NYS SOciety of ORTHOPAEDIC Surgeons

The Centers for Medicare & Medicaid Services (CMS) announced relief for clinicians, providers, and facilities participating in the Medicare quality reporting programs.

Among other programs, clinicians and providers will be granted exceptions from reporting requirements and extensions pertaining to measure reporting and data submission for the Merit-based Incentive Payment System (MIPS). The deadline for submitting 2019 MIPS data has been extended to April 30.

Those clinicians who fail to submit their MIPS data by that date will receive an extreme and uncontrollable circumstances exemption (i.e., they will receive a neutral adjustment).

> Learn more

Both the New York State Department of Financial Services (DFS) and Department of Health (DOH) have sent out notifications relating to the Covid-19 outbreak reminding health insurers, physicians and hospitals that New York law requires coverage for telemedicine in the same manner as if care had been provided in an office setting.  For more information about how to start and choosing a vendor visit the AAOS Practice Management/Telemedicine center

• To read the NYS Department of Financial Services circular letter, click here
• For NYS Medicaid guidance click here
  

NYS Workers Compensation has issued amendments to allow telemedicine in some circumstances for social distancing purposes due to the outbreak of COVID-19. The text can be found here
Moreover, Congress passed a law last week that reduces current restrictions on Medicare coverage for telemedicine. A fact sheet can be found here.

Summary of Medicare Telemedicine Services

Source: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

We have all been receiving multiple notifications and updates on the COVID-19 pandemic.  There are more confirmed cases, school systems are closed and concerns regarding infrastructure, ICU beds, emergency room and hospital personnel exposure, and recent more restrictive bans on gathering sizes and nursing home visitation.  The CDC recommends rescheduling non-urgent outpatient visits as necessary.

Current efforts to mitigate the spread of the virus include social distancing and quarantine restrictions as necessary depending on exposure, risk, symptoms, and testing. Testing still lags behind and hopefully continues to improve.  As physicians we need to continue to be prudent, compassionate, lead by example, and be guided by science.  We collectively need to practice improved health hygiene going forward and limit the spread not only of this virus, but other innumerable transmissible diseases in our society.

Our Executive Director Babette Grey is continuing to actively monitor the  MSSNY website, New York State Department of Health, CDC, and other resources daily.  She and the board are a resource and are here to help as needed. > Access the resource page

Protecting our patients, staff and visitors continues to be of the utmost importance.  My private single specialty orthopaedic practice, physical therapy, imaging and ASC process more than 1000 patients per day.  Instituting social distancing earlier has been shown to save lives.  Many of our patient population falls into a vulnerable category and much of the work we do is elective.  We currently are seeing urgent patients and keeping our open access clinic for fractures open to help offload the emergency rooms with screening of patients and discouraging non--urgent office visits.  That being said, we are still having patients in the elderly group trying to walk in to get a cortisone shot in the knee and other nonessential visits as today I have seen patients with arthritic knees and pain since July and an elbow problem since July despite discouraging those visits.  This is one of the problems unless people completely shut down.

On behalf of the NYSSOS Board, our thoughts and prayers are with you and your families, patients, staff, facilities and your communities.  We are continuing to work for the orthopaedic surgeons of the state of New York and nationally to be able to continue to improve the ability to take care of musculoskeletal problems for our patients.  Please reach out to us if we can be of assistance or a resource.

James Slough, MD FAAOS
President

Physicians should utilize the New York State Department of Health website that has up-to-date information on COVID-19 and includes information on known cases of COVID-19, cleaning and disinfection guidance, help for childcare providers and schools, and guidelines for individuals who have recently traveled internationally.
https://health.ny.gov/diseases/communicable/coronavirus/providers.htm

Reporting
COVID-19 is a reportable disease.  If novel Coronavirus is suspected, immediately notify the local health department (LHD) where the patient resides.

Health care providers should review: CDC's Interim Guidance for Healthcare Professionals Evaluating Persons Under Investigation (PUI)

Free Communication Resources 
CDC offers free resources including video, fact sheets, and posters. https://www.cdc.gov/coronavirus/2019-ncov/communication/index.html

Additional Resources
CDC Website for Healthcare Professionals 
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

 

OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health.

The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living. All content is developed and peer reviewed by AAOS members.

Written in simple language, OrthoInfo articles can help your patients be better informed and participate more fully in their care and recovery.

Visit the site

The Centers for Medicare & Medicaid Services (CMS) proposed a three-year extension and changes pertaining to episode definition and pricing to its Comprehensive Care for Joint Replacement (CJR) model.

The proposed changes would incorporate outpatient hip and knee replacements into the episode of care definition, as well as change the reconciliation process, the beneficiary notice requirements, gainsharing caps, and the appeals process.

