AAOS January 22, 2019
Advocacy Now
 
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AAOS Praises Introduction of Hospital Competition Act

Advocacy In Action


Members of Congress Request Revision in Medicare Shoulder Policy

AAOS Urges CMS to Address Concerns in BPCI Advanced

Pandemic Prevention Bill Awaits Senate Action

State Corner: State Societies Advocate for Network Adequacy, Fair Reimbursement

Results of 2018 Black Out the Map Challenge

Thank You to Our Current Orthopaedic PAC Advisor’s Circle Members!

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Hospital Competition Bill, Surprise Billing
 
For questions or concerns on these or other advocacy issues, contact us at dc@aaos.org.

AAOS Praises Introduction of Hospital Competition Act

AAOS praised Representative Jim Banks (R-IN) for introducing the Hospital Competition Act of 2019 (H.R.506) on January 11. The bill aims to combat the rising cost of health care by increasing choice among hospital providers and addresses several AAOS priorities including: lifting restrictions on physician-owned hospitals, discouraging hospital consolidation and certificate of need laws, expanding site neutral payments, and increasing price transparency.

“It’s not every day that a bill comes along which so closely mirrors not one, but several of our legislative and regulatory goals,” AAOS President David A. Halsey, MD, said in a press release. “That’s why we strongly support the Hospital Competition Act and praise Rep. Banks for tackling these critical changes to America’s health care system.”

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Advocacy in Action
 
Advocacy in ActionHow the AAOS Office
of Government Relations
is working for you…
  • Continued working to ensure two AAOS-supported provisions are included in the final disaster preparedness package, which recently passed the House for a second time and awaits Senate action.
  • Presented solutions, in coordination with state orthopaedic societies, to end the surprise insurance gap for patients resulting from balance billing reimbursements for out-of-network providers at in-network hospitals.
  • Praised Rep. Jim Banks (R-IN) for introducing the Hospital Competition Act of 2019, which aims to combat the rising cost of health care by increasing choice among hospital providers and addresses several AAOS priorities.
  • Urged the Center for Medicare and Medicaid Innovation Center to reinstate in BPCI Advanced the financial methodology used in BPCI Classic, and allow excess Net Payment Reconciliation Amount funds to flow to any physician group practice participating in the new model.
  • Joined the Physician Clinical Registry Coalition in expressing our concerns to the Centers for Medicare and Medicaid Services about the new rules for Qualified Clinical Data Registries’ participation in the Merit-Based Incentive Program.
For more information on all AAOS advocacy efforts, visit: http://www.aaos.org/dc.
Follow the AAOS Office of Government Relations on Twitter: www.twitter.com/AAOSAdvocacy.
 
 
 
Members of Congress Request Revision in Medicare Shoulder Policy

On January 4, Representatives Larry Bucshon, MD (R-IN), Andy Harris, MD (R-MD), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA), sent a letter to the Centers for Medicare and Medicaid Services (CMS) asking that current Medicare payment policy on shoulder procedures be revised. They argued that payment policy should align with and support appropriate patient care, but the goal is not being met under existing policy.  

The 2019 National Correct Coding Initiative defines the shoulder as a “single anatomic structure.” The members of Congress pointed out that all basic anatomy textbooks define the shoulder as comprised of five separate anatomical structures, and CMS payment policies should reflect this anatomical definition. “Physicians’ work in the five distinct areas of the shoulder are not mutually exclusive and represent treatment of different pathologic entities,” they argued.

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AAOS Urges CMS to Address Concerns in BPCI Advanced

AAOS has advocated aggressively with regulators and Congress regarding continuing concerns with the Bundled Payment for Care Improvement Advanced (BCPI-A) model. The model was announced in January 2018 and launched on October 1, 2018. The advocacy effort has included letters, conference calls, and meetings with the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI), as well as meetings with legislators. AAOS is pleased that BPCI Advanced is a voluntary model that is available nationally, allows for physician leadership, and is an Advanced Alternative Payment Model (APM). However, our primary concern is the current CMS interpretation of the cap on physician reimbursement.

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Pandemic Prevention Bill Awaits Senate Action

The House of Representatives has passed a large disaster preparedness bill containing two provisions affecting orthopaedic surgeons: one to allow military trauma surgeons to keep up their skills in civilian trauma centers, and another to help protect physicians who volunteer in disaster zones. It’s not the first time the House has passed this legislation which, despite enjoying broad bipartisan support, has been blocked in the Senate due to a disagreement among senators on unrelated provisions.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) contains the MISSION ZERO Act. This is an AAOS and Orthopaedic Trauma Association (OTA)-supported bill to fund grants to allow military physicians and care teams to offer trauma care and related acute care at civilian trauma centers.

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State Corner: State Societies Advocate for Network Adequacy, Fair Reimbursement

As a result of high deductibles and narrowing insurance networks, balance billing for out-of-network providers at in-network hospitals has become a major issue for regulators, the media, and physicians. In January, state legislators across the country introduced laws banning balance billing, curtailing surprise charges, and setting payment rates for out-of-network reimbursements.

Though each law is different, state legislators seek to end “surprise bills” that arise when patients go to an in-network facility for health care services but are unaware that some services may be delivered by an out-of-network provider. When patients receive a bill from the provider for services their insurance is not obligated to fully cover, they are surprised and frustrated—and they've communicated their feelings to legislators.

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Results of 2018 Black Out the Map Challenge

The Orthopaedic PAC had 22 states either reach a 21 percent participation rate or raise more than $100,000. Delaware (68 percent), Puerto Rico (64 percent), and the District of Columbia (41 percent) had the highest rate of participation. The most improved states include Delaware and Puerto Rico (11 percent increase), Alabama (9 percent increase), Arkansas, the District of Columbia, and North Dakota (7 percent increase). 

Click here, to view the interactive version of the map below, which features each state’s PAC support for 2018.

Participation Leader Board

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Thank You to Our Current Orthopaedic PAC Advisor’s Circle Members!

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  Announcements
  • The Centers for Medicare and Medicaid Services updated its Quality Payment Participation Status Tool based on calculations from the third snapshot of data from Alternative Payment Model entities. Access the tool here.
 
     
 
 
 
  AAOS Orthopaedic PAC Online and Mobile Donations

image Did you know? Supporting our Orthopaedic PAC by phone is easy: simply text AAOS to the number 41444, and follow the link, no log-in required. We encourage our supporters to share this technology with your colleagues who have yet to renew or join and to encourage signing up on a recurring basis. For just $84 a month, or $250 a quarter you can become part of our Capitol Club Program. And don’t forget! The Orthopaedic PAC website features an online contribution center, which can accept contributions via credit card by visiting the site and using your AAOS login credentials. Credit card contributions can also be conveniently scheduled for a monthly, quarterly or yearly recurring donation. Visit www.aaos.org/pac and select Donate to the Orthopaedic PAC for more information or to contribute today.

Don’t remember when you last contributed? Log in to the contribution center today to view your complete donation history!