News

1. AAOS Responds to House Health Care Reform Draft Legislation (Read More)
2. AAOS Discusses “Meaningful Use” of HIT with the Office of the National Coordinator (Read More)
3. AAOS Submits Comments to CMS on IPPS Proposed Rule (Read More)
4. Council Releases Report to the President and Congress on Comparative Effectiveness Research (Read More)
5. Institute of Medicine Releases Report on Priorities for Comparative Effectiveness Research (Read More)
6. AAOS Attends FDA Transparency Meeting and Meets with Commissioner (Read More)
7. AAOS Incorporates the American Joint Replacement Registry in the State of Illinois (Read More)
8. Advocacy in Action (Read More)

1. AAOS Responds to House Health Care Reform Draft Legislation

On Friday, June 19, 2009 the House Ways and Means, Energy and Commerce, and Education and Labor Committees unveiled their discussion draft for health care reform. View the discussion draft in its entirety or view a summary.

The House proposal contains numerous reform measures, including an updated Medicare physician payment formula, a public option, and a change to the Physician Sunshine Provision. On Tuesday, June 30, 2009, the AAOS submitted a response to the House draft with the surgical community. The AAOS will be issuing a separate response letter with the Alliance of Specialty Medicine.

Physician Payment Reform. The updated payment model would have two “buckets” or expenditure targets. The first bucket would be for primary care, preventive services and all evaluation and management codes, regardless of what type of physician provided the service. In order to transition to this new model, the House has proposed a payment update for 2010 which would be increased at the rate of the Medicare Economic Index (MEI) and would also rebase the Sustainable Growth Rate (SGR), both very positive steps for the physician community. In addition, clinical laboratory services would be removed from the spending calculations as well as drugs. In subsequent years, payment updates to the two buckets would be based on the gross domestic product (GDP).

In addition, there would be a third bucket outside of the two physician payment buckets for Accountable Care Organizations. This expenditure target has not yet been defined within the discussion draft.

The AAOS has stated that any comprehensive health reform efforts must include a permanent fix to the SGR in order to preserve quality access to orthopaedic care. For more information on the AAOS position, read the Principles of Medicare Reform and Principles of Health Care Reform and Specialty Care.

“Public Option.” Under the House proposal, a “public option” would be used to reduce the number of uninsured. Provider participation in the “public option” would be voluntary under the House proposal. In the first three years, physician payment rates would be the same as the Medicare reimbursement rates. After three years, the Secretary of Health and Human Services would be able to adjust the reimbursement rates for the “public option.”  In addition, balance billing would be prohibited in the “public option.” To incentivize participation in the “public option,” the House proposal would provide an additional 5 percent increase in payments for providers who participate in both the public option and Medicare during an “initial incentive period.” The AAOS has not taken a position on the public plan, but has voiced opposition to a mandate for providers to participate, as well as setting reimbursement at Medicare rates.

Physician Payment Sunshine Provisions. Under the proposed plan, the Physician Payments Sunshine Provision would require industry reporting to include “a sponsor of a continuing medical education program” and “an organization of health care professionals.” The AAOS continues to review this provision and its impact on the physician community.

Congressional Activity & Outlook. After releasing the draft, the Committees of jurisdiction, the House Education and Labor Committee led by Chairman George Miller (D-CA) and Ranking Member Buck McKeon (R-CA); the Energy and Commerce Committee led by Chairman Henry Waxman (D-CA) and Ranking Member Joe Barton (R-TX); and the House Ways and Means Committee led by Chairman Charlie Rangel (D-NY) and Ranking Member Dave Camp (R-MI), each held hearings on the proposed health care reform measures on June 23 and June 24, 2009.

