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68th Annual Mtg

VOS 68th Annual Meeting
April 24-26, 2015
The Homestead
Hot Springs, VA


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NOLC Held in Washington, DC

On Thursday, May 1, 2014, more than 300 orthopaedic surgeons from around the country participated in the American Association of Orthopaedic Surgeons (AAOS) National Orthopaedic Leadership Conference (NOLC). Attendees met with their members of Congress, attended various symposiums on advocacy issues, and participated in discussions surrounding government relations efforts at both the state and federal levels.

NOLC
The VOS delegation visits Andrew Rothe in the office of Congressman Scott Risell. Pictured from left: Wilford K. Gibson, MD; Karen Simonton, CPA, Chief Administrative Officer, Orthopaedic Center of Central Virginia; Steve Leibovic, MD; Carrie Triepel, MD; David Romness, MD, VOS Board of Councilor Representative; Andrew Rothe, Legislative Aid to Congressman Risell; Gautham Gondi, MD; Thomas B. Fleeter, MD, AAOS Chair of the Medical Liability Committee; N. Douglas Boardman, MD, VOS Board of Councilor Representative.
NOLC
Molly Newcomb, Legislative Assistant to Congressman Eric Cantor,
receives the VOS delegation during the AAOS NOLC.
NOLC
Pictured from left: Thomas B. Fleeter, MD; David Romness, MD; N. Douglas Boardman, MD; Steve Leibovic, MD; Carrie Triepel, MD; Wilford K. Gibson, MD
NOLC
The Virginia Delegation waiting for their appointed time
to meet with Senator Tim Kaine in his office.

Because permanent repeal and replacement of the sustainable growth rate (SGR) formula remains a top priority of the AAOS, when meeting with their members of Congress, NOLC participants urged legislators to work together to attain bipartisan offsets and pass permanent SGR reform by the end of the year.

“The cumulative cost of enacting temporary patches now exceeds the cost of a permanent SGR fix,” stated Thomas C. Barber, MD, Chair of the AAOS Council on Advocacy. “Continuing the reckless system of patch after patch is harmful to the economy and to Medicare patients seeking access to specialties they desperately need. The AAOS has worked diligently with all committees of jurisdiction to put into place real reform and we look forward to final passage of H.R. 4015/S. 2000 by the end of this year.”

NOLC participants also raised awareness about the importance of protecting health care professionals engaged in contractual negotiations with a health plan for the delivery of health care services from federal antitrust prosecution. Further, NOLC participants asked Congress to support H.R. 3722/S. 2220. Introduced by Congressman Tom Latham (R-IA), Congressman Cedric Richmond (D-LA), along with Senator John Thune (R-SD) and Senator Amy Klobuchar (D-MN), this legislation protects sports medicine professionals from civil and criminal malpractice liability when they provide care to athletes at sporting events in another state.

In addition to Capitol Hill  visits, this year’s NOLC also featured symposiums on “The Future of the Practice of Orthopaedic Surgery,” which focused on workforce and GME issues, “The Social and Economic value of Orthopaedic Surgery: An Update,” and “The Role of the AAOS in Performance Measurement in Orthopaedic Surgery.” Other symposiums included an update on federal and state health exchanges, a discussion on antitrust and health care monopoly issues, as well as a primer on Congressional Budget Office (CBO) scoring. Representative Phil Roe, MD (R-TN) also addressed the NOLC participants. Finally, the AAOS Office of Government Relations (OGR), with support from the Advocacy Resources Committee (ARC), hosted a reception at the AAOS OGR offices.

AAOS
ARC Committee Chair Wilford Gibson, MD, with NOLC attendees at the OGR reception.

For more information on the NOLC, visit the AAOS website at http://www3.aaos.org/govern/federal/nolc/nolc.cfm. Further updates and photos will be posted as they become available. For questions or concerns, contact the Office of Government Relations at dc@aaos.org.

AAMC Hosts GME Briefing
On Tuesday, May 6, 2014, the Association of American Medical Colleges (AAMC) held a briefing regarding the physician workforce shortage. In addition to discussing federal policies that support physician workforce development and graduate medical education (GME), the briefing also touched on the issues contributing to the medical student shortage, including increased insurance coverage, a growing/aging population, the expected decline of physicians per capita, and an increase in utilization due to medical advances. 

