August 24, 2020
Can it be that we are already nearing the end of the summer? We certainly have not had the typical summer dominated by vacations and weekend travel. Instead, we are preoccupied with being socially responsible physician leaders. We have devoted much energy into ensuring that our patients receive timely care in a safe and socially distanced manner. It appears that the autumn season will not be much different. However, I am confident that our clinical volumes will continue to grow and that our patients will continue to have access to our high-quality care. We cannot forget: Our patients respect us, not just as orthopaedic surgeons, but as trusted physicians. This means that it is our responsibility to model the precautions necessary to stem the spread of COVID-19. In the end, we will all be better for it, and our patients will continue to hold us in high regard.
We are nearing the end of our nationwide campaign (#OrthoAdvocacyinAction) to engage with members of Congress “in-district.” So far, we have had very positive feedback on the meetings and conversations that have taken place. Conceived of, and led by, AAOS First Vice President
Daniel Guy, MD, FAAOS, this initiative continues to receive high praise. It is an effective tactic to develop and/or solidify relationships with our lawmakers, who are getting a better sense of the hardships that the orthopaedic community has faced during this unprecedented national public health emergency. They are also gaining a better understanding of why the draconian reimbursement cuts being proposed for all surgical services would be so detrimental to our patients and our profession.
Thanks to those event participants who have volunteered to advocate on behalf of the full membership. Congress is hearing our concerns over the increased use of prior authorization and the need for increased medical liability protections. They are getting concrete examples as to why increasing the footprint of physician-owned hospitals would be beneficial for communities in need. Advocacy is a year-round effort but, in unifying around one coordinated message this August, we are showing Congress what a powerful force we can be when we work together. Another important weapon in our advocacy armamentarium is our AAOS Orthopaedic PAC so, if you have not donated already, please contribute to help elect and re-elect candidates to federal office who align with our principles, regardless of party affiliation.
You may have seen the action alert we recently sent out encouraging members to help us protect access to specialty care. This is not just an exercise or excuse to get you engaged. It is a crucial opportunity for you to speak directly to the Centers for Medicare and Medicaid Services (CMS) and your legislators about these proposed payment cuts before they are finalized. Thomas Muzzonigro, MD, FAAOS (BOC Chair), and Craig Satterlee, MD, FAAOS (BOS Chair), are mobilizing their respective constituents to mount an aggressive grassroots campaign to fight the cuts to total hip and knee arthroplasty work relative value units, as well as the overall 11% proposed decrease to the conversion factor in the physician fee schedule. The window of time to make a difference is small and ends on October 5th, so we hope that you will harness the momentum coming out of our In-District Advocacy Event to participate in this important “ask” of policymakers. Take action today via the AAOS Advocacy Action Center!
The Office of Government Relations (OGR) has been working with Anthem to seek clarification on its new policy around setting of care for certain musculoskeletal procedures. We learned that, effective October 1, 2020, four spine codes: 1) 22633 and 22634 (transverse process fusions) and 2) 63265 and 63267 (laminectomy and excision lesion other than herniated disk), and two knee arthroscopy codes: 29871 (arthroscopic I&D for infection) and 29892 (arthroscopically assisted OCD fixation), will be incorporated into the AIM Level of Care Guidelines for Musculoskeletal Surgery and Procedures. Anthem will review requests for inpatient admission and will require providers to substantiate the medical necessity of the inpatient setting with proper medical documentation, thus adding more impediments to providing the care our patients need. If the government moves forward with phasing out the Inpatient Only List and increasing the feasibility of performing surgery in ambulatory settings, there will be pressure by payers to steer patients to less expensive surgical venues. Your Academy’s stance is that physicians, in consultation with patients, NOT payers, are the ones who should determine the proper surgical venue for patients. We will continue to advocate for this principle.
Lastly, if you missed the June 3rd deadline to apply for additional Provider Relief Fund payments—equal to 2% of your total patient care revenue—you now have a second chance to do so. The government has extended the deadline to August 28th. This includes Medicaid and Children's Health Insurance Program (CHIP) providers with low Medicare revenues, or providers who experienced a change in ownership and were previously ineligible for Phase 1 funding. Remember, this is not a loan and does not need to be repaid. This is a well-deserved grant to partially compensate us for the government’s shutdown of elective surgery. This program came to fruition through the efforts of our OGR working with our PAC-supported congressional allies. Learn more at aaos.org/covid-19-financial-relief-information.
Enjoy the remainder of your summer. If you have school-aged children (like I do), best wishes for a smooth start to the school year.
Joseph A. Bosco III, MD, FAAOS