December 2021

Ortho News: Medicare Cuts Postponed, Dues 2022 Renewal, Private Equity Webinar & Federal Surprise Billing Action

In this Issue: Medicare Cuts Delayed; COS Dues Renewal for 2022; Webinar Recording on Private Equity; Federal Surprise Billing & More. OrthoNews & Updates December 2021/January 2022 CONGRESS ACTS Mitigates 2022 Medicare Payment Cuts Thanks to extensive national advocacy augmented by the state specialty organizations lobbying their Representatives and Senators in Washington, the U.S. Senate passed legislation on December 9th to halt Medicare physician payment cuts that were scheduled to take effect on Jan. 1, 2022. The Legislation now goes to President Biden's desk for signature.   Highlights of the physician payment provisions legislation include:   • A delay in resuming the 2% Medicare sequester for three months (January 1- March 31, 2022), followed by a reduction to 1% for three months (April 1-June 30, 2022).   • A one-year increase in the Medicare Physician Fee Schedule of 3% (0.75% less than the conversion factor boost provided for 2021).   • A one-year delay in the cuts to the clinical lab fee schedule.   • A one-year delay in the Medicare radiation oncology demonstration.   AAOS Headline News - December 10, 2021 Congress Passes Bill to Mitigate 2022 Medicare Pay Cuts Yesterday evening, Congress passed a bill to avoid several Medicare payment cuts that would otherwise go into effect Jan. 1, 2022. Specifically, the legislation delays the 4 percent PAYGO (Pay As You Go) cut until 2023, delays the 2 percent sequester cut until April 2022 (when it will start at 1 percent before going back up to 2 percent in July), and drops the 3.75 percent Medicare fee schedule cut to 0.75 percent. As a result, in 2022 orthopaedic surgeons will see a 0.75 percent cut from January through March, a 1.75 percent cut from April through June, and a 2.75 percent cut from July through December. AAOS appreciates that Congress once again heeded the pleas of the healthcare community by averting some of the cuts, but will continue to advocate for a long-term solution to Medicare’s broken payment system. More work will need to be done next year to prevent any further reductions. Thanks to all those who took the time to answer the Grassroots Advocacy Alert. COS Sponsored Webinar Is Private Equity Right For You? Webinar Recording & Slide Deck Available If you missed the recent COS sponsored webinar, Is Private Equity Right for You? - Evaluating the Risks and Benefits and presented by Barry B. Cepelewicz, MD, Esq. and Kimberly Kempton-Serra, Esq., Attorneys at Law at Garfunkel Wild, P.C.   A recording of the webinar (use Passcode:$Lf*t52+) and the accompanying slide deck is available as a benefit of membership. We hope you will find the overview of private equity deals, what you need to consider, what questions you should ask, and how you can better assess whether this is a right move for you and your practice presentation helpful.   COS Membership Have You Renewed for 2022? The COS is your strongest ally and the only statewide association committed to effecting positive change for the orthopaedic community and patients while delivering value to members with the low annual membership fee of $295.00.   This past year, COS representatives held virtual meetings, with CT House of Representatives and U.S. Senators on key federal issues impacting medicine and patient care including Prior Authorization Reform, Telehealth Modernization Act and 2022 Medicare Payment Reductions.   Throughout the year, COS and its leadership worked to secure 100% Connecticut orthopaedic surgeon participation in the AAOS OrthoPAC, a vital voice of orthopaedic surgeons in Washington, DC.    COS members lobbied on a state level on important issues impacting the profession and patients included prohibiting drug formulary changes, securing Telehealth provisions enacted during the public health emergency and protecting patients from scope expansions of allied health professionals.    Your Society represented the orthopaedic community and patients during discussions with Anthem on prior authorization difficulties and delays; Worker’s Compensation matters impacting peer review and treatment protocols and initiating discussions with key legislators on Medicaid reform for orthopaedic surgeon reimbursement and access to surgical care for Medicaid patients at ASCs.   We have much more work ahead to be done in the coming year advocating for fair Medicaid reimbursements, ensuring scope expansions equate to training and education, prior authorization reform and collection of high deductibles by insurers, not practices.   Your ongoing participation and 2022 membership in the Society is instrumental to the work of the COS and its Board. Simply go online to pay by credit card or complete the form and mail with your check payment.   RENEW ONLINE   Select MEMBERSHIP RENEWAL to pay securely using your credit card and be sure to check your new “SURGEON PROFILE” to make changes or updates. (Note: Only 2021 paid members have an existing profile.)   Membership in the Society provides orthopaedic surgeons and their staff with: Representation ·      Medicare Carrier Advisory Committee Representation ·      Government Agencies including the Attorney General and Commissioner of Public Health ·      Ambulatory Surgery Tax Relief Coalition ·      Connecticut Worker's Compensation Representation  Advocacy & Lobbying ·      COS lobbyists dedicated to orthopaedic and health care issues ·      Public Hearing testimony at the Capitol ·      Lobbying in DC for Federal healthcare issues ·      100% AAOS PAC Participation – Members & Non-Members       Continuing Medical Education and Training ·      CME accredited Annual Meeting – September 23, 2022 (details to follow). ·      CPT Coding & Revenue Enhancement Workshops for members & staff ·      Resident Engagement including Annual Forum, Paper Presentations, and funding support       Communication, Programs and Services ·      Monthly Enews Alerts to keep you up to date and informed. ·      Orthopaedic Surgeon Directory – All Active Members ·      Discounted Credit Card Processing Fees for your practice ·      Legal Review of Employment Contracts – Special Legal Package & Rate   Call or email COS with any questions at 860-690-1146; email: ctorthoexec@gmail.com COS Supports AAOS Federal Surprise Billing Regulations The COS was pleased to support the AAOS comment letter regarding Requirements Related to Surprise Billing; Part II Interim Final Rule (CMS-9908-IFC), published in the Federal Register on October 7, 2021. AAOS COMMENT LETTER Have you Updated Your Member Profile Online? Visit www.ctortho.org today for timely updates, membership renewal and directory of surgeons* and be sure to update your profile. Any questions, comments, concerns, please contact Susan Schaffman. *Please note that this area of the website is for current members (2021 dues paid) of the Connecticut Orthopaedic Society. Once logged in, members will have the ability to request a password and manage their directory listing on our “Find a Surgeon” page and to renew your membership. If you wish to join/renew, you can do so online and create your profile.