AAMC estimates there will be a shortage of 130,000 physicians in the next decade, which will be distributed equally amongst specialty and primary care. They also reported that on the most recent “Match Day” (March 2014), approximately 1,800 U.S. medical students did not match into programs. Finally, AAMC estimates that a 10% cut in GME funding would result in a 30% cut in programs. According to AAMC, increasing graduate medical education by eliminating the 13-year freeze in Medicare’s support for training positions is essential to address the projected physician shortage.

AAOS
Image courtesy of AAMC

A presenter from the American Association of Neurological Surgeons (AANS) commented that there will be a very dramatic shortage in specialties generally versus primary care in the next decade. AANS emphasized the aging workforce, implications of GME cuts, and highlighted Texas as the state with fewer physicians per person than the rest of the U.S. According to AANS, in Texas alone, we need to produce 2.5 to 3.5 doctors per day to keep up with the population growth. To alleviate current and future physician shortage, the presenter stated, Congress should pass legislation increasing Medicare support for GME.

Legislation discussed at the briefing included H.R. 1201, the Training Tomorrow’s Doctors Today Act, which addresses short and long-term workforce demands by increasing the number of Medicare-supported residency positions. S. 577, the Resident Physician Shortage Reduction Act of 2013 was introduced by Senators Bill Nelson (D-FL), Charles Schumer (D-NY), and Senate Majority Leader Harry Reid (D-NV), and similarly increases, by 15,000, the number of Medicare direct graduate medical education and indirect medical education slots. The AAOS has worked to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for GME through these and other legislation.

Upcoming Deadline for PQRS Participation
The Centers for Medicare and Medicaid Services (CMS) has implemented a suite of quality- and value-oriented initiatives in recent years, one of which is the Physician Quality Reporting System (PQRS). Participation in PQRS is now required for physicians who practice in groups of 10 or more treating Medicare beneficiaries. For physicians who do not participate this year (2014), a 2 percent penalty will be applied to their Medicare payments in 2016. Similarly, eligible physicians who did not participate in 2013 will receive a 1.5 percent payment penalty in 2015.

In order to be compliant with the PQRS program, 50 percent of the physicians in a group of 10 or more must participate as an individual in PQRS, or must participate through the Group Practice Reporting Option (GPRO). The deadline for physicians to register to participate through GPRO is September 30, 2014. More details on registration and participation in the PQRS program can be found on the CMS website here: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/pqrs/index.html

CMS Announces Minimal Progress on EHR
AAOSAccording to the Centers for Medicare & Medicaid Services (CMS), only four hospitals and 50 doctors nationwide have achieved Stage 2 meaningful use of electronic health records (EHR). The data was presented during a May 6 meeting of the Health Information Technology Policy Committee, which is a federal advisory body for the Office of the National Coordinator for Health IT. According to Modern Healthcare, such low numbers mean that many hospitals and vendors “will be under tremendous pressure in the closing months of their incentive payment years to hit Stage 2 or suffer lower Medicare reimbursements.” Further, the numbers are worrying some federal health IT policy observers.

“It is too early to tell if meaningful use will be successful in 2014,” Jeff Smith, director of public policy at the College of Healthcare Information Management Executives, told POLITICO. “The reporting year will end before CMS can say for sure… That is the limitations of administrative data.”

For hospitals, the first Stage 2 attestation period began at the start of the federal fiscal year, October 1, 2013, with the second 90-day period starting January 1, 2014. Physicians and other eligible professionals who have attested to two or more years at Stage 1 are required to step up to Stage 2 but have until the end of 2014. Unlike hospitals, the payment year for physicians and other professionals is measured by the calendar year, so their first 90-day attestation period began January 1, 2014.

In March, more than 8,300 physicians enrolled in the Medicare EHR incentive program with 4,100 enrolling in the Medicaid incentive program. While this number is an increase slightly over February enrollment, the number of hospitals enrolling continued to decline in the month-over-month comparisons. Additionally, there is increased pushback as a result of reports that vendors have been late in readying their systems for the demands of the EHR incentive-payment program. Further, more hospitals have applied for hardship exceptions from the meaningful use program this year than attested to meeting either Stage 1 or Stage 2 program requirements, the CMS reported, raising questions about the success of the program. CMS is currently reviewing the physician exception applications, which total approximately 600.

View the presentation slides HERE.

Physician Registration for CMS Open Payments
(Sunshine Act) Program Began June 1

Physicians and teaching hospital representatives can now register on the U.S. Centers for Medicare & Medicaid Services (CMS) Enterprise Portal. Registration is a voluntary process, but only registered users will be able to dispute information reported by industry that they believe to be inaccurate or incomplete. Registration will be conducted in two phases for the first Open Payments reporting year:

  • Phase 1 (begins June 1) includes user registration in CMS' Enterprise Portal.
  • Phase 2 (begins in July) includes physician and teaching hospital registration in the Open Payments system, and allows them to review and dispute data submitted by applicable manufacturers and applicable group purchasing organizations prior to public posting of the data.

