AAOS wants CMS to reform physician pay, emphasize value-based care


The American Association of Orthopaedic Surgeons has issued formal comments to CMS on its proposed payment policy changes for 2023.

AAOS urged the agency to address rising healthcare costs, increase access to care and reduce the burdens on physicians who continue to deal with financial and practice management challenges exacerbated by the COVID-19 pandemic.

The society is concerned about continued cuts to physician reimbursement in the Medicare physician fee schedule, which includes a 4.42 percent cut to the conversion factor, while the cost of running a practice continues to rise. 

"With inflation soaring to 40-year highs this year, ongoing and scheduled statutory payment cuts and many physician practices still dealing with pandemic-related financial and staffing issues, the current proposal from CMS undermines the long-term sustainability of physician practices while threatening patient access to physicians participating in Medicare," AAOS President Felix "Buddy" Savoie III, MD, wrote in a Sept. 2 letter to CMS Administrator Chiquita Brooks-LaSure.

AAOS asked CMS to reform the physician reimbursement system and create value-based payment models that include incentives tailored to the specific needs of specialty physicians. It also wants CMS to apply the RVS Update Committee's recommended changes to the evaluation and management component of surgical global codes to maintain the relativity of the physician fee schedule.

"The statutory prohibition on paying physicians differently for the same work applies regardless of code valuation method and the incremental increases should apply to all physicians," Dr. Savoie said.

AAOS' comments address the "dangerous precedent" of increasing prior authorization in the hospital outpatient setting and how it affects patient care. Requiring approval from a third-party which is removed from clinical decision-making "erodes the doctor-patient relationship, and the ability to make decisions that are in the best interest of the patient," according to Dr. Savoie, who requested that the proposal be formally removed from the 2023 Hospital Outpatient Prospective Payment System and ASC final rule.

The society is also advocating for the removal of CPT code 22632 (arthrodesis) from the inpatient-only list because it believes there is sufficient evidence to prove the procedure can be performed safely in the outpatient setting. 

"Surgeons should decide on the actual setting of surgery and there should not be any mandates and preauthorizations necessary to determine inpatient versus outpatient surgery even if a procedure moves out of the IPO list," Dr. Savoie wrote.

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