The AAOS has previously responded to the Senate Finance Committee’s health care proposals via the Alliance of Specialty Medicine and the surgical community. For more information on AAOS’s responses to the Senate Finance Committee’s discussion paper on delivery system reform and expanding coverage and financing health care reform, see the May 19, 2009 edition of AAOS Advocacy NOW and the June 2, 2009 edition of AAOS Advocacy Now.
While the entire health care reform legislative schedule is fluid and subject to sudden change, several House and Senate actions are possible during the next several weeks:
·        House of Representatives. Leadership has signaled its intention to markup the draft legislation the week after the July 4th recess. The intent is for the full House to vote on the legislation the week of July 20th.
·        Senate Finance Committee. Markup of the Senate Finance Committee proposal is expected the week of July 7th.
·        Senate HELP Committee. The Committee is in the process of completing the markup of their bill and will resume this process after the July 4th recess.
·        Senate. After completion of the Senate Finance and HELP committee’s markup processes, the two bills must be merged prior to proceeding to a vote of the full Senate. The goal is to vote on the merged legislation the first week of August.

2. AAOS Discusses “Meaningful Use” of HIT with the Office of the National Coordinator
On Friday, June 26, 2009 the AAOS, in conjunction with other members of the Alliance of Specialty Medicine, participated in a discussion with John Glaser, PhD, Senior Advisor to the National Coordinator, in the Office of the National Coordinator. The call was centered on specialty physician concern in meeting the “meaningful use” criteria for physician adoption of Health Information Technology (HIT). The American Recovery and Reinvestment Act of 2009 (ARRA) provided financial incentives for physicians who could demonstrate “meaningful use” of HIT by 2011. The AAOS and other members of the Alliance were able to discuss concerns regarding meaningful use and the potential burden on specialty practices and methods to encourage physicians to begin to use HIT.

The AAOS provided comments to the Office of the National Coordinator about meaningful use.

3. AAOS Submits Comments to CMS on IPPS Proposed Rule

On June 29, 2009, the AAOS, through the Council on Advocacy’s Health Care Systems Committee, formally submitted comments to CMS on the fiscal year (FY) 2010 Inpatient Prospective Payment System (IPPS) proposed rule. The American Association of Hip and Knee Surgeons (AAHKS), Pediatric Orthopaedic Surgeons of North America (POSNA), and Orthopaedic Trauma Association (OTA) all worked with the AAOS to address the specialty specific issues included in the FY 2010 IPPS proposed rule. The comment letter focused on Medicare Severity-Diagnosis Related Groups (MS-DRG) classifications, hospital-acquired conditions, new quality measures, graduate medical education (GME), and EMTALA. Important to highlight, based on AAOS and AAHKS recommendations, CMS reclassified infected joint replacement into a more appropriately paid MS-DRG. Read the complete AAOS, AAHKS, OTA, and POSNA comment.

For a summary of the contents of the FY 2010 proposed rule, see the May, 19, 2009 edition of AAOS Advocacy NOW.

4. Council Releases Report to the President and Congress on Comparative Effectiveness Research

On June 29, 2009, the Federal Coordinating Council (the Council) for Comparative Effectiveness Research (CER) released their congressionally mandated report to the President and the Congress. The Council, led by Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), held three public meetings, two in Washington, DC and one in Chicago, IL, and accepted comments for two months prior to release of this report. AAOS participated in each of these listening sessions and formally submitted comments on April 14, 2009.

Most noteworthy, the Council made two key priority recommendations for how the Office of the Secretary will spend its $400 million from the American Recovery and Reinvestment Act of 2009 (ARRA). The Council recommended that the primary investment for CER be in data infrastructure. Specifically, the Council envisions data infrastructure to link data sources, create data networks, and develop registries. The secondary areas for investment recommended by the Council are in the areas of dissemination and translation of findings, priority populations, and priority interventions. Specifically, the Council identified the priority populations as racial and ethnic minorities, persons with disabilities, persons with multiple chronic conditions, the elderly, and children. The identified priority interventions are devices, procedures/surgery, behavioral health, prevention, and delivery systems. In addition to specific funding priorities, the Council also established a definition, criteria, and a strategic framework for CER.

The AAOS, through the Council on Advocacy’s Health Care Systems Committee and the Council on Research, Quality Assessment, and Technology, has been working with legislators, federal agencies, and other stakeholders to ensure the highest quality of care for musculoskeletal patients. We will continue to stay actively engaged in the discussions and activities around CER.