AAOSCMS states that disputed data, if not corrected by industry, will still be made public, but will be marked as disputed. AAOS strongly encourages members to register.

Read more...

Learn more about the review and dispute process…

AAOS Meets with MedPAC on Imaging Study
AAOSAs part of the roll-out of the Oxford Outcomes (ICON) study on imaging self-referral to key stakeholders, the AAOS met recently with Mark Miller, PhD, Director of the Medicare Payment Advisory Commission (MedPAC).  Participating were AAOS Medical Director Will Shaffer, MD, Senior Manager of Policy and Medical Affairs, Matt Twetten, and Senior Manager of Government Relations Julie Williams. MedPAC is an independent Congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program.  In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.  MedPAC meets often with the Centers for Medicare and Medicaid Services (CMS), healthcare researchers, healthcare providers, and ­beneficiary advocates to help them with their recommendations to Congress.

The Oxford study of Medicare claims data and survey data on orthopaedic surgeons found no statistically significant difference in the rate of change between the MRI utilization behavior of orthopaedic surgeons who purchased Magnetic Resonance Imaging (MRI) equipment and those who did not for Medicare patients.  It is a robust and methodologically sound study (view more information HERE).  Its longitudinal design examined MRI utilization over time, statistically controlling for practice and demographic characteristics, and a rigorous “apples-to-apples” comparison of practices that do and do not have on-site MRI capacity.  This differs from some previous studies of the issue which did not have an appropriate comparison group and/or did not follow physician practices longitudinally.

Historically, MedPAC has argued that Physician self-referral of ancillary services creates incentives to increase volume under Medicare’s current fee-for-service payment systems, which reward higher volume. Despite that, they have not advocated closure of the in-office ancillary services exception. Instead, they have recommended a model of integrated care in which providers receive a fixed payment in advance for a group of beneficiaries (capitation) or an episode of care (bundling), systems that reward providers for constraining volume growth while improving the quality of care.  Because it will take several years to develop new models and payment delivery systems, they have also considered several options in the interim, including: a targeted prior authorization program for advanced imaging; reducing payment rates for diagnostic tests performed under the exception; excluding diagnostic tests that are not usually provided during an office visit; limiting the exception to physician practices that are clinically integrated and reducing payment rates for diagnostic tests performed under the exception.

Because of their level of influence with Congress and their position on self-referral, it was critically important to share the study data with MedPAC.  According to Dr. Shaffer, it was a productive meeting.  They thoughtfully reviewed the data and several areas of commonality were discussed, including the value of integrated care and the need to protect the in-office ancillary services exception.

Fifth Annual Physician & Dentist Candidate Workshop
August 2, 2014

With many health policy challenges on the horizon, it is more important than ever that individuals who understand and care about the future of medicine are elected to public office. Fortunately, physician involvement in politics has grown considerably in recent years. In the 113th Congress there are 20 physician members serving in Congress, including two orthopaedic surgeons Dr. Tom Price (R-GA-06) and Dr. John Barrasso (R-WY).

The Orthopaedic PAC strives to educate and help elect AAOS members and other specialty physicians to political office at all levels.  AAOS is co-hosting the 5th Annual Specialty Physician and Dentist Candidate Workshop on Saturday, August 2 in Washington, DC along with the American Congress of Obstetricians and Gynecologists, American Society of Anesthesiologists, American College of Radiology and the American Dental Association.
Workshop participants will learn important campaign preparatory information from a multitude of political experts including nationally renowned political consultants. Among the topics covered are how to develop a campaign plan, messaging and fundraising strategies, the importance of polling, and the pros and cons of various communication outlets.
Physicians already possess many attributes that are attractive to voters. They are well educated, credible, compassionate and often small business owners. In addition, they often have a dependable network of patients, colleagues and others which is necessary to build a strong grassroots campaign and acquire donations. While there are certainly challenges to being a physician candidate including time limitations, participants are provided with a realistic outlook on how to run a modern and well-executed campaign for any elected office from School Board or City Council to the U.S. Congress.

For more information on the Specialty Physician & Dentist Candidate Workshop or to RSVP, please contact Kristin Leighty at leighty@aaos.org or 202.548.4150.

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