State orthopaedic societies have had a successful year in advocating for patient access to prevention and treatment of musculoskeletal conditions. Since August 2016, state orthopaedic societies secured 16 laws that protect physician ownership of ancillary services, end certain harmful insurer practices, and promote patient-centered policies. For detailed reports on every win, please email AAOS’ State Government Affairs Manager, Manthan Bhatt, at firstname.lastname@example.org
Protecting Physician Ownership
In a major win for the AAOS, the South Carolina Supreme Court agreed with two orthopaedic surgeons in their decade long fight protecting the integration of physical therapy (PT) and physician services. The AAOS’ Health Policy Action Fund and the South Carolina Orthopaedic Association have invested significant time and resources into this battle and protecting physician ownership of ancillary services like PT.
Similarly, the Massachusetts Orthopaedic Association (MOA) successfully advocated for significant reforms in Massachusetts’s determination of need (DoN) law, a highly restrictive certificate of need law. Existing ASC’s now have the freedom to expand and the door for new ASC’s in Massachusetts is open for the first time in over 20 years. All existing facilities will be allowed to apply for a DoN without affiliation or in a joint venture with an acute care hospital. Multispecialty facilities will be allowed to add a new service line, expand the facility and transfer ownership. Similar pathways will be created for single specialty facilities.
The Maryland Orthopaedic Association successfully advocated for HB 403, a measure that exempts a health care practitioner who has a specified compensation arrangement with a health care entity from the prohibition against self-referral so long as that compensation if from an advanced payment model. Maryland, before this law, had the most restrictive regulatory burdens on physician ownership of imaging services. The project was funded, in part, by the AAOS’ Health Policy Action Fund.
Recognizing Visiting Sports Team Physicians
In Nevada, Georgia, Tennessee, and Missouri, the governor recently signed laws allowing for visiting sports team physicians to practice in a state where they are not licensed so long as they maintain licensure in any other state. The model legislation and campaign was developed through a partnership between AAOS and the American Orthopaedic Society for Sports Medicine (AOSSM) and implemented by state orthopaedic societies and AOSSM members. Texas, Idaho, Wisconsin, Massachusetts, Maine, Oklahoma, Kansas and New York are currently working on recognizing visiting sports team physicians.
The Pennsylvania Orthopaedic Society successfully advocated for HB 2241, a bill that ends the harmful healthcare insurer practice of clawing back paid claims. Sponsored by State Representative Karen Boback (R, Luzerne), HB 2241 prohibits insurer retroactive denial of paid claims beyond a 24-month period. The General Assembly’s actions end a ten-year odyssey that pitted the medical community against the healthcare insurance industry. POS led the healthcare provider coalition that forged the compromise contained in HB 2241. The Society is widely recognized in the General Assembly and medical community as the driving force in securing this vital legislation. The activity was funded, in part, by the AAOS’ Health Policy Action Fund.
In 2016, Sociedad Puertorriqueña de Ortopedia y Traumatologia (SPOT), Puerto Rico’s orthopaedic society, faced a major issue when certain Medicare Advantage health insurers in the state stopped covering disposable materials. Health insurers claimed that since the devices were not implantable, the patient or physician must cover the cost. SPOT applied for a grant from the Health Policy Action Fund and hired a lawyer. The Court sided with SPOT. It was decided that the payment for disposables supplied by orthopaedic device companies for the use of implantation of a device during an orthopaedic procedure must be covered by Medicaid Advantage health insurers.
Texas is the first state legislature to pass legislation related to patient-reported outcomes (PROs). SB 55 (Sen. Judith Zaffirini, D-Laredo and Rep. JD Sheffield, DO, R-Gatesville) will direct the Teacher Retirement System of Texas (TRS) and Employees Retirement System of Texas (ERS) to determine whether collecting PROs for musculoskeletal care within the system could enhance the care provided to millions of Texans. SB 55 was signed on June 15th 2017. TOA educated lawmakers on the concept of how PROs may serve as a better judge of quality, as opposed to the current quality measures that measure hard endpoints, such as complications, clinical processes, and costs. PROs have the ability to measure whether a treatment increased mobility and decreased pain, which are the two goals of musculoskeletal care.
Texas Orthopaedic Association (TOA) Leads on Childhood Spinal Screening Standards
Texas lawmakers responded to a 2013 study surrounding bracing for scoliosis. The Legislature passed HB 1076, a bill heavily lobbied for by TOA, physician groups and nursing groups, which will update the state's scoliosis screening standards in schools to match the latest science, which determined that bracing is effective when scoliosis is found early.
With recent proposed classification changes at the US Preventive Services Task Force on scoliosis screening standards, AAOS will be taking lessons learned from TOA and adopting them in a nationwide campaign to require childhood spinal screenings to identify and treat scoliosis early.