November 2017 BOS Washington Update

BOS Washington Update


Congress agrees with AAOS and societies, protects critical DOD research

Annual legislation authorizing defense spending no longer contains provisions threatening critical research such as the Peer Reviewed Orthopaedic Research Program (PRORP).  The provisions were stripped out of the final 2018 National Defense Authorization Act (NDAA) following a campaign from many medical groups and patients that included a letter signed by AAOS and 14 BOS societies. Read the letter here. The NDAA is expected to come up for a vote in the House this week.

POSNA and SRS lead effort on CHIP

On November 1, AAOS joined POSNA, SRS, and the American Academy of Pediatrics (AAP) in a joint letter of support for the Children’s Health Insurance Program (CHIP). Funding for the program lapsed on September 30 when Congress failed to reauthorize it, putting medical care for millions of children in jeopardy. The letter follows a grassroots campaign driven by POSNA and SRS that generated over 400 emails to members of Congress. AAOS continues to support this bipartisan program and urges Congress to quickly pass legislation reauthorizing CHIP. Read the joint letter of support here.

House passes IPAB repeal

On November 2, the U.S. House of Representatives passed H.R. 849, the Protecting Seniors’ Access to Medicare Act, by a vote of 307-111. AAOS commends members of the House for passing this important legislation (introduced by Reps. Phil Roe, M.D. (R-TN) and Raul Ruiz, M.D. (D-CA)), which would eliminate sections 3403 and 10320 of the Affordable Care Act (ACA) and repeal the Independent Payment Advisory Board (IPAB) before it is activated. This board – charged with making recommendations to cut Medicare expenditures if spending growth reaches a certain level – threatens the ability of elected representatives in Congress to ensure seniors have access to the health care they need when they need it. The bill now moves to the Senate and AAOS urges quick action on the legislation. Read more about AAOS efforts on IPAB here.

CMS finalizes outpatient and ASC rule, removes TKA from IPO list

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) finalized the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule, which includes updates to the 2018 rates and quality provisions, and other policy changes.

Importantly, the rule finalizes changes to the Medicare inpatient-only (IPO) list for CY 2018. AAOS recognizes CMS for removing total knee arthroplasty (TKA) from the IPO list and for acknowledging this decision should be “made by the physician based on the beneficiary’s individual clinical needs and preferences.” AAOS further acknowledges CMS for noting that “the surgeons, clinical staff, and medical specialty societies who perform outpatient TKA and possess specialized clinical knowledge and experience” are most suited to create guidelines to identify appropriate candidates. AAOS is currently developing measures to assist selection of the ideal candidate for these procedures. Read the full AAOS comments online here and the AAOS press release here.

Quality payment program and physician fee schedule finalized

On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018. The calendar year (CY) 2018 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

CMS also issued the final rule for the second year of the Quality Payment Program (calendar year 2018), as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In comments to CMS on the proposed rule AAOS applauded the increase in the low-volume threshold, noting that this will give clinicians in solo and small practices more time to prepare and meet the participation requirements. However, AAOS emphasized that there must still be more pathways for specialists to participate in the Quality Payment Program through the Advanced APM track. AAOS also commented on new proposals for virtual groups and the need for provision of clinician/practice data.

To read the full AAOS comments on the Quality Payment Program Year 2, click here.

Stark reform bill introduced

New legislation that would remove barriers to MACRA implementation due to the 30-year old Stark law has been introduced in Congress.  The Medicare Care Coordination Improvement Act of 2017 is sponsored by Representatives Larry Bucshon (R-IN), Raul Ruiz (D-CA), Ron Kind (D-WI), and Kenny Marchant (R-TX) in the House of Representatives as well as Senators Rob Portman (R-OH) and Michael Bennett (D-CO) in the Senate. The bill would remove some of the prohibitions on self-referral that pose barriers to care-coordination.