Ortho News: Act to Stop Medicare Reductions, Register for 2021 Annual Meeting & More

OrthoNews & Updates September 2021 Take Action to Stop Proposed 2022 Medicare Cuts Orthopaedic surgeons face significant cuts in Medicare reimbursement beginning in January 2022. It is estimated that the cuts amount to almost 10% reduction. The COS is adding its collective voice to an AAOS comment letter (to be released) to CMS urging reconsideration of the proposed reductions. In addition, members of the COS Board will be meeting with members of Congress later this month to urge the Connecticut Delegation to protect patients access to care and stop the payment cuts to orthopaedic surgeons treating Medicare patients. You can help too! Please take a few minutes to answer the AAOS Call to Action and contact members of Congress. The AAOS Action Advocacy Center makes it easy for you to take action. Simply click on the link and follow the prompts. Thank you. Add your voice to Stop the 2022 Proposed Medicare Cuts.  Don’t Delay, Act Today! Congratulations COS Board Member, Lisa Lattanza, MD 2021 AAOS Diversity Award Recipient COS Board member and Chair of the Department of Orthopaedics & Rehabilitation at Yale, Lisa Lattanza, MD, was the recipient of the 2021 annual Diversity Award from the American Academy of Orthopaedic Surgeons (AAOS) and presented during the Academy’s 2021 Annual Meeting held recently in California.  The Diversity Award recognizes AAOS fellows and emeritus members who have distinguished themselves through their outstanding commitment to making orthopaedics more representative of and accessible to the diverse population it serves. Her commitment to diversity and equity is evident in her work for The Perry Initiative, a STEM non-profit, which she cofounded in 2009. Dr. Lattanza has also served as president in 2017 for the Ruth Jackson Orthopaedic Society and on the steering committee for Movement is Life, a multi-disciplinary coalition seeking to eliminate racial, ethnic, and gender disparities in muscle and joint health. My hope is that inclusivity will become naturally ingrained in the culture of orthopaedic surgery,” Lattanza concluded. The COS and its Board are grateful for her contributions and congratulates Dr. Lattanza on receiving this prestigious award.  2021 Annual Meeting - Your Invited to Attend IMPORTANT NOTICE : YOUR SAFETY IS A PRIORITY The COS will be following State Covid-19 Safety Protocols. In addition, the COS requires all meeting participants wear masks, be fully vaccinated or have a negative Covid PCR test 72 hours prior to the meeting. Please register in advance. Thank you. View Program Agenda Register Online Have you Updated Your Member Profile Online? Visit www.ctortho.org today for timely updates, membership renewal and directory of surgeons* and be sure to update your profile. Any questions, comments, concerns, please contact Susan Schaffman. *Please note that this area of the website is for current members (2021 dues paid) of the Connecticut Orthopaedic Society. Once logged in, members will have the ability to request a password and manage their directory listing on our “Find a Surgeon” page and to renew your membership. If you wish to join/renew, you can do so online and create your profile.

