September BOS Washington Update




House Passes H.R. 921, the Sports Medicine Licensure Clarity Act

On September 12, the House passed H.R. 921, the Sports Medicine Licensure Clarity Act, by voice vote. The bill, introduced by Representatives Brett Guthrie (R-KY) and Cedric Richmond (D-LA), would clarify medical liability rules to ensure team providers are properly covered by their medical professional liability insurance while traveling with athletic teams in another state. AAOS continues to work with the Senate on consideration before the end of this legislative session. Read the AAOS press release online here.


Blue Cross Blue Shield of North Carolina (BCBSNC) Policy is Tabled

Blue Cross Blue Shield of North Carolina recently made a policy statement that they would no longer pay for corticosteroid injections for rotator cuff disease (and knee osteoarthritis), stating that it is “experimental.” BCBSNC received numerous inquiries and significant feedback from their local orthopaedic community, including AAOS, and in reaction, the policy will not be implemented until there is additional evaluation of providers’ concerns. Also, additional scientific literature that was received must be reviewed by their Medical Policy department. BCBSNC has also agreed to further work with local North Carolina physicians and the North Carolina Medical Association to help in the process. Read more in Advocacy Now online here.


House Energy and Commerce Subcommittee on Health Markup on H.R. 4365, an AAOS and Orthopaedic Trauma Association Priority

On September 13, the House Energy and Commerce Subcommittee on Health continued a markup of five bills, one of which included H.R. 4365, the Protecting Patient Access to Emergency Medications Act. The bill would protect the current practice of physician Medical Directors overseeing care provided by paramedics and other emergency medical service practitioners via “standing orders” regarding use of controlled substances. H.R. 4365 was favorably reported out of committee by voice vote and was also part of an earlier hearing in July addressing our nation’s trauma system. Read the AAOS letter of support here.


AAOS Sends Letter to CMS Requesting Finalizing the 90-Day Reporting Period for Meaningful Use

In a letter to Acting Administrator of CMS Andy Slavitt, AAOS along with 20 other organizations, requested the agency expedite a 90-day reporting period over a full-year for 2016 for the meaningful use program. Following months of pressure from health care providers, CMS announced the change in a July proposed rule. The proposed change recommended the EHR reporting period for any hospitals or eligible provider be any continuous 90-day period between January 1, 2016 and December 31, 2016. In order to ensure eligible professionals (EPs) and eligible hospitals (EHs) are able to take advantage of the flexibility associated with the shortened reporting period, it is imperative CMS finalize the rule and make the necessary changes to prepare for the first Medicare Access and CHIP Reauthorization (MACRA) program year.


MDUFA Reauthorization Update

Over the past year, the Federal Drug Administration (FDA) has hosted numerous meetings regarding the reauthorization of the Medical Device User Fee Act (MDUFA). Under the user fee system, medical device companies pay fees to FDA when they register their establishments and list their devices with the agency and when they submit applications or notifications to market a new medical device in the U.S. On August 22, 2016, the FDA and representatives from the medical device industry and laboratory community reached an agreement on proposed recommendations. Under the new draft agreement, the FDA would be authorized to collect $999.5 million in user fees starting in October 2017, a 68% increase from the last reauthorization in 2012.


House Budget Committee Holds Hearing on the Center for Medicare and Medicaid Innovation (CMMI)

Recently on September 7, the House Budget Committee held a hearing to address one of the core responsibilities of Congress, oversight. Chairman Tom Price (R-GA) expressed his concern about the Congressional Budget Office (CBO) oversight authority, specifically CBO’s analysis of the CMMI – and the assumptions within that analysis and Congress’s ability to perform its legislative and oversight duties. Congress should be able to rely on CBO’s well-reasoned, non-partisan analysis. In its first five plus years of operation, CMMI has spent nearly $6.1 billion with no specific tangible savings yet to show for it. And, yet, CBO explains they expect the program to cover those expenses with savings by 2017. While at the same time, in its own Long-Term Budget Outlook, CBO has admitted that it does not know which, if any, of the current demonstration projects CMMI has embarked upon will result in savings. An orthopaedic surgeon from OrthoForum testified and AAOS submitted a letter for the record. Read the AAOS letter here.


AAOS Sends Comment Letters to CMS

On September 6, AAOS sent comment letters on the Medicare Physician Fee Schedule (PFS) and the Outpatient Prospective Payment System (OPPS) Proposed Rules to the Center of Medicare and Medicaid Services (CMS). AAOS is in opposition to the Physician Fee Schedule (PFS) proposed rule to collect all data for all 10- and 90-day global services from all practitioners who perform these services, rather than from a “representative sample” of practitioners, which was required by the MACRA. The proposed rule is in direct contravention to congressional intent, and AAOS is seeking legislative assistance to ensure that CMS not implement this proposal in the final rule. The proposal would require all surgeons to submit data in 10-minute increments for all 10-and 90-day global code services through use of eight non-payable codes. AAOS further has concerns with the OPPS Proposed Rule, which recommends removing Total Knee Arthroplasty (TKA) Procedure from the In-Patient Only (IPO) list. You can read the letters here.


