Additional Support Needed to Maintain Access to Musculoskeletal Care

As lawmakers continue discussions on a fourth COVID-19 response bill, the American Association of Orthopaedic Surgeons (AAOS) is asking for additional support to ensure the survival of musculoskeletal care and to allow its members to effectively respond to this crisis. It noted the growing impact of the virus on orthopedic surgeons and the patients they care for in a recent letter to congressional leadership, which was signed by several other orthopedic organizations.

“Orthopaedic surgeons are complying with Centers for Medicare & Medicaid Services’ (CMS) guidance to postpone elective surgeries, leading directly to plummeting case volumes, with practices struggling to stay in business and keep their employees on staff,” wrote AAOS President Joseph A. Bosco III, M.D., FAAOS. “As the pandemic becomes more manageable and these surgeries can take place, we are concerned that too many of our private practices will have become financially insolvent, threatening access to care.”

Dr. Bosco continued by citing alarming results from a recent AAOS survey.* More than a third of orthopaedic surgery practices reported financial impact totaling over $1 million. The average number of surgeries cancelled or indefinitely postponed totaled 150 per respondent, while nearly half of respondents noted a decline in volume of 80 percent or more.

“Over half of the members of the AAOS are in private practice, with each orthopaedic surgeon performing on average nearly 36 procedures per month,” wrote Dr. Bosco. “The capacity of these surgical practices to stay open and manage the expected influx of need following this crisis will correspond directly to how quickly Americans can get back to work and help the economy recover.”

In the interim, orthopaedic surgeons are utilizing expanded telehealth capabilities to provide care to patients and helping their colleagues across medical specialties fight the virus—some have even deployed to cities with critical need like New York City and San Francisco. Small private practices and eligible Medicare providers can also access some financial support from the Coronavirus Aid, Relief, and Economic Security (CARES) Act. AAOS members are already receiving their payments from the initial $30 billion, which the Department of Health and Human Services started to deliver last Friday (April 10).

While this initial support is helpful for paying staff and keeping practices afloat, AAOS says it may not be enough to maintain this critical resource for safeguarding the nation’s musculoskelteal health. It outlined specific provisions for Congress to consider in the fourth COVID-19 stimulus package, including the prioritization of funds for physician practices at risk of closing and blanket liability protections for volunteers, among others (full list below).

“The historic challenge of the COVID-19 pandemic requires an equally historic response from Congress,” said Dr. Bosco. “We thank you for your work in this fast-moving crisis environment and ask that you take these steps to ensure orthopaedic surgeons are best equipped to help get the nation through this and provide care when this crisis is over.”

For more information on AAOS’ COVID-19 related advocacy efforts, please visit aaos.org/covid19.

Requests for the next COVID-19 response legislation:

• Prioritize relief provided within CARES for physician practices in communities at risk of losing access to needed musculoskeletal care should those practices be unable to remain open.
• Extend the recoupment deadline in the Medicare accelerated payments program to Dec. 31, 2021, and clarify the tax liability for recipients.
• Include the Immediate Relief for Rural Facilities and Providers Act, introduced by Senator Michael Bennet (D-CO) and Senator John Barrasso, M.D. (R-WY).
• Expand eligibility within the Paycheck Protection Program for physician practices with over 500 employees.
• Add blanket liability protections for physicians who are working outside their normal practice area in order to provide surge capacity but not volunteering.
• Ensure physicians, healthcare workers, and first responders are included and covered under the paid sick leave provisions instituted by the Families First Coronavirus Response Act.