5. Institute of Medicine Releases Report on Priorities for Comparative Effectiveness Research

Today, June 30, 2009, the Institute of Medicine (IOM) released their Congressionally-mandated report to the Secretary and the Congress on the national research priorities for comparative effectiveness research. The IOM recommended many different areas of focus with health delivery and disparities as the top two areas for primary and secondary research priorities. Specifically, the IOM committee recommended twelve different research priorities in musculoskeletal care. Of these twelve research priorities, five specifically address spine care. The remaining musculoskeletal priorities address anticoagulation in hip and knee arthroplasty, osteoporosis, osteoarthritis, falls, imaging, and broader topics such as disparities and obesity.

6. AAOS Attends FDA Transparency Meeting and Meets with Commissioner

On June 24, 2009, AAOS staff attended a public meeting on the Food and Drug Administration’s (FDA) transparency initiative. In response to two Presidential memoranda, the Administration has taken steps to provide information to the public more rapidly and in a user-friendly format.

Toward that end, the FDA has formed an internal task force to provide recommendations to Commissioner Margaret A. Hamburg, MD on FDA activities and decision making processes. The task force is chaired by Principal Deputy Commissioner, Joshua M. Sharfstein, MD and will take the following actions:

• Seek public input on issues related to transparency
• Recommend ways that the agency can better explain its operations, activities, processes, and decision making, compatible with the agency’s goal of appropriately protecting confidential information
• Identify information FDA should provide about specific agency operations, activities, processes, and decision making, including enforcement actions, recalls, and product approvals
• Identify problems and barriers, both internal and external, to providing useful and understandable information about FDA activities and decision making to the public, taking into consideration health literacy and the needs of special populations
• Identify appropriate tools and new technologies for informing the public
• Recommend changes to FDA’s current operations (e.g., internal policies and procedures, standards, information formats, and guidance) to improve the agency’s ability to provide such information to the public in a timely and effective manner
• Recommend legislative or regulatory changes, if appropriate, to improve FDA’s ability to provide such information to the public
• Submit a written report to the Commissioner on the task force’s findings and recommendations

The task force is expected to complete its work in 6 months. The AAOS will provide a comment on ways the FDA might increase transparency by the deadline of August 7, 2009. Recently, the FDA posted a blog to accept comments and suggestions to increase transparency at the Agency. To submit a comment, go to: http://fdatransparencyblog.fda.gov/

On June 29, 2009, AAOS staff met with Commissioner Hamburg and Principal Deputy Commissioner Sharfstein and other FDA officials. Only a few specialty societies were invited to this meeting and staff was invited to share concerns and comments with FDA officials.

The AAOS is an active participant in many FDA activities but specifically mentioned concerns about the pre-market notification or 510(k) pathway which has been the subject of numerous newspaper articles recently. Commissioner Hamburg stated that she will call for an objective review of the program and assess the application of some of the “substantial equivalence” determinations. AAOS staff also shared that guidance document development processes are at times lengthy and suggested that more resources be allocated for those endeavors.

Additionally, other areas of interest at the FDA are the unique device identification initiative that would provide bar coding or radiofrequency to identify devices, post-market surveillance, pediatric device development, FDA panel selections, the sentinel event initiative, antibiotic development, approval process issues, and risk, evaluation, and mitigation strategies (REMS). Commissioner Hamburg and Deputy Commissioner Sharfstein pledged to partner with medical societies in numerous ways acknowledging that they needed and valued outside expertise to assure the public’s health. 

7. AAOS Incorporates the American Joint Replacement Registry in the State of Illinois

The American Joint Replacement Registry (AJRR) officially became incorporated as a not-for-profit organization in the State of Illinois on June 17, 2009. The AAOS led the effort among stakeholders to establish the independent not-for-profit organization. The AAOS continues to move the AJRR forward developing policy and procedures for data collection, privacy, monitoring, and by identifying long-term funding sources. In order to proceed, the AAOS believes that there must be legal protections for patients, implant manufacturers and orthopaedic surgeons.

The development and implementation of the AJRR will proceed quickly and be modeled on successful independent registries, some operating for more than 25 years, in Europe, Australia, and Canada, as well as in the U.S.

8. Advocacy in Action

If you are interested in becoming more active both politically and financially to work toward influencing key legislative decisions on Capitol Hill through the AAOS Orthopaedic PAC, please contact Lauren Bates at bates@aaos.org or call our toll-free number, 1-877-389-AAOS.