AAOS Sends Thank You to House Speaker Paul Ryan for 21st Century Cures Support and Urging Action

AAOS joined with numerous medical specialty societies in thanking Speaker of the House Paul Ryan for his support to move a compromise 21st Century Cures bill in the fall. The proposal seeks to accelerate innovation, boost research, streamline drug and device approvals and enhance interoperability of electronic health records technology. In particular, the letter states AAOS support for the Senate HIT legislation that creates a definition of clinician-led clinical data registries and requires HIT vendors to share data with those registries as a condition of certification to ensure such registries have efficient, cost-effective access to clinical outcomes data. Both Senator Lamar Alexander (R-TN), Chair of the Senate Health, Education, Labor & Pensions Committee, and Representative Fred Upton (R-MI), Chair of the House Energy and Commerce Committee, predict a 21st Century Cures package would gain final approval by the end of the year.


Energy and Commerce, Ways and Means Leaders Issues Statement on the CMS Announcement of Increased Flexibility for MACRA

Energy and Commerce Committee Chairman Fred Upton (R-MI), Ranking Member Frank Pallone, Jr. (D-NJ), House Ways and Means Committee Chairman Kevin Brady (R-TX) and Ranking Member Sander Levin (D-MI), issued the below statement after the CMS announcement regarding the implementation of MACRA. The announcement comes just days after the Members sent a letter to the Administration urging additional flexibility for all practitioners. Read the AAOS press release online here.


“We’re pleased to see the Administration is including our recommendations in its implementation of MACRA. By providing flexibility for doctors and other health care providers, we are helping ensure this historic law delivers the quality, value-based care Medicare beneficiaries deserve. We’re committed to continuing our work with each other, stakeholders, and the Administration so that doctors can prioritize patient care instead of focusing on burdensome paperwork.” 


1-Year Grace Period for ICD-10 Codes to End

October 1, 2016 marks the end of a 1-year grace period that the CMS established for new ICD-10 diagnostic codes and will no longer accept unspecified ICD-10 codes on Medicare fee-for-service (FFS) claims when a specific one is warranted by the medical record. Other major health insurers that also followed Medicare’s lead on leniency in coding are expected to get tougher, as well. There is a worry that the end of the grace period could result in a wave of claims being rejected by Medicare and private insurers. Dr. Pfeifer, MD, who sits on the coding and reimbursement committee of the AAOS was recently quoted in Medscape Medical News saying, “The most important thing is what you do for your patient. The second most important thing is documenting what you do. The third most important thing is sending a bill out the door that gets you paid for your work.” Read the Medscape article online here.


Surgeon General Writes to Physicians on Opioid Abuse

U.S. Surgeon General Vivek Murthy launched the nationwide campaign “Turn the Tide Rx” in an effort to end the opioid epidemic. Surgeon General Murthy has called on physicians to take a pledge to 1) educate themselves to treat pain safely and effectively 2) screen patients for opioid use disorder and provide or connect them with evidence-based treatment and 3) shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing. The opioid epidemic has been the subject of much debate in Washington, D.C. and beyond. However, this recent action from Dr. Murthy is the first time in history a surgeon general has sent a letter directly to American physicians. Read more in Advocacy Now here.


House Ways and Means Subcommittee on Health Holds Hearing on Medicare Part A

On September 7, the House Ways and Means Subcommittee on Health held a hearing to examine whether existing Medicare Part A policies are improving the quality and cost-efficiency of care in hospitals. Specifically, Members heard from physicians, researchers, and administrators about opportunities to improve post-acute care settings—such as home health agencies, long-term care hospitals, or skilled nursing facilities—to deliver better outcomes for patients.  Witnesses expressed support for Value-Based purchasing as a natural next step in the evolution of patient-centric Medicare policy and tying Medicare payments to minimum quality thresholds to ensure services are appropriate and cost effective.  Support was also expressed for consolidating the hospital pay-for-performance programs similar to those adopted for physicians in order to streamline the programs, balance the incentives and improve fairness.  While the hearing did not specifically address physician-owned hospitals or registries, AAOS is submitting a letter for the record highlighting the fact that they represent the value and quality emphasized in the hearing.


Open Payments Data Update

2015 Open Payments data is public, but you can still review and dispute records in the Open Payments system until December 31. Physicians should check their data every year – even if they don’t believe there has been data reported on them. Drug or device companies can submit older data from previous years. Although the data is old, should it be the first time it has been published, they still have until the end of the year to review and dispute information if necessary. If there’s anything inaccurate, it is encouraged to dispute it quickly – this will let the drug and device companies know there is disagreement with their records and gives them a chance to resolve the dispute.  If help is needed with the data review and dispute process, or any questions about how Open Payments works, email the CMS Open Payments Help Desk at and find step by step guidelines, including the review & dispute guide and more information  at


Hospital Ownership of Physician Practices Increases

A new study prepared by Avalere Health finds that the number of physician practices owned by hospitals/health systems rose 90 percent between 2012 and 2015, with the percentage of physicians employed by hospitals or health systems increasing in every region of the U.S. during this time. It is a fact Medicare spends less when patients receive treatment in a physician’s office, yet the number of physician-owned medical practices is rapidly shrinking. The shift towards physicians employed by hospitals could mean higher costs to the entire healthcare system. Most importantly, it has a profound impact on patients as it impacts both where they receive and how much they pay for their healthcare needs.


Call to Action in the Treatment of Osteoporosis

A recent call to action to address the crisis in the treatment of osteoporosis  from the American Society for Bone and Mineral Research (ASBMR) included new evidence emerging that the 30-year downward trend in hip fractures in the U.S. has hit a plateau in the last few years, indicating the field as a whole must take action to aggressively reduce fracture risk in our aging population. Experts are now acknowledging there is a crisis caused by the declining rate of testing, diagnosis and treatment of high-risk patients.  Allowing these patients to go untested and untreated frequently leads to debilitating fractures that cause disability, loss of independence and death.


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