Trending Topics in Advocacy
Legislative, political, and health policy activity directly affects our practices and our patients. Read below to stay up-to-date on the current issues affecting our specialty.
AAO-HNS Comments on U.S. Preventive Services Task Force Draft OSA Plan
On January 20 the AAO-HNS submitted comprehensive comments to the U.S. Preventive Services Task Force (USPSTF) on its Draft Research Plan for Obstructive Sleep Apnea in Adults: Screening. Integrating input from the Sleep Disorders Committee and other Academy sleep surgery experts, our comments opposed the exclusion of upper airway surgery from the list of validated interventions for treatment of OSA. The Academy strongly urged the USPSTF to instead include well-proven surgical procedures in both the “treatment” and “outcomes” sections of the proposed Research Plan.
AAO-HNS Urges VA to Protect Health of Veterans
On January 11, the AAO-HNS submitted comments in opposition to the Department of Veterans Affairs’ Interim Final Rule, entitled “Authority of VA Professionals to Practice Health Care.” The rule permits virtually all Veterans Health Administration-employed non-physician providers (NPPs) to practice without the clinical supervision of physicians. The Academy’s comments, which encourage the VA not to weaken current standards of care for veterans, highlight the differences in education and training that exist between non-physician providers and physicians, national standards versus state licensing, and the importance of adequate oversight.
AAO-HNS Comments on Proposed AASM Obstructive Sleep Apnea Guideline
On December 3 the AAO-HNS submitted comments to the American Academy of Sleep Medicine (AASM) regarding their draft Clinical Practice Guideline (CPG), “Referral of Adult with Obstructive Sleep Apnea for Surgical Consultation”. The comments on the proposed CPG were developed in conjunction with the Academy’s Sleep Disorders Committee, Guidelines Task Force, Physician Payment Policy workgroup, and other sleep surgery experts within the specialty.
Congress Approves 5th COVID Relief Package
Late evening on December 21 Congress passed the Consolidated Appropriations Act, 2021, a $900 billion COVID-19 relief package and $1.4 trillion omnibus spending bill. The package provided economic relief through additional funding for a wide constituency. Specifically, the bill included a new round of stimulus checks, extended and expanded unemployment benefits, funding for small businesses and transportation, COVID-19 vaccine distribution and schools. The legislation also includes a number of provisions addressing healthcare that are of interest to practicing otolaryngologist-head and neck surgeons. Detailed here is our preliminary analysis of the bill’s impact on our members and their patients. As further details emerge, we will keep you informed about any changes and their effects.
AAO-HNS Signs Joint Letter to President-elect Biden on NIH Funding
The AAO-HNS joined with members of the Ad Hoc Group for Medical Research in urging President-elect Biden to support funding for the National Institutes of Health (NIH). The coalition letter thanked President-elect Biden for his support of science and medical research throughout his career, urged attention to issues to bolster scientific discovery and improve the nation’s health and economy, and also requested that the incoming administration prioritize emergency supplemental funding to combat COVID-19.
AAO-HNS Continues Advocacy Opposing Scheduled 2021 Medicare Payment Cuts
Following months of targeted Congressional advocacy efforts, the AAO-HNS has both directly endorsed, as well as joined over 70 other medical organizations, in support of H.R. 8702, “the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020”. This critical legislation would provide stability for otolaryngologists, their practices, and their patients by holding physicians harmless from planned Medicare payment cuts, scheduled to take effect January 1, 2021. The Academy will continue to work with the bill’s sponsors and colleagues throughout the house of medicine to advocate for passage of H.R. 8702 prior to the end of the year.
