AAOS December 12, 2017
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AAOS Signs Letters on Medicare Cuts


In a recent letter, AAOS urged Congress not to include Medicare cuts in the tax bill, an end of the year spending package, or other legislation. Specifically, a proposed misvalued codes offset may be included in the legislation to reauthorize the Children’s Health Insurance Program (CHIP) and the annual package of Medicare payment extensions.

“We understand the challenge of identifying offsets and appreciate the bipartisan work to advance the Medicare extenders, the Children’s Health Insurance Program (CHIP), and other legislation to improve access to care,” the letter states. “However, we are particularly concerned that the Medicare extenders package identifies an extension of the misvalued code target recapture policy. The effort to ensure the accuracy of values attributed to services received by Medicare beneficiaries is one to which we are firmly committed. But this is also work that has been ongoing for years and reinstating the target recapture policy in the future would likely result in across-the-board cuts given that much of the revaluation that the policy seeks has already occurred or is currently being addressed.”

The letter also states that we have serious concerns about the cumulative effect of further Medicare sequestration cuts beyond the current two percent cuts through 2022. Those cuts could be triggered by the tax legislation should Congress not waive the PAYGO violation. These concerns are especially acute at a time when physicians have just begun participation in the Merit-based Incentive Payment System and other aspects of Medicare Access and CHIP Reauthorization Act.

In closing, the letter emphasizes that AAOS remains committed to working with Congress toward needed reforms to Medicare and our health care system in order to improve patient access to surgical care.

“We urge you to support our shared commitment to preserving access to care for Medicare patients by not compounding existing cuts to Medicare with an extension of the misvalued code target recapture or expansion of Medicare sequestration cuts,” it concluded.

The Alliance of Specialty Medicine sent a similar letter, expressing deep concern with the misvalued code offset provision and any expansion of the Medicare budget sequester beyond 2022 or possible additional cuts that could result from PAYGO violations.

“Previously, we have expressed concerns about the misvalued code provisions, particularly since the work to identify potentially misvalued services is ongoing through the American Medical Association’s (AMA) Relative Value System Update Committee (RUC) and the Centers for Medicare and Medicaid Services (CMS),” the letter stated. “The vast majority of physician services have been reviewed, resurveyed, and revalued, over the course of the last few years. Indeed, these ongoing efforts have squeezed value out of most specialty codes to the point where the target set by Congress cannot be met, resulting in reductions in the annual conversion factor for all physicians for the three consecutive yearssince passage of the Achieving a Better Life Experience (ABLE) Act (P.L. 113-295). When added to the annual two percent sequestration cut, we believe this provision is detrimental to the Medicare program and risks inappropriately undervaluing physician services and threatening patient access to care. The Alliance, therefore, urges its elimination.