This week Congress is set to approve a $900 billion COVID-19 aid package, along with a $1.4 trillion omnibus spending bill. The combined legislation incorporates several wins for orthopaedic surgeons, including a freeze on increasing Alternative Payment Model (APM) thresholds for two additional years, revival of the Paycheck Protection Program and additional funding for health care professionals and graduate medical education.
Most importantly, it contains language to help mitigate the impact of impending Medicare cuts and finally ends surprise medical bills that have plagued our patients for years. This success was only made possible by the year-long advocacy of AAOS members who sent over 19,000 grassroots messages to Congress through the Advocacy Action Center, met with legislators during our August In-District Advocacy Event, and supported the AAOS Political Action Committee.
Below are some of those highlights…
Medicare Pay Cuts
- AAOS has long been opposed to and advocated against the cuts which were recently finalized in the 2021 Medicare Physician Fee Schedule (MPFS). See timeline of our advocacy around these changes.
- AAOS is pleased to see several provisions that we tirelessly advocated for in the package before Congress, including:
- A three-year delay of the G2211 add-on code – this is a substantial win, as it frees up additional dollars from the fee schedule and eliminates duplication created by the code. CMS will not be able to implement this code until 2024 at the earliest.
- An additional $3 billion in funding for the MPFS, which translates to a 3.75% increase across the board for all codes (not just those that were being reduced). We are still analyzing the effects of this increase but understand that it will minimize the cuts to general orthopaedic codes and those proposed for hip/knee substantially.
- An additional three months of sequestration relief into 2021. Physicians were slated to receive a 2% payment reduction due to sequestration for all Medicare Fee-For-Service (FFS) claims, but the cut is now suspended through the end of the year in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This package extends the delay through the beginning of 2021.
- Bottom Line: AAOS is pleased to see the work of our advocacy produce such tangible results on this issue. In addition to mitigating the scheduled cuts almost entirely for 2021, we will receive reduced cuts than previously scheduled for 2022 and 2023. As always, we will continue to monitor the implementation and success of these solutions and advocate for preserving the value of specialty medicine.
Surprise Medical Billing
- AAOS has been working to protect patients from unexpected medical bills while preserving physicians’ ability to negotiate with health plans since this debate began more than two years ago. While the compromise legislation announced last week represented significant progress towards meeting AAOS’ principles, we continued to urge Congress to make additional improvements in final text. See press release and related letter.
- The version of the “No Surprises Act” that was packaged with COVID-19 relief and government funding on December 21 includes the following AAOS priorities:
- An independent dispute resolution (IDR) process, which replaced a government benchmark approach that had been favored by insurers.
- The ability to batch claims and refrains from requiring a monetary threshold for accessing the IDR process.
- Clarity that the initial response from an insurer —required within 30 days of service—must be an initial payment or a specific notice of denial of payment.
- Prohibition against insurers factoring in public payer rates, more time for physicians to file for negotiations, and an interim report into the effects of the included 90-day waiting period to ensure that it is not preventing the process from working as it should.
- Bottom Line: AAOS thanks Congress for rejecting a benchmark approach and choosing an IDR process to finally resolve this longstanding problem. We will continue to advocate for all possible improvements to the IDR process, including during crucial federal rulemaking that will occur between now and the bill’s effective date on January 1, 2022. We will work with lawmakers and regulators to protect orthopaedic surgeons during the rulemaking process.
Unfortunately, Congressional negotiators were unable to reach a compromise on any sort of medical liability reform so the meaningful protections we advocated for are not included. We are still proud of the significant wins mentioned above and wanted to be the first to communicate them to you in advance of the holiday. I have said it before and cannot emphasize enough they would not have been possible without the dedication of our member leaders. We hope this good news bring you the peace and motivation we need as a musculoskeletal community to build on our success in 2021.
Thanks, and have a wonderful holiday season.
Joseph A. Bosco III, MD, FAAOS