- Coalition Letter of support for H.R. 8702, “the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020”
- AAO-HNS letter of endorsement for H.R. 8702, “the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020”
New Law Enacts Positive Changes to Medicare Accelerated and Advance Payment Program
On October 1, the President signed into law a Continuing Resolution to fund the federal government through December 11, 2020 and avoid a government shutdown. In addition to necessary spending measures included in the legislative package, the bill also incorporates changes strongly advocated for by AAO-HNS for providers who received Medicare Accelerated and Advance Payments (AAP). These changes include:
- extension of the repayment period to a full year before recoupment begins
- reduces the per claim recoupment amount from 100% to 25% for the first 11 months and 50% of claims withheld for an additional 6 months
- lowers the interest rate for any unpaid balance from 10.25% to 4%
U.S. Senate Republican Leadership Releases Fourth COVID Relief Package
On July 27, U.S. Senate Republican leadership released a fourth legislative relief package, the “Health, Economic Assistance, Liability Protection, and Schools Act” (HEALS Act), in response to the ongoing COVID-19 pandemic. The key elements of this proposal impacting Otolaryngologist Head and Neck Surgeons include:
- Liability Protections for Health Care Providers
- Medicare Accelerated and Advance Payment Programs during COVID-19
- Public Health and Social Services Emergency Fund/Provider Relief Fund
- Paycheck Protection Program (PPP) Improvements and Second Draw Loans
- Safe and Healthy Workplace Tax Credit
- Authority to Extend Medicare Telehealth Waivers
- Requirement to Purchase Personal Protective Equipment (PPE) for the National Strategic Stockpile from Domestic Suppliers
- Improving and Sustaining State Medical Stockpiles
The HEALS Act serves as the first step in Republican Senate negotiations with U.S. House of Representatives Democrats who separately passed COVID 4.0 legislation, the “Health and Economic Recovery Omnibus Emergency Solutions Act” (HEROES Act) on May 15, 2020. You can find a detailed summary of the previously listed provisions here. The AAO-HNS Advocacy team will continue to provide updates as negotiations between the House of Representatives and Senate develop.
AAO-HNS Advocates for Appropriate Physician Oversight After PHE Concludes
On July 22, the AAO-HNS joined more than 50 physician organizations in urging the Centers for Medicare & Medicaid Services (CMS) to sunset temporary waivers involving scope of practice and licensure when the public health emergency (PHE) concludes. These temporary waivers enabled physicians and non-physician health care professionals to provide critical care during the extraordinary circumstances resulting from the pandemic. Through the joint letter, the AAO-HNS reaffirmed support for the physician-led team-based approach to care and vigorously opposed efforts that undermine the physician-patient relationship during and after the pandemic.
Paycheck Protection Flexibility Act Passes U.S. Congress
On May 28, 2020 the U.S. House of Representatives passed H.R. 7010, the “Paycheck Protection Program Flexibility Act.” The legislation passed nearly unanimously by a vote of 417-1 and would change certain conditions of the Paycheck Protection Program (PPP) that originally passed in the “Coronavirus Aid, Relief, and Economic Security Act” or the “CARES Act.” H.R. 7010 makes the following changes to the PPP;
- Extends the period for recipients to spend their received funds from 8 weeks to 24 weeks
- Lowers the percentage that small businesses must spend on payroll costs from 75% to 60% in order to qualify for loan forgiveness
- Allows PPP loan borrowers who seek forgiveness of the loan to qualify for deferred payment of the employer’s portion of certain payroll taxes
- Provides a rehiring safe harbor for businesses unable to rehire employees
- Extends the PPP through December 31, 2020
- Extends the payment deferral period to up to 10 months after the covered period ends
On June 3, 2020, H.R. 7010 passed the U.S. Senate by unanimous consent. H.R. 7010 will now be sent to the President's desk for signature.
U.S. House of Representatives Passes Coronavirus Relief Legislation
On May 15, the U.S. House of Representatives passed H.R. 6800, the “HEROES Act." The Act is the fifth legislative package in the federal government’s response to the COVID-19 pandemic. The following provisions included of the HEROES Act would have a direct impact on practicing otolaryngologist-head and neck surgeons. The Act would:
- Provide additional Provider Relief Fund emergency funding to help struggling physician practices keep their doors open by partially offsetting revenue losses and increased expenses relative to COVID-19;
- Make improvements in the Medicare Accelerated and Advance Payment Program;
- Make physicians eligible for hazard pay as essential frontline workers;
- Expand coverage and increase federal funding for Medicaid; and,
- Fund the infrastructure and health system capacity needed to rapidly expand testing and contact-tracing, thereby enabling economic, social and medical care activities to gradually resume on a prioritized basis while mitigating transmission and deaths from COVID-1
The legislation was sent to the U.S. Senate for consideration. Republican leadership in the Senate has indicated that the bill has no chance of passage. The AAO-HNS’ Advocacy team will continue to provide updates as they develop.