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Ortho News: Medicare Proposed 2022 Fee Schedule, CT License Renewal, 2021 Annual Meeting & More

OrthoNews & Updates August 2021 Medicare Proposes Decrease in 2022 Payment Rates and Other Changes 2022 Proposed Fee Schedule The Centers for Medicare and Medicaid Services Proposes Decreases to Payment Rates in 2022 In mid-July, CMS issued the proposed 2022 Physician Fee Schedule and other changes to Medicare Part B effective January 1, 2022. Comments regarding the proposed changes will be accepted until September 13, 2021.   CMS is proposing several changes including a significant cut the Medicare conversion factor in 2022 by 3.75%, from a $34.89 to $33.58. This year’s cut is reinstating the cut that Congress prevented last year with the Consolidated Appropriations Act. It is estimated that the overall reduction will be a decrease of 2.7% when considering changes to the RVUs and the loss of last year's Congressional intervention.  Other payment changes proposed would authorize Medicare to make direct payments to Physician Assistants for professional services they provide under Medicare Part B and refine the current policy of split (or shared) E/M service reimbursement. In addition to the cuts, CMS is proposing several other changes impacting orthopaedic surgeons. These include: ·     Telehealth Extensions Added Services for telehealth following the end of the PHE including specific codes related to Office/Outpatient Services and telephone E/M. ·      Health Policy Updates Delay of AUC for Advanced Diagnostic Imaging. ·      Quality Payment Programs Changes proposed impact MIPS, Value Pathways and Advanced Payment Models. The AAOS along with many other national specialty societies will be advocating on behalf of physicians and their patients; calling on Congress to prevent the proposed payment cuts and amending other proposed changes.  The COS will be working to support CT's orthopaedic community. For a detailed look at the impact the proposed changes and cuts will have on orthopaedic surgeons, please review the information from the AAOS - CY 2022 Medicare Physician Fee Schedule Proposed Rule: What Physicians Need to Know. Formal comments are currently being accepted. To submit your comments by September 13, 2021, please use this link. Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems   For a detailed review of the proposed rule and potential impact on orthopaedic surgeons, please review the information from the AAOS - Hospital Outpatient Prospective Payment and ASC Payment Systems Proposed Rule: What Physicians Need to Know. Please share your comments with the AAOS or email the COS with your feedback concerning the affects the elimination or scale back of the IPO list will have on patients, quality of care and physician incentive or any other concerns you have specific to this proposed rule. Thank you.  The rule will be published on August 4th. To view the unpublished proposed rule click here. CT License Renewal Information Executive Orders issued by Governor Lamont during the pandemic public health and civil preparedness emergency exempted licensure renewals and CME requirements. If you opted not to renew during this time, you may now need to renew and comply with CME requirements (if applicable as outlined below). Renewal notices to physicians are sent by the DPH via EMAIL ONLY. If you have questions regarding the current status of your renewal and requirements, please email DPH, oplc.dph@ct.gov or phone: (860) 509-7603.   CME Requirements for Licensure Renewal A licensed physician applying for renewal shall earn a minimum of fifty contact hours of qualifying continuing medical education within the preceding twenty-four month period. One contact hour means a minimum of fifty minutes of continuing education activity.   Continuing medical education shall be in an area of the physician’s practice, reflect the professional needs of the licensee in order to meet the health care needs of the public and during the first renewal period in which continuing medical education is required and not less than once every six years thereafter, include at least one contact hour of training or education in each of the following topics: Infectious Diseases Risk Management Behavioral Health Sexual Assault Domestic Violence Cultural Competency   Suggested Sources for CME AAOS https://www.aaos.org/education/maintenance-of-certification/cme-resources/ AMA Ed Hub https://edhub.ama-assn.org/ Hospitals National Orthopaedic Specialty Organizations   For detailed information including exemptions, waivers, documentation, and reinstatement visit the DPH website. Register to Attend COS 2021 Annual Meeting  Friday - October 29, 2021 8 a.m. - 2 p.m.   *NEW LOCATION * NEW LOCATION* DoubleTree by Hilton, Bristol, CT *Advance Registration is Required. Please register online. The Society is looking forward to hosting the 2021 Annual Meeting (LIVE EVENT) on October 29th from 8 a.m. to 2 p.m. Thanks to the leadership and dedication of COS Program Director, Dr. Michael Kaplan, plans are underway for another great CME accredited Annual Meeting program. Click here for the updated agenda. As a benefit of membership, all 2021 MD and Affiliate Members attend at no charge. Simply reply to this email with your name and practice name to register.  If you have not yet renewed for 2021, please visit the COS website at www.ctortho.org for easy online payment and to update your new directory profile.   Thank you for your ongoing support and membership participation in the Society. Hope to see you in the Fall where we can gather and learn together again.  COS Foundation Thank you for Your Contribution The COS would like to extend a warm thank you to those who donated to the COS Foundation through the 2021 Birdies for Charities program. This year, the Foundation received $11,500.00, in contributions from COS members and will receive an additional 15% from the Birdies for Charities program. Thank you for your contribution to the 2021 Birdies for Charities Program benefitting the COS Foundation. Your support is greatly appreciated and will allow the Foundation to continue to support orthopaedic residents and Connecticut's orthopaedic residency programs. 2021 Contributors Michael Aronow, MD Connecticut Orthopaedic Society Gary Friedlaender, MD F. Scott Gray, MD Robert Green, MD Mariam Hakim-Zargar, MD Tarik Kardestuncer, MD Scott Mallozzi, MD Augustus Mazzocca, MD Issac Moss, MD Update Your Surgeon Profile Online Visit www.ctortho.org today for timely updates, membership renewal and directory of surgeons* and be sure to update your profile. Any questions, comments, concerns, please contact Susan Schaffman. *Please note that this area of the website is for current members (2021 dues paid) of the Connecticut Orthopaedic Society. Once logged in, members will have the ability to request a password and manage their directory listing on our “Find a Surgeon” page and to renew your membership. If you wish to join/renew, you can do so online and create your profile.

