by Stephen M. Engstrom, MD
2018-2019 AAHKS Health Policy Fellow

This week, AAHKS members and staff returned to Washington, D.C. as part of the American Academy of Orthopaedic Surgeons (AAOS) National Orthopaedic Leadership Conference (NOLC) to meet with members of Congress to formulate bipartisan solutions to current legislative issues impacting arthroplasty surgeons and patients. The removal of total knee arthroplasty (TKA) from the inpatient only (IPO) list was again a top topic priority. AAHKS delegates urged members of Congress to seek clarification from the Center for Medicare and Medicaid Services (CMS) as to which patients qualify for inpatient admission following TKA in order to correct the monumental shift toward outpatient hospital admission. We recommended that the determination of a patient’s admission status should remain with the clinical judgement of the surgeon and asked that members of Congress urge CMS to suspend the Two-Midnight rule for TKA until such clarification can be given.


Steve Engstrom, MD, Chick Yates, MD, Mike Bolognesi, MD, Juan Suarez, MD, Dave McNitt and Josh Kerr represent AAHKS at #NOLC2019

Another pivotal topic discussed revolved around the current process for reviewing potentially misvalued CPT codes. Currently, any member of the public can nominate a code as misvalued. In 2018, a commercial insurance company nominated the current total hip and total knee CPT codes with the intent of decreasing physician reimbursement. AAHKS delegates presented data to members of Congress that the survey cited by the insurance carrier to trigger the evaluation was not statistically significant and was never intended to establish a national baseline. We asked that the process for triggering a review of potentially misvalued CPT codes:

  1. Be made public
  2. Provide an opportunity for the specialty to respond
  3. Allow CMS to evaluate both the nomination and the response before issuing a recommendation to the CMS Relative Value Scale Update Committee (RUC)

Currently, AAHKS is working with the AMA and CMS to demonstrate why the 2014 evaluation of the codes is accurate. We are also advocating for innovating reimbursement assessments that reflect the changing role physicians play in value-based care.

Finally, AAHKS delegates addressed the issue of choice in Advanced Practice Models (APMs). We impressed upon members of Congress that as early adopters of the value-based care movement, we are heavily invested in providing exceptional care to our patients while being mindful of rising healthcare costs. We discussed that because of current APM regulations, many of our joint replacement surgeons are unable to choose the APM that best suits their practice. We asked that members of Congress support physician choice when it comes to selecting the APM in which they participate.  We also offered our enthusiastic support for developing new and innovative advanced practice models that better serve our patients and improve surgeon efficiency.

Overall, AAHKS delegates pledged our continual availability as a resource to our representatives in Washington. As surgeons dedicated to providing high quality care to arthroplasty patients, we wish to serve as source of information and guidance to those tasked with developing legislation impacting our patients and physicians. By participating in advocacy efforts like the NOLC, AAHKS hopes to foster personal and long-lasting relationships with legislators, so that the full impact of our message can be realized. Follow along with the meeting on Twitter by searching #NOLC2019.