Congress Passes Fourth Coronavirus Relief Package
On April 24, following passage by the U.S. Senate, the U.S. House of Representatives passed a fourth coronavirus aid package, the “‘Paycheck Protection Program and Health Care Enhancement Act." The Act provides $484 billion in new federal funding intended for those most heavily impacted by the COVID-19 pandemic. The following elements of the package will administer needed relief for the specialty, including an additional:
- $310 billion in PPP loans - of that total:
- $30 billion in guaranteed loans for lenders with less than $10 billion in assets, to distribute to approved borrowers
- $30 billion in guaranteed loans for lenders with $10 billion to $50 billion in assets, to distribute to approved borrowers
- $75 billion in funding for hospitals and healthcare providers to support the need for COVID-19 related expenses and lost revenue
- $10 billion for Emergency Economic Injury Disaster (EIDL) grants and an additional $50 billion for the Disaster Loans Program Account
- $25 billion to research, develop, manufacture, purchase, administer and expand capacity for COVID-19 tests
President Trump signed the bill into law on April 24. We urge AAO-HNS members who are seeking but have not received PPP funds to apply immediately with your community lender.
CARES Act Provisions Impacting Otolaryngology-Head and Neck Surgery
On March 27, President Trump signed into law H.R. 748, the “Coronavirus Aid, Relief, and Economic Security Act” or the “CARES” Act. A summary of the provisions that most significantly impact Otolaryngology- Head and Neck Surgeons and their practices is available here.
AAO-HNS Advocates for Financial Relief for Members in New COVID-19 Stimulus Package
The U.S. Senate is currently crafting a third economic stimulus package in response to the COVID-19 pandemic. The Academy, and our partners in the Surgical Coalition, sent a letter to Congressional leadership on March 19 advocating that Congress address the following elements in the new relief package under development:
- Ensure Physicians Have the Equipment they Need
- Ensure Good Samaritans are Protected When Crossing State Lines
- Prevent Frivolous Lawsuits for Telehealth
- Fund Military-Civilian Partnerships
- Temporarily Allow Physician-owned Hospital Expansion
- Relieve Unnecessary Prior Authorization
- Small Business Relief for Physician Practices
- Ensure Physicians have the Disability protections that they Need
- Loss Forgiveness for the Bundled Payment for Care Improvements Initiative
The letter also advocated for suspension of the following to ensure that closures of independent physician practices are not an unnecessary consequence of this virus:
- Suspend Budget Neutrality
- Suspend Sequestration
- Suspend MACRA Reporting Requirements
- Suspend Medical Student Loan Repayment
AAO-HNS Celebrates House of Representatives Passage of Anti-Tobacco Legislation
Over the course of the past year, the American Academy of Otolaryngology- Head and Neck Surgery (AAO-HNS) has collaborated with a number of physician and public health organizations to advance H.R. 2339, the “Reversing the Youth Tobacco Epidemic Act.” H.R. 2339, which was introduced by Representatives Pallone (D-NJ) and Shalala (D-FL) on April 18, 2019, would prohibit all flavored tobacco products, including e-cigarettes, increase the minimum age for purchasing tobacco products to 21, ban all non-face-to-face sales for tobacco products, and protect kids from the marketing of tobacco products.
H.R. 2339 was marked up by the House Energy and Commerce Committee on February 21 and referred to the full House of Representatives for consideration. On February 28, the House passed the “Reversing the Youth Tobacco Epidemic Act” by a vote of 213-195. The AAO-HNS and Partners Coalition will now continue advocacy efforts in the U.S. Senate, where the bill has now been sent for further consideration.
The Tobacco Partners Coalition (Tobacco Partners), through which AAO-HNS worked to advocate for passage of this integral legislation, is composed of more than 50 organizations with the shared goal of protecting public health and reducing the incidence of smoking in the U.S. The Partners are working on a range of smoking-related issues to protect children, youth and adults from the consequences of tobacco use.
What You Should Know! Advocacy Update from James C. Denneny III, MD
Several notable legislative and regulatory events have occurred recently that have the potential to profoundly affect otolaryngology and the practice of medicine in general. The Centers for Medicare & Medicaid Services (CMS) released their 2020 Medicare Physician Fee Schedule proposed rule, as well as the Hospital Outpatient Prospective Payment System (OPPS) proposed rule for the coming year. The Medicare Audiologist Access and Services Act of 2019 (H. R. 4056) was introduced by Representative Tom Rice (R-SC) in the U.S. House of Representatives. A companion bill is expected to be introduced in the U.S. Senate by Senator Elizabeth Warren (D-MA). Legislation designed to remedy “Surprise Billing” is advancing in both houses of Congress, but contains payment options unfavorable to physicians.