Ortho News: CT Legislative Final Session Report & COS 2021 Annual Meeting

OrthoNews & Updates June/July 2021 2021 CT Legislative Summary Telehealth, ASC Tax and More On June 9th, the regular session of the State Legislature ended a busy session, with a special session called in mid-June for the budget and recreational marijuana.   Despite the challenges of a closed Legislative Office Building, the Legislature conducted virtual public hearings on hundreds of bills. The COS submitted and presented testimony on more than a dozen bills directly impacting the orthopaedic community, the practice of medicine and patients. In addition, COS Officers, Lobbyists and Executive Director met remotely with key legislative leaders to discuss several of the proposed bills and their impact on medicine.    The Society is grateful to all the members that answered the call to action related to tax relief for ASCs. Thank you for making the time to advocate for your colleagues and patients.   Listed below are key bills COS worked on this session including ASC tax relief, drug formulary changes and telehealth provisions. In addition, legislators passed, and the Governor signed bills to legalize the recreational use of marijuana and remove the religious exemption for vaccines.  For additional details, please view the Executive Summary as prepared by COS lobbyist, Ross Gionfriddo, FOCUS. Please contact COS if you have any questions.   Bills passed and signed by the Governor:   ·      HB 5596, An Act Concerning Telehealth – COS testified in support of extending telehealth provisions initiated by the State of Emergency Executive Order until June 2023.   Bills passed both chambers, awaiting Governor’s signature:   ·      SB 1202 (ASC Related), An Act Concerning Provisions Related to Revenue and Other Items To Implement The State Budget For The Biennium Ending June 30, 2023 – The bill includes a changing to a facility fee tax from a gross receipts tax and reduces the ASC tax from 6% to 3%, effective in 2023. The COS testified in support of a bill that would have provided extensive tax relief for ASCs however the proposed bill was cited by both the Office of Policy Management and the Governor’s Office as having the potential to negatively impact federal Medicaid reimbursement funds. Despite extensive lobbying by COS lobbyists, FOCUS, the extended tax relief was not proposed in the implementer bill.   This 837-page bill also includes parity for podiatry services within the Medicaid system and contracting with carriers.   ·      HB 6622, An Act Concerning Prescription Drug Formularies and Lists of Covered Drugs – COS testified in support of prohibiting most changes to drug formularies during coverage period.   ·      SB 1070, An Act Allowing Advanced Practice Registered Nurses and Physician Assistants to Issue Home Health Orders (this is the vehicle for the physician assistant bill) – COS testified and requested amendments to the bill to clarify and ensure compliance to CT scope of practice statutes for both APRNs and Physicians Assistants.    Bills that did not pass this session:   ·      SB 1045, An Act Concerning Step Therapy, Adverse Determination and Utilization Reviews, And Health Insurance Coverage for Children, Stepchildren And Other Dependent Children – COS testified in support of favorable Utilization Review procedures and policies for physicians.   ·      SB 238, An Act Increasing Oversight of Mergers and Acquisitions Of Group Practices – COS testified in opposition to expanding government oversight of independent practice. Please Join Us COS 2021 Annual Meeting  Friday - October 29, 2021   *NEW LOCATION * NEW LOCATION* DoubleTree by Hilton, Bristol, CT The Society is looking forward to hosting the 2021 Annual Meeting (LIVE EVENT) on October 29th from 8 a.m. to 2 p.m. Due to the sale and closure of the Marriott in Farmington, the COS has moved the meeting location of the 2021 Annual Meeting on October 29th from 8 a.m. to 2 p.m., to the DoubleTree by Hilton, 42 Century Drive in Bristol, CT.   Thanks to the leadership and dedication of COS Program Director, Dr. Michael Kaplan, plans are underway for another great CME accredited Annual Meeting program. Click here for the tentative meeting agenda (subject to change).   As a benefit of membership, all 2021 MD and Affiliate Members attend at no charge. Simply reply to this email with your name and practice name to RSVP. If you have not yet renewed for 2021, please visit the COS website at www.ctortho.org for easy online payment and to update your new directory profile.   Thank you for your ongoing support and membership participation in the Society. Hope to see you in the Fall where we can gather and learn together again, better, and stronger.  COS Seeks to Resolve AIM and Anthem Issues Extensive Prior Auth Wait Times, Peer to Peer Issues and more with AIM As the COS continues to work to resolve the AIM/Anthem hassles and administrative burdens offices are experiencing (which are clearly the issues at hand), it is important to share your practice’s issues if you haven’t already. For Case Specific Prior Authorization &/or Peer-to-Peer Matters: Please send to AIM representative, Laurie Seaman via email SeamanL@aimspecialtyhealth.com. Please email Laurie Seaman the patient’s name, ID and DOB along with your name, Anthem number and an outline of the issue.     For Hold Time Issues: Please email the COS (ctorthoexec@gmail.com) the physician’s name and their Anthem number along with an outline of the hold time complaints including; What the contact to AIM was for (authorization, peer to peer, etc.) How long of a hold time your practice experienced How long it took from submission to decision How long to obtain a peer to peer (if applicable)  Important: DO NOT INCLUDE ANY PATIENT IDENTIFIERS OR INFORMATION TO THE COS. Update Your Surgeon Profile Online Visit www.ctortho.org today for timely updates, membership renewal and directory of surgeons* and be sure to update your profile. Any questions, comments, concerns, please contact Susan Schaffman. *Please note that this area of the website is for current members (2021 dues paid) of the Connecticut Orthopaedic Society. Once logged in, members will have the ability to request a password and manage their directory listing on our “Find a Surgeon” page and to renew your membership. If you wish to join/renew, you can do so online and create your profile.

