2019 AAOS Annual Conference and Advisor's Circle Meeting Update

Posted on Friday, March 29, 2019 in Blog

2019 AAOS Annual Meeting and Advisor’s Circle Update

The largest gathering of orthopedic surgeons occurred earlier this month at The American Academy of Orthopedic Surgeons (AAOS) annual meeting.  Dr. John Powell, Orthopedic Surgeon at Signature Medical Group in St. Louis, MO, and I attended the Advisor’s Circle Orthopedic Political Action Committee (AC PAC) meeting held at the conference. Signature joined the Advisor’s Circle in August 2017, a newly formed PAC for AAOS member orthopedic physician group practices (PGPs), to help our advocacy efforts related to physician group participation in advanced payment models (APMs), like BPCI.

Signature’s work and the efforts of the AAOS’ AC PAC staff were instrumental in the successful change of key aspects of the BPCI-Advanced Participation Agreement that favorably impacted orthopedic physicians, specifically the elimination of the financial cap placed on participating physician groups. We want to share the agenda of the AC PAC meeting and 2019 initiatives.

The purpose of the AC PAC is to leverage the expertise of each member group to advance issues of interest and priority for PGPs within the larger framework of AAOS’s Orthopaedic PAC, which raises political contributions from all individual member physicians, i.e., orthopaedic physicians associated with PGPs, as well as hospitals and academic medical centers, and sets the broader advocacy agenda for all of AAOS physician membership. Contributing at the highest level to the AC PAC, which Signature does, gives us tremendous access to AAOS staff to assist with our lobbying efforts in Congress and our policy and regulatory advocacy among federal agencies. Several orthopaedic specialty associations have also joined the PAC in an advisory capacity.

A primary objective for Signature in the AC meeting was to promote the need to obtain funding for a peer-reviewed research study that demonstrates the effectiveness of physician-led APMs and bundled payments. This research is essential because the majority of BPCI analysis has largely ignored physician-led impact and focused on hospital performance. A recent study on BPCI hip replacements, though limited in scope, employed a methodology that compared physician led to hospital-led elective hips and also compared results with non-BPCI participants.

The results of the BPCI hip study led researchers to the important conclusion that physicians are more likely to achieve greater cost savings in APMs than hospitals. This finding is very important when we argue for legislative and regulatory policies that promote physician leadership in APMs through various mechanisms, such as model precedence.

Although many organizations are ready to take full risk in value-based contracts, a convener partner can ease the transition of government downside risk contracts by taking on some or all of the risk to better prepare physician group practices, both clinically and financially. However, it appears CMS wants to diminish the role of conveners in APMs in order to increase the risk share for physicians. A research study may support the value conveners bring to these models by examining the relative performance differences for both PGPs and hospitals aligned and those not aligned with a convening entity. Feedback from the AC group was very positive. AAOS staff is engaging AAOS researchers to determine what data they can obtain from CMS and will then review foundation opportunities to pursue a grant to fund the research.

Other discussion items included the need to prepare a strategy to support Medicare’s eventual move to allow outpatient TKAs in ASCs, advancing a demonstration model with CMS that will allow physician-owned hospitals to expand, and several legislative and regulatory initiatives to reform Stark and Anti-Kickback laws and evidence-based strategies around opiate use.

During the open discussion and reports from AAOS staff, Signature was recognized several times for work that was instrumental in getting key aspects of the Advanced participation agreement changed favorably for PGP participants. These efforts included the successful policy change of eliminating the financial cap placed on PGPs in BCPI-Advanced. This recognition included participation in meetings with Congressional staff, contributions to AAOS correspondence, position papers to CMS and CMMI, and our jointed efforts at meetings with CMMI on Classic and Advanced issues.

We look forward to our continued progress and appreciate the feedback and support from our orthopedic community.


Joel James

Director of Public and Government Affairs

Signature Medical Group

jjames@signaturehealth.net | 314-662-3163