Presidental Update: Consolidated Appropriations Act, 2021 (H.R. 133)

January 11, 2021

I hope that you had a peaceful and safe holiday season and are prepared to face the many challenges that 2021 will bring. The next 3-6 months promise to be difficult, despite the vaccine rollout. This is not the time to lose our grit and determination or to shrink from our exigencies—we are not summer soldiers. I am convinced that our profession will emerge from these travails stronger and better. My confidence is not rooted in hope. It is based on the real actions that you and the AAOS are taking on behalf of our patients and the musculoskeletal community. This has been, and will continue to be, our tradition.

On December 27, 2020, President Trump signed into law the Consolidated Appropriations Act, 2021 (H.R. 133). At over 5,500 pages, it is one of the longest bills ever passed by Congress and it has taken us several weeks to decipher. Importantly, it took the three major steps below to mitigate the impact of planned cuts in the 2021 Medicare Physician Fee Schedule (MPFS) final rule:

  1. Increased Medicare payments across all specialties by 3.75% for one year, which were originally going to decrease by 10.2% beginning in 2021.
  2. Suspended implementation of the G2211 add-on code for complex visits until 2024.
  3. Delayed the scheduled 2% Medicare sequestration cut until March 31, 2021.

The conversion factor was also recalculated to mirror budget neutrality changes and is now $34.89 for 2021, up from the planned decrease to $32.41 this year from $36.09 in 2020. Office/outpatient evaluation and management (E/M) codes will also see an overall increase of up to 30%. Obviously, the exact reimbursement calculation will depend on practice type, but this is a much better situation than if the planned cuts by the Centers for Medicare & Medicaid Services (CMS) had not been addressed through legislative action. For many orthopaedic surgeons, Medicare reimbursements will remain the same or be slightly increased in 2021. Lessening the severe impact of these planned cuts was accomplished through the efforts of the AAOS Office of Government Relations (OGR) and our congressional supporters, and we are grateful for their efforts. We will continue to advocate for long-term changes that will prevent further reductions to the value of orthopaedic care in 2022 and beyond.

Legislative action could not protect against the egregious attack on total hip and knee arthroplasty codes, but it was able to provide some relief on their overall reimbursement. The combined impact of the planned decrease in work relative value units (RVU) by CMS and budget neutrality adjustments by Congress is lessened from an approximately 10% decrease to a 6.5% decrease. The new payment rates for 2021 will be $1,322.45 for THA and $1,320.70 for TKA. Still, the decrease in value of these procedures is disappointing, as the patient value of these procedures remains unsurpassed. The procedures dramatically improve patients’ lives and help get them back to work. In fact, our care pathways and perioperative risk modification strategies have decreased both the length of stay and complications, while outcomes have improved. This has resulted in fewer documented in-person postoperative visits and shorter operating room times. The payment change for these procedures is unfair and only disincentivizes us from continuing to add value. We will continue to work with the American Association of Hip and Knee Surgeons (AAKHS) to protect total joint reimbursements.

Aside from these updates on the healthcare policy front, I know that the worsening pandemic and the recent political events have been unsettling to many of our patients and peers. The most abiding lesson that Frank Wilson, MD, FAAOS, chair of my residency program, taught me was that orthopaedic surgeons are viewed by society as leaders—both within and outside the confines of medicine. We ought to realize this and act accordingly. In stressful times, our communities look to us for guidance and comfort. We have always risen to the occasion, and this crisis is no exception. This spirit is captured in the new AAOS video “Persevering Together in 2020,” which demonstrates our tenacity over the past year in the face of adversity. I am very proud of the work we are accomplishing together and encourage each of you to watch the video here.

Let us carry ourselves into 2021 with confidence and equanimity. In this way, we continue to honor those who have preceded us and to serve the country that has given ourselves and our families limitless opportunities.

Thank you,

Joseph A. Bosco III, MD, FAAOS
AAOS President