Ortho News: Impt. Legislative News - ASC Bill Support, Telehealth Passes, & More

OrthoNews & Updates May 2021 CALL TO ACTION Keep ASC Tax Relief in HB 6443 Your voice matters. Please contact legislators TODAY!  The COS continues to support the efforts of the CT Ambulatory Surgery Centers Association in support of tax relief for Connecticut’s ASCs (see below). The Society urges its members to answer the call to action (see below). Thank you. The Finance, Revenue & Bonding Committee included ASC tax relief both in the tax package (HB 6443) and in SB 1107.  The bills provide relief by expanding the exemption to $1.5m, continuing the Medicaid and Medicare exemptions, limiting the tax to ASC services (exempting implants, tissue and other biologics) while changing the tax to a 6.35% sales tax, creating a new 50% credit for Medicaid revenue and a 25% credit for state employee revenue, as well as adding a new Covid expense exemption for the current tax year. We need to contact members of the House and Senate to urge leadership to keep the ASC tax relief provisions in HB 6443 during budget negotiations with the administration. Please click here to send a quick email today! Thank you. Donate to the CT Orthopaedic Society Foundation Traveler's Championship's Birdies for Charity Gives 15% of each Donation Received! The CT Orthopaedic Society Foundation, Inc. is excited to announce our fundraising partnership with the 2021 Travelers Championship Birdies for Charity program. With your help the Foundation will also receive additional Birdies for Charity funds through the Bonus Bucks sponsored by Webster Bank.   Your donation will help the Foundation continue its support of Connecticut’s two orthopaedic residency programs and assist other non-profit organizations. Since 2003, $180,000.00 has been donated to Yale and UConn to support the residency education and training. Simply click on the direct donation link below to make your tax-deductible donation. Thank you! Your Donation + 15% Bonus=MORE funding for Contributions Donate! NEW LOCATION * NEW LOCATION* COS 2021 Annual Meeting  Friday - October 29, 2021   DoubleTree by Hilton, Bristol, CT The Society is looking forward to hosting the 2021 Annual Meeting (LIVE EVENT) on October 29th from 8 a.m. to 2 p.m. Due to the recent sale and imminent closure of the Marriott in Farmington, the COS needed to locate a new venue and will be moving the location of the 2021 Annual Meeting on October 29th from 8 a.m. to 2 p.m., to the DoubleTree by Hilton, 42 Century Drive in Bristol, CT.   Thanks to the leadership and dedication of COS Program Director, Dr. Michael Kaplan, plans are underway for another great CME accredited Annual Meeting program. Click here for the tentative meeting agenda (subject to change).   As a benefit of membership, all 2021 MD and Affiliate Members attend at no charge. Simply reply to this email with your name and practice name to RSVP. If you have not yet renewed for 2021, please visit the COS website at www.ctortho.org for easy online payment and to update your new directory profile.   Thank you for your ongoing support and membership participation in the Society. Hope to see you in the Fall where we can gather and learn together again, better, and stronger.  2021 CT Legislative News With the close of the 2021 legislative session just a few weeks away, the COS and its lobbyists are working hard to get meaningful ASC Tax relief passed (Refer to Call to Action; top of page). In addition, the extension of telehealth provisions initiated by Executive Order will continue until June 2023 with the passage of HB 5596, which was signed into law by Governor Lamont. Other important bills remain active including:   Governor’s Budget/ASC Tax Change The Governor proposed to eliminate the $1 million dollar exemption for ASCs.  COS Strongly Opposes.   Drug Formularies Prohibit Changes During Coverage Period. An amendment was filed that would require the Insurance committee to approve the rest of the frozen formulary provisions, which they could do as early as the 2022 session. While the amendment may delay the possibility of frozen formularies, the COS continues to support the concept of this bill.   Utilization Review and Adverse Determinations - Modification to the UR and AD processes. COS supports. Scope of Practice –Physician Assistants - Proposed over 75 statute revisions to add physician assistants alongside Medical Doctors and APRNs. An additional amendment is possible that would allow Physician Assistants and APRNs to issue home health care orders, including Physician Assistants and APRNs licensed in other states. COS opposes. Look for the 2021 Legislative Session Summary in the June issue. COS Seeks to Resolve AIM and Anthem Issues Extensive Prior Auth Wait Times, Peer to Peer Issues and more with AIM Late last month, members and their staff joined a virtual presentation by AIM and Anthem for an informational session to review AIM and its portal and discuss the ongoing issues many practices are experiencing with long wait times for prior authorization and peer to peer reviews. In response to