The CJR model three-year extension would provide time to assess the changes in practice. > Learn More

Editor’s note: AAOS partners with KarenZupko & Associates, Inc. (KZA) on the organization’s coding education, and KZA often provides content for AAOS Now. For more information, visit www.aaos.org/membership/coding-and-reimbursement.

Whether due to the complexities of hiring billing staff or a result of hospital employment and practice acquisition, many orthopaedic practices are moving their billing operations to a third-party entity or centralized billing office.

This process is part of what institutions call revenue cycle management.

If you find yourself in this situation, these best practices will help improve coding accuracy:

1. Keep Current Procedural Terminology (CPT) and International Classification of Diseases, 10th Edition coding as physician-primary tasks.
2. Insist that the third party follows AAOS coding guidelines.
3. Verify that the third-party billing staff includes coding experts, not just billing staff.
4. Ask for reports that illustrate the third party’s coding knowledge and performance.
5. Require ongoing orthopaedic coding education.

> Learn more

The AAOS Office of Government Relations (OGR) is proud to introduce its 2020 Resident Advocacy Fellows: Carl L. Herndon, MD, and Kacy Peek, MD.

Launched in early 2018, the one-year fellowship is designed to encourage orthopaedic residents to participate in the national health policy arena and ultimately become lifelong advocates of the profession. Eligible post-graduate year (PGY)-3 and -4 residents who are selected for the fellowship have the opportunity to gain a greater understanding of health policy legislative and regulatory processes; contribute to the development of new policies and programs, as well as strategic planning; work on various projects with senior AAOS staff; and develop a strong foundation for leadership in the healthcare environment.

During their tenure as Resident Advocacy Fellows, participants will attend the National Orthopaedic Leadership Conference, partake in Capitol Hill visits and advocacy training, spend a week at the AAOS OGR office, develop a presentation on health policy issues covered during the program, and actively engage in resident advocacy.

Carl L. Herndon, MD

Dr. Herndon is a PGY-4 orthopaedic surgery resident at the Columbia University Medical Center in New York. Originally from the Chicago area, he graduated from Northwestern University and completed medical school at the University of Florida College of Medicine prior to residency. From an early age, he has had multiple opportunities to travel on medical missions abroad with his mother, an obstetrician-gynecologist, and cultivate a heart of service. After graduating from Northwestern University and before enrolling in medical school, Dr. Herndon worked on the medical operations team of a large, federally qualified, inner-city health center, where he was first exposed to advocacy and how health policy can affect the daily lives of both patients and healthcare professionals. In medical school, he served as president of his class and was a member of both the local chapter of the American Medical Association and the Florida Medical Association. He was elected to the Alpha Omega Alpha Honor Medical Society and won several other awards for service. During residency, he has been an active member of the New York State Society of Orthopaedic Surgeons and also serves on both the AAOS Council on Education and the Resident Assembly Health Policy Committee. After residency, he plans to pursue a fellowship in total joint arthroplasty and continue to advocate for both surgeons and patients.

A study published in the Feb. 15 issue of the Journal of the AAOS evaluated how Affordable Care Act (ACA)-associated Medicaid expansion impacted the utilization of elective orthopaedic surgery in New York state. The abstract is below.  Full article can be found here.

Background: 

As part of the Patient Protection and Affordable Care Act, states were given the option of expanding Medicaid coverage to include adults younger than age 65 years with income at or below 138% of the federal poverty level. Although this expansion was intended to provide health care coverage to an estimated 20 million Americans, several studies have shown increased coverage does not equate to increased access to care by specialty providers.

Methods: 

We queried the New York Statewide Planning and Research Cooperative System database and identified all patients who underwent the 10 most common elective orthopaedic surgeries from January 1, 2012, through March 31, 2016. Medicaid monthly enrollment for the 4-year study period was obtained from NY Department of Health Medicaid Managed Care Enrollment Reports.

Results: 

Our query identified 700,159 patients who underwent the investigated orthopaedic surgeries. Of these, 60,786 were Medicaid recipients. During the 4-year study period, Medicaid enrollment and the number of procedures reimbursed by Medicaid increased significantly (P < 0.001 for both).

Conclusions: 

Affordable Care Act–supported Medicaid expansion was associated with an increase in Medicaid enrollment and a concomitant increase in the utilization of orthopaedic surgery by Medicaid beneficiaries in New York State.

Late last week, the House Ways & Means Committee issued bipartisan legislation tackling surprise medical billing. The proposal, which is scheduled for markup on Feb. 12, would eliminate balance billing for emergent procedures. Conflicts would be resolved with an independent mediation process.

AAOS is reviewing the proposal and continues to advocate for a fair, accessible Independent Dispute Resolution process for resolving payment disputes.

Contact your congressional representative to voice your concerns.