Collectively, these three seemingly unrelated actions continue alarming trends that inappropriately devalue surgical services, fail to provide any relief for constantly increasing practice expense, expand scope of practice for nonphysicians, and further limit physicians’ rights to negotiate for their services. Unfortunately, these trends seem to have accelerated in recent years.
As always, we will strongly advocate for guiding principles of fair payment for physicians no matter what healthcare regulatory or legislative proposals or systems emerge, so that our members can continue to provide the best medical care possible for their patients. We will also continue to advocate for patient safety, ensuring those diagnosing and treating medical problems have adequate training to do so, and we will continue to identify important principles and concepts that we feel are important for optimizing patient care. Those related to the above issues are contained in the detailed summaries below.
CMS 2020 Medicare Physician Fee Schedule Proposed Rule Released July 29, 2019
The proposed rule would:
- Devalue surgical care through large increases in E/M services not uniformly applied across the fee schedule.
- Include a conversion factor of $36.09 for 2020, a slight increase from the $36.04 factor in 2019, but virtually unchanged dating back to 1998 ($36.69) or 2008 ($38.09).
- Implement many of the changes to E/M codes first introduced in last year’s regulations, adopt the CPT-recommended updates to E/M visits approved for 2021, as well as the RUC-recommended values for these codes. The E/M values approved by the RUC are substantially higher than the current reimbursement rates. However, the rule does not extend these values to the postoperative office visits included in global surgery bundled payments.
- Result in an estimated zero percent update for 2020 for otolaryngology. CMS projects a five percent increase for otolaryngology if the proposed changes to the E/M payment and coding policies scheduled for 2021 were adopted in 2020. This is based on increased billing of high-level E/M services by otolaryngologists and the reduced rate of surgery for Medicare patients. When applied to the non-Medicare population, this results in a decline in payment for otolaryngology.
We will provide comments to CMS addressing issues impacting the specialty prior to the September 27 comment deadline.
Medicare Audiologist Access and Services Act of 2019: Introduced in the U.S. House of Representatives on July 25, 2019
The legislation would:
- Designate audiologists as “practitioners” under Medicare.
- Allow audiologists direct access to Medicare beneficiaries without the current patient protections that require a physician referral.
The House and Senate bills stand in direct opposition to the AAO-HNS principles on the necessary treatment of the medical conditions associated with hearing loss or balance disorders. These long-standing principles include:
- A physician-led hearing healthcare team, with coordination of services, is the best approach for providing the highest quality care to patients. Granting audiologists direct access to Medicare beneficiaries would remove existing physician referral requirements
- Hearing and balance disorders are medical conditions that require a full patient history and physical examination by an MD/DO.
- While audiologists are valued health professionals who work for and with physicians, they do not possess the medical training necessary to perform the same functions as physicians, nor are they able to provide patients with the medical diagnosis and treatment options they deserve.
Bipartisan Congressional Efforts to Address “surprise billing” for Services Continue to Gain Momentum
The AAO-HNS is very concerned about the impact of surprise or unanticipated medical bills on our patients. Surprise bills only add to patients’ already unbearable out-of-pocket costs, threaten to impede a patient’s decision to seek care, as well as disrupt the physician-patient relationship.
- The AAO-HNS supports legislation that protects patients by removing them from billing disputes, increases insurer and hospital accountability, maintains access to care, and ensures greater transparency. We also support an independent dispute resolution process that allows a neutral third party to choose between the physician charge or the plan’s initial payment amount. This “baseball style” arbitration is efficient and encourages both parties to make reasonable offers at the outset.
- We believe that any legislative solution should require hospitals that advertise themselves as participating in insurance networks only bill patients in-network rates, irrespective of whether the provider has joined their network.
While we are pleased that all the legislative proposals introduced in this Congress seek to remove patients from postcare billing disputes and increase hospital and insurer accountability, we oppose those which tie physician reimbursement to a benchmark such as Medicare or an insurer’s in-network contracted rate. Doing so would potentially lead to the unilateral devaluation of physician services by eliminating negotiating ability with private insurers. An example of this is recent legislation enacted in California that limits reimbursement to 125 percent of the Medicare fee schedule. Network fee schedules affect all medical and surgical services, not just hospital and emergency care. A significant reduction can result in an inability to keep pace with technical advances and decrease overall access to services.