several questions regarding peer to peer review, AIM provided a Peer to Peer Quick Connection Option sheet designed to improve the Peer to Peer scheduling or consult with an actual MD (scroll to end of article). A copy of the slide deck from the webinar presentation is available here. As the COS continues to work to resolve the AIM/Anthem hassles and administrative burdens offices are experiencing (which are clearly the issues at hand), it is important to share your practice’s issues if you haven’t already. For Case Specific Prior Authorization &/or Peer-to-Peer Matters: Please send to AIM representative, Laurie Seaman via email SeamanL@aimspecialtyhealth.com. Please email Laurie Seaman the patient’s name, ID and DOB along with your name, Anthem number and an outline of the issue.     For Hold Time Issues: Please email the COS (ctorthoexec@gmail.com) the physician’s name and their Anthem number along with an outline of the hold time complaints including; What the contact to AIM was for (authorization, peer to peer, etc.) How long of a hold time your practice experienced How long it took from submission to decision How long to obtain a peer to peer (if applicable)  Important: DO NOT INCLUDE ANY PATIENT IDENTIFIERS OR INFORMATION TO THE COS. Update Your Surgeon Profile Online Visit www.ctortho.org today for timely updates, membership renewal and directory of surgeons* and be sure to update your profile. Any questions, comments, concerns, please contact Susan Schaffman. *Please note that this area of the website is for current members (2021 dues paid) of the Connecticut Orthopaedic Society. Once logged in, members will have the ability to request a password and manage their directory listing on our “Find a Surgeon” page and to renew your membership. If you wish to join/renew, you can do so online and create your profile.

Ortho News: Impt. Legislative News, AIM Issue, Support AAOS - Surprise Billing Policy, 2021 Meeting, Renew Dues

OrthoNews & Updates April 2021 COS 2021 Annual Meeting  Friday - October 29, 2021   In an effort to conduct the Society’s 2021 Annual Meeting in person and within a safe environment while allowing time for the COVID-19 vaccination distribution to reach a wider population, the COS Board has decided to move the meeting date to Friday, October 29, 2021 from 8 a.m. to 2 p.m. The meeting will be held at the Farmington Marriott.   Thanks to the leadership and dedication of COS Program Director, Dr. Michael Kaplan, plans are underway for another great CME accredited Annual Meeting program. Details and meeting agenda will be forwarded to the membership as they become available. Remember, all current COS dues paying members (for 2021) attend at no additional cost. If you have not yet renewed for 2021, please visit the COS website for easy online payment and to update your new directory profile.   The Society is looking forward to offering members an opportunity to gather and learn together again, better, and stronger. Look forward to seeing you in the Fall. Thank you for your ongoing support and membership participation in the Society. 2021 CT Legislative News The COS and its representatives have been providing testimony on a number of bills that have been heard by various legislative committees. Due to the ongoing closure of the Legislative Office Building due to the pandemice, the hearings have been held via Zoom to provide the public with the opportunity to testify before the legislators.   Since the last article in the February/March Enews issue, the Society has submitted written testimony on the following bills and also presented during the public hearings on several of the bills. To obtain the COS testimony on the bills, simply click on the underlined subject matter. If you have any questions or concerns, please contact the COS or phone 860-690-1146. While most of the Committee’s hearings and deadlines are this month, there is still much more work and advocacy the COS will need to do. We need the collective voice of Connecticut's orthopaedic community to help deliver strong messages to the Legislature. Please answer the call to action and add your voice to debate.   Governor’s Budget/ASC Tax Change – The Governor proposed to eliminate the $1 million dollar exemption for ASCs.  COS Strongly Opposed.   Prior Authorization and Provider Contracts – Numerous changes to prior authorization and notifications for provider contracts.  COS Supported.   Telehealth - Reimbursement Parity and Audio Coverage. COS Supported.   Drug Formularies – Prohibit Changes During Coverage Period. COS Supported.   Utilization Review and Adverse Determinations – Modification to the UR and AD processes. COS supported.   High Deductible Health Plans (HDHPs)– While this bill focused solely on changing HD to a calendar year, the COS provided additional language and requested an amendment to the bill to require out of pocket HD collection by insurance companies, not physicians.  