • Practice Management
Communication is vital in crisis situations and we have developed and implemented a robust plan. The centerpiece of this plan is the AAOS COVID-19 Member Resource Center. It contains the latest information on advocacy efforts and regulatory changes as well as detailed instructions on how to apply for support through the Small Business Administration (SBA). Additionally, it contains our guideline for distinguishing elective from non-elective surgery and links to the Centers for Medicare & Medicaid Services (CMS) and other governmental sites of value. It is updated daily and should be your “go to” resource for COVID-19 information. The following highlights some of the resources available on the site:
  • AAOS COVID-19 Coding Guide
  • AAOS Guide on SBA loans in the Coronavirus Aid, Relief, and Economic Security (CARES) Act
  • AAOS Telemedicine Policy Tracker
  • Centers for Disease Control and Prevention Interim COVID-19 Guidance
  • COVID-19 Emergency Declaration CMS Fact Sheet
We are also active on social media, including our Twitter, Instagram, LinkedIn and Facebook pages. On Thursday, April 9th at 9:00 p.m. (EDT),we are hosting a live webinar. The purpose of this webinar is to provide a COVID-19 update and enable you to ask questions.
The 2020 CARES Act allotted $2.2 trillion dollars to COVID-19 relief. Our Office of Government Relations (OGR) is working literally seven days a week to decipher the law, and most importantly, to make sure that our practices and patients are provided the tools that they deserve to survive this pandemic.
The majority of our practices are small businesses which employ multiple workers for each surgeon. Our dedicated workers serve essential roles in patient care and without them, we will be unable to provide our patients the care they deserve. Despite our best efforts, our workers are being adversely affected by the pandemic.
The OGR is actively advocating on behalf of our practices and staff to ensure that relief is timely, fair and easy to obtain. The upcoming weeks and months will see an expanding role in both state and federal government relief programs. The OGR will continue to advocate on your behalf to insure we get the help we need. We are also working with state orthopaedic societies to make sure that the state-based programs serve our needs.
We have been successful in rolling back and/or easing the regulatory burden and constraints of many federal government rules and programs. Examples include, but are not limited to:
  • HIPAA rules relaxation for “Good faith efforts to provide telehealth”
  • Delaying 2019 Merit-based Incentive Payment System reporting
  • Implementing Good Samaritan protection for COVID-19 volunteers
  • Allowing expansion of physician-owned hospitals
  • Suspension of the 2% Medicare cuts                                                                        
Our practice management efforts revolve around solutions to problems unique to the COVID-19 pandemic. These include how to best incorporate telemedicine into our practices. It is clear that telemedicine will continue to play an increasing role in our practices long after the pandemic is over. Federal regulations fostering the use of telemedicine will continue to evolve and we will keep you informed as to policy changes.
Billing and coding issues pertaining to COVID-19 are also addressed on the AAOS COVID-19 Member Resource Center. We have also provided you a resource to use in the event that difficult treatment decisions must be made around the lack of resources. It is possible that resources, especially ventilators, may be unavailable to meet demand; thus rationing, (similar to that done in organ transplantation) may occur. Courtesy of Dr. Casey Humbyrd and our colleagues at the American Orthopedic Foot and Ankle Society, the COVID-19 Member Resource Center contains instructions on how to navigate such a scenario.
Lastly, we presented general guidelines for how to distinguish elective from non-elective surgery. For details, please see the Resource Center, but generally, the AAOS feels that this is best determined on a local level as resources and circumstances are changing day-to-day and region-by-region.
A few thoughts before closing… These are truly unprecedented times. We have not faced a crisis like this since WWII. The sociologists tell us that times like these bring out the altruism in all of us and I believe that to be true. Many of our colleagues are being “repurposed” and volunteering in their hospitals either on the wards or in the ER. I have faith that each of us will contribute in whatever way we can or have to. There is work and sacrifice to be made and our profession has a rich history of selflessness in the face of adversity. I am certain that the upcoming weeks will be no exception. See you Thursday. Stay safe and healthy.
Joseph A. Bosco, III, MD, FAAOS
AAOS President