|Letter from COS President Raj Bazaz, MD|
The Colorado Orthopaedic Society and our partners in the House of Medicine made great gains for physicians in the 2020 Colorado General Assembly — despite it being temporarily adjourned due to COVID-19 and drastically affected by budget cuts due to the economic downturn triggered by the pandemic. Among the highlights: Colorado’s liability climate remains stable, telehealth expansions adopted during COVID-19 were extended, chiropractors were prevented from being able to refer to themselves as physicians, and practice acts for non-physician providers continued without dangerous scope expansions.
However, even as physicians continue to care for patients on the frontlines of the COVID-19 pandemic, cuts to physician payment for surgical services are looming. Finalized and recently proposed policies from the Centers for Medicare & Medicaid Services (CMS) conflict with current law and will have drastic consequences for Medicare patients seeking surgical services at a time when physician practices are struggling to stay afloat. Learn more about AAOS and COS efforts to stop these changes below.
Looking to the 2020 general election, I encourage all COS members to register and cast your vote. Doctors historically tend to vote less than the general population and other professionals, including lawyers. You can also promote voting to patients and staff to increase representation among all voter groups — particularly those who are traditionally underrepresented. This bipartisan toolkit for practices and providers includes printable flyers, stickers and general information on voting in Colorado.
Finally, I want to commend all of you for continuing to care for patients through these tumultuous times. We are here for you as well. Reply to this email with any comments or concerns and I will be sure to respond.
|News Updates and Events|
|AAOS and COS lobbying to prevent Jan. 1, 2021 payment cuts|
In partnership with AAOS and other surgical specialties, COS is lobbying its Congressional Delegation to stop the proposed cuts to Medicare that threaten access to care and fragile physical practices tyring to cope with the effects of the pandemic. Here are a few takeaways important to the orthopaedic community.
Cuts to Musculoskeletal Care Services
In the CY 2021 Medicare PFS proposed rule, CMS proposes to follow through with two major funding cuts for orthopaedic surgery. The proposed physician conversion factor is $32.26, an 11% reduction from 2020. In addition, CMS proposes to accept the AMA-RUC recommendations to decrease the work relative value units (RVUs) for hip and knee arthroplasty CPT codes 27130 & 27447 from 20.72 to 19.60. These changes will have a severe and lasting impact on access to care for America’s seniors. Ask CMS to maintain current funding levels, and accept the data provided by the American Association of Orthopaedic Surgeons (AAOS) and the American Association of Hip and Knee Surgeons (AAHKS), which demonstrates increased surgeon time spent on evaluation activities related to value-based care.
E/M Global Surgical Codes Changes
In the CY 2021 Medicare Physician Fee Schedule (PFS) proposed rule, CMS restated their plan to increase the payment levels for stand-alone office and outpatient E/M codes. It did not, however, apply these adjustments to global codes. This change was first finalized in the CY 2020 PFS rule, but the changes would not take effect until 2021. Arbitrarily adjusting some E/M codes but not others conflicts with the Omnibus Budget Reconciliation Act (OBRA) of 1989(P.L. 101-239), which prohibits Medicare from paying physicians differently for the same work. Failing to adjust the E/M portion of the global codes is tantamount to paying surgeons less than physicians in other specialties, in contradiction of the law.
Read more in this AAOS one-pager on planned payment policy changes. The federal CMS will accept comments on the proposed rule until Oct. 5, 2020, and will respond to comments in a final rule. Given the concerns of COS and AAOS, preventing or mitigating negative changes is our top advocacy priority. Join us in this effort by using the action form on this AAOS webpage to contact your congressional representative today.
|More changes proposed for Medicare|
The Centers for Medicare and Medicaid Services also recently released the Calendar Year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) proposed rule that proposes to eliminate the Inpatient Only (IPO) List beginning with nearly 300 musculoskeletal-related services, adjust the criteria for procedures covered in the ambulatory setting, and remove certain restrictions on the expansion and development of physician-owned hospitals.
The IPO list change would make these procedures eligible to be paid by Medicare in the hospital outpatient setting when outpatient care is appropriate in addition to the existing ability for payment in the hospital inpatient setting when inpatient care is appropriate. As AAOS explains, we support policies that give orthopaedic surgeons and their patients greater choice.
However, the concern is that such a drastic change may exacerbate many of the same unresolved issues orthopaedic surgeons face. The concern is payers, including Medicare Advantage and commercial carriers, often misinterpret the policy change to mean that these procedures must be performed exclusively in the outpatient setting — jeopardizing patients’ safe, timely access to care and increasing delays and prior authorization paperwork.
Again, comments will be accepted through Oct. 5. Join us in advocating for the profession by using the action form on this AAOS webpage to contact your congressional representative today.
|Need PPE? Order through ActionPPE|
Order your next round of PPE through ActionPPE.org, which has partnered with the Colorado Medical Society to give Colorado physicians and practices access to medical-grade PPE supplies. Available products are KN95 or disposable tri-fold masks, disposable gowns, face shields, gloves and hand sanitizer. Place your order through the order form here — actionppe.org/3/cms/ — and share this link with your colleagues. Use discount code cms-save5 for 5 percent off all orders through the link above.