COS Requested additional language and amendments be including to attempt to address the issues with HDHPs and collection by physician offices. Scope of Practice –Physician Assistants - Proposed over 75 statute revisions to add and include physician assistants alongside Medical Doctors and APRNs. COS opposed. Allowing Physician Assistants & APRNs to Sign off on Home Orders- This bill expanded access to writing orders by physician assistants and did not provide any safety net for patients for those APRNs that are not in independent practice. In addition, the allowance of out of state practitioner's to write orders who may have different scopes as licensed by the state they practice was also opposed by the COS.   Government Oversight and Reporting Requirments for Group Practices- Proposed a change in group definition from 30 to 2; requiring reporting to Attorney General and OHS. COS opposed. Immunity for Businesses Sued for Covid 19 Exposure – Provide protection to businesses to prevent lawsuits by consumers contracting Covid 19. COS supported.   The COS advocates for meaningful legislative change to benefit patients and the practice of orthopaedic surgery.   COS Working on AIM and Anthem Issues Extensive Prior Auth Wait Times, Peer to Peer Issues and more with AIM The Connecticut Orthopaedic Society Board representatives held a recent meeting with AIM and Anthem representatives to discuss the ongoing, unacceptable prior authorization wait times, peer to peer issues and inadequate communication regarding prior authorizations, denials and peer to peer meetings. Society representatives provided the Anthem and AIM representatives with a variety of case scenarios including excessive wait times, unacceptable timeframe for urgent care authorization and more. While initially Anthem indicated that there was a technological issue that created long delays, the other issues point to a much more serious issue(s). Many of you had previously submitted data and patient cases to the COS and as we continue to work on this matter, we are asking that you please submit any updates to wait times and additional case information pertaining to AIM if applicable. Please feel free to email COS with your practice name and the information. Additional data will assist us in our ongoing discussions to reach a resolution to this current situation. Thank you. COS Supports AAOS Outreach No Surprises Act of 2020 The COS was pleased to support the AAOS letter to HHS and CMS outlining concerns and providing comments to both agencies regarding the upcoming rulemaking on the No Surprises Act of 2020 passed by Congress.   The AAOS letter emphasized the importance of retaining a balance billing option for physicians; supporting the use of a an in-network median rate for all local health plans; the mechanics of the arbitration process and implications for state surprise billing laws. The COS will share AAOS updates on this matter as they continue to monitor the rulemaking process in Washington. Update Your Surgeon Profile Online Visit www.ctortho.org today for timely updates, membership renewal and directory of surgeons* and be sure to update your profile. Any questions, comments, concerns, please contact Susan Schaffman. *Please note that this area of the website is for current members (2021 dues paid) of the Connecticut Orthopaedic Society. Once logged in, members will have the ability to request a password and manage their directory listing on our “Find a Surgeon” page and to renew your membership. If you wish to join/renew, you can do so online and create your profile. Renew Your 2021 COS Membership Your participation and renewal is vital to the work of the COS; supporting the profession, the practice and patients. While this has been a challenging time for our profession and critical time for the health of our State, the Connecticut Orthopaedic Society continues to advocate, inform, and support the orthopaedic community. The COS is your strongest ally and the only statewide association committed to effecting positive change for the orthopaedic community and patients while delivering value to members with the low annual membership fee of $295.00. Your ongoing involvement and dues renewal for 2021 is critical to the Society and vital to the advocacy, programs and representation by COS for the entire orthopaedic community – private practice, hospital and academic employed.  Now more than ever, your membership support is needed.  The Society looks forward to serving, representing, and assisting the orthopaedic community and patients in 2021. Be sure to save the date for the 2021 COS Annual Meeting, scheduled for October 29, 2021, in Farmington, CT, when we plan to gather together again for another great program developed by Michael Kaplan, MD, Meeting Program Director. Please Renew Your COS Membership for 2021. Three Easy Ways to Pay.   Pay online and update your new directory profile.                                                                    Credit Card Online www.ctortho.org Complete the form and enclose it with a check payable to the CT Orthopaedic Society.                                                           Arrange for convenient group billing, please call the COS at 860-690-1146, or email your request to ctorthoexec@gmail.com.

