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From 12-14 September 2022, leaders in the American Association of Orthopaedic Surgeons (AAOS) met in Washington, D.C. for the National Orthopaedic Leadership Conference (NOLC). The NOLC is an annual event of the AAOS where selected leaders of the Academy meet to discuss current trends as well as to lobby Congress on issues pertinent to orthopaedic surgery. I have been attending NOLC since 2006, and it is my favorite AAOS event. The Board of Councilors (BOC), who represent the individual state orthopaedic societies, and the Board of Specialty Societies (BOS), who represent the individual orthopaedic specialty societies, are the largest constituents of the NOLC. Hassan Mir, MD; Kathleen Caswell; and myself represent the OTA on the BOS, and Mike Archdeacon, MD, OTA president, participated on behalf of the BOC.

The policy issues that we presented to members of Congress are very central to the vast majority of orthopaedic surgeons in the United States. Recognizing that there are many “just causes” for which we could advocate, the AAOS Council on Advocacy is responsible for determining the pertinent issues to bring up to Capitol Hill. We are very effective at efficiently deploying our efforts to where they are the most likely to make a difference. There are other “just causes” that are worthy of our effort, but the political climate in Washington may see them more as a partisan rant than an effect plea for policy change. We also tend to limit our efforts to actual or pending legislation so that there is a legitimate vehicle to carry our issue. I will elaborate our four issues:

1. The Improving Seniors’ Timely Access to Care Act (HR 3173/ S 3018) – this bill (which has both a House and Senate companion) seeks to reduce the hassle of preauthorization with Medicare Advantage. Please note that the majority of your insurance preauthorization headaches with the private payers is a state and not a federal issue, and this federal bill will not address that concern directly. We advocated strongly for this legislation, and to our joyful surprise, this bill was taken up for a vote on the floor of the House of Representatives the day after we lobbied Congress. It is important to remember that only 5-6% of all the bills introduced into Congress ever see a floor vote, and this was one of them! I am pleased to announce that the bill passed the House vote and now waits for Senate action.
2. Supporting Medicare Providers Act of 2022 (HR 8800) – Medicare payment was supposed to be fixed when the MACRA law was passed, however that clearly didn’t happen. We bore reductions in Medicare payments in 2022 through the sequester cuts along with most other sectors of the economy. We did successfully delay the Medicare payment cuts in the Conversion factor and PAYGO, but we will face those cuts again in 2023 if Congress doesn’t act. In addition, we are woefully behind in an inflationary update to what we are paid from Medicare. We lobbied Congress to update the Medicare Conversion Factor by 4.42% and to update payments based on inflation. We will address the PAYGO cuts during the lame duck session this winter. We received favorable opinions from leaders in Congress that the PAYGO cuts will be addressed this year. It is critical to understand that the timing of when you lobby for certain issues is very important so that your efforts are most effective.
3. Improving Access to Workers’ Compensation for Injured Federal Workers Act (HR 6087) – this is a piece of legislation that we fought against in the House, but unfortunately it passed on 7 June 2022. This bill allows PAs and Nurse Practitioners to diagnose, prescribe, treat, and certify an injury for federal workers’ compensation claims. We are now addressing this Bill on the Senate side to hopefully defeat it. This is one of many scope-of-practice issues that we are always addressing.
4. Safety from Violence for Healthcare Employees (SAVE) Act (HR 7961) – this is a great bill that establishes penalties for those who knowingly assault and intimidate hospital employees. It includes enhanced penalties for the use of a dangerous weapon that results in injury and authorizes $25 million in grant funding to reduce violence and intimidation in hospitals. We encouraged Members of Congress to cosponsor the Bill and Senators to introduce the bill into the Senate.

The OTA continues to advocate our issues in front of federal legislators and regulatory leaders alongside our colleagues in the AAOS. Only a very limited minority of legislation ever makes it to the floor of either chamber for debate and vote, and we are doing pretty well overall. Stay tuned for more information about our advocacy efforts, and contact Hassan, Kathleen or myself for more information.

Douglas Lundy, MD