The bipartisan legislation is supported by a large coalition of physician groups, including AAOS, that together represent more than 500,000 physicians and clinicians.  Read the coalition letter of support here.

House committee holds hearing on APMs

On November 8, 2017, the House Energy and Commerce Subcommittee on Health held a hearing titled “MACRA and Alternative Payment Models: Developing Options for Value-based Care.” Subcommittee Chairman Michael C. Burgess, M.D. (R-TX) convened the hearing to discuss the implementation of one of the two tracks eligible professionals can be reimbursed under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – Alternative Payment Models (APMs). The committee reviewed Medicare payment reforms, including models that are already under way and those that are returning savings to the program while improving outcomes.

Read the AAOS statement for the record and watch the hearing here.

House discusses NIH funding

The House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, chaired by Tom Cole (R-OK), held a hearing on October 24, 2017 to discuss the recently proposed budget costs regarding NIH funding. The current proposal is to cap NIH Indirect Cost Reimbursement at 10% of total research costs in FY 2018, a large reduction from the 28% spent by NIH in FY 2017. Not only would this proposal adversely affect researchers and doctors in all arenas, but the proposal would also inspire the trend to keep diminishing NIH research appropriations from Congress. Decreased funding for NIH research has been a major burden for the orthopedic community over the last several years, and AAOS is working with Congress and the orthopedic community to put money back in the hands of researchers, all with the goal of improving the quality of life for Americans suffering from unfortunate musculoskeletal conditions. Read more and watch the hearing here.

Replacement for VA Choice program stalled

Bipartisan legislation to replace and improve the Department of Veterans Affairs (VA) care in the community programs was pulled from consideration during a House VA Committee hearing on November 8. Committee leaders cited problems with the cost of the bill as an explanation for the last-minute reversal. “I was not comfortable asking members to vote on final passage of a bill of this significance without some idea of cost,” said House VA Committee Chairman Phil Roe MD (R-TN).

The VA Care in the Community Act, introduced by Dr. Roe and cosponsored by every member of the committee, would end the VA’s troubled Veterans Choice Program and implement a new system for veterans to receive care from private providers. The bill would do away with current rules allowing veterans to seek private-sector care only if they’ve been waiting for a VA appointment for 30 days or if they live more than 40 miles driving distance from a VA facility. Instead, the bill leaves that decision to a veteran’s VA primary care physician.

AAOS supports truth in medical advertising

AAOS joined a coalition of medical specialty groups, including NASS, in supporting legislation to prevent deceptive and misleading advertising in health care. The Trust in Healthcare Marketing Act of 2017, introduced by Rep. Larry Bucshon (R-IN) would make it unlawful for any provider to misrepresent whether they hold a state license or misrepresent their education or training in any way. The Federal Trade Commission would be charged with enforcing this standard. Read the coalition letter of support here.

EMS bill to president’s desk

Bipartisan legislation allowing EMS providers to carry and administer controlled substances is headed to the president’s desk for signature following passage in the House and Senate. The Protecting Patients Access to Emergency Medications Act of 2017, introduced by Rep. Richard Hudson (R-NC), allows the DEA to register an EMS agency to administer controlled substances as long as its not prohibited in the state in which the agency practices. A medical director, physician, PA, or APRN would be allowed to give a written or verbal order with criteria for administering the substance. AAOS supports this legislation.

AAOS joins organizations supporting mentorship for veterans

AAOS has joined American Corporate Partners (ACP), a coalition of organizations setting up one on one mentorship opportunities for veterans. Colonel (ret) Jim Ficke, MD and Colonel (ret) John McGraw, MD represented AAOS at a reception on Capitol Hill November 6 to celebrate this new endeavor. Orthopaedic surgeons serve military personnel and veterans every day, treating some of the signature injuries of the wars in Iraq and Afghanistan. AAOS is pleased to offer this opportunity for interested members to continue their service to veterans and will be looking for members to participate as mentors in this program in the coming months. For more information, email Stacie Monroe at