Ortho News: Legislative News, BCBS/Anthem Prior Authorization, 2021 Meeting, Renew Dues

OrthoNews & Updates February/March 2021 2021 CT Legislative News COS Advocating for Orthopaedic Surgeons & Patients The 2021 session of the CT Legislature is well underway with bills introduced, Committee meetings and public hearings in full swing. Despite the continued closure of the Legislative Office Building, COS and their lobbyists from Focus Government Affairs, have been meeting with legislators and Committees and providing testimony during public hearings via Zoom and other remote communication.   Last month, the COS submitted written testimony to the Human Services Committee requesting amendments to the language to clarify that while authorizing physician assistants and advanced practice registered nurses to issue order for home health services, they must still practice within and according to their respective scope of practices. READ TESTIMONY OF MICHAEL ARONOW, MD, COS PRESIDENT   The COS was also represented during the Insurance Committee’s public hearing and presented testimony opposing reimbursement parity for podiatrists. This bill would have mandated that commercial insurers reimburse podiatrists at the same rate as physicians, a claim that had no data to support they were not being paid at the same rate. During the public testimony the podiatrists were focused more on expanded their scope than the actual bill language. The COS opposed this bill noting this was a contractual matter and not a legislative matter. READ TESTIMONY OF MICHAEL ARONOW, MD, COS PRESIDENT   The proactive, patient centered advocacy we will be working toward this legislative session includes reforms to the High Deductible Health Plans to ensure that the collection of payment is done by the insurer and does not interfere with Physician Patient Relationship, prohibiting drug formulary changes mid policy contract, telehealth reimbursement parity, prior authorization reforms, all scope expansion and much more. In addition, we will seek to collaborate and augment the legislative work of our State and Specialty organizations.   The COS advocates for meaningful legislative change to benefit patients and the practice of orthopaedic surgery.     Our actions are expertly guided by COS lobbyists, however we need the collective voice of Connecticut's orthopaedic community to help deliver strong messages to the Legislature. Throughout the session, we will be reaching out to the membership with grassroots alerts. Please answer the call to action and add your voice to debate. Thank you for your continued involvement and support of the Society, your colleagues and patients. COS and Anthem Issue Anthem - Extensive Prior Auth Wait Times & Issues with AIM The Connecticut Orthopaedic Society has been working to address the concerns of its members and their practice staff regarding the recent dramatic increases in prior authorization wait times with Anthem.   Society representatives provided Anthem with specific data from their members related to the significant and unacceptable wait times to obtain procedural prior authorizations and online prior authorizations through AIM.   Anthem has indicated that there was a technological issue that created the long delays and wait times and they had resolved the issue and expected prior authorization and AIM processing to return to normal wait times.    After several weeks from the initial discussion with Anthem representatives, wait times continue to be unacceptable, Peer to Peer reviews are difficult to obtain and some are reporting another issue with AIM deny authorization of certain codes that according to Anthem are approved per the physician contract with Anthem.   As your Society continues to work on this matter, we would appreciate any data you may have specific to your practice and wait times with Anthem including AIM. Please feel free to email COS with your practice name and the information. Additional data will assist us in future discussion with Anthem Announcing the COS 2021 Annual Meeting  Friday - October 29, 2021   In an effort to conduct the Society’s 2021 Annual Meeting in person and within a safer environment while allowing time for the COVID-19 vaccination distribution to reach a wider population, the COS Board has decided to move the meeting date to Friday, October 29, 2021 from 8 a.m. to 2 p.m. The meeting will be held at the Farmington Marriott.   Thanks to the leadership and dedication of COS Program Director, Dr. Michael Kaplan, plans are underway for another great CME accredited Annual Meeting program. Details and meeting agenda will be forwarded to the membership as they become available. Remember, all current COS dues paying members (for 2021) attend at no additional cost. If you have not yet renewed for 2021, please visit the COS website for easy online payment and to update your new directory profile.   The Society is looking forward to offering members an opportunity to gather and learn together again, better, and stronger. Look forward to seeing you in the Fall. Thank you for your ongoing support and membership participation in the Society. Renew Your 2021 COS Membership Your participation and renewal is vital to the work of the COS; supporting the profession, the practice and patients. While this has been a challenging time for our profession and critical time for the health of our State, the Connecticut Orthopaedic Society continues to advocate, inform, and support the orthopaedic community. The COS is your strongest ally and the only statewide association committed to effecting positive change for the orthopaedic community and patients while delivering value to members with the low annual membership fee of $295.00. We have much more work ahead to be done. Your ongoing involvement and dues renewal for 2021 is critical to the Society and vital to the advocacy, programs and representation by COS for the entire orthopaedic community – private practice, hospital and academic employed.  Now more than ever, your membership support is needed.  The Society looks forward to serving, representing, and assisting the orthopaedic community and patients in 2021. Be sure to save the date for the 2021 COS Annual Meeting, scheduled for October 29, 2021, in Farmington, CT, when we plan to gather together again for another great program developed by Michael Kaplan, MD, Meeting Program Director. Please Renew Your COS Membership for 2021. Three Easy Ways to Pay.   Pay online and update your new directory profile.                                                                    Credit Card Online www.ctortho.org Complete the form and enclose it with a check payable to the CT Orthopaedic Society.                                                           Arrange for convenient group billing, please call the COS at 860-690-1146, or email your request to ctorthoexec@gmail.com.  Visit the New COS Website Update Your "Find a Surgeon" Profile The COS is pleased to launch the newly revised COS website. Visit www.ctortho.org today for timely updates, membership renewal and directory of surgeons* and be sure to update your profile. Any questions, comments, concerns, please contact Susan Schaffman. *Please note that this area of the website is for current members (2020 dues paid) of the Connecticut Orthopaedic Society. Once logged in, members will have the ability to request a password and manage their directory listing on our “Find a Surgeon” page and to renew your membership. If you wish to join/renew, you can do so online and create your profile.