Letter from the President
It is truly a great honor to have been elected to serve as the President of the New Jersey Orthopaedic Society for this year. During the last several years serving on the board of The New Jersey Orthopaedic Society and organizing two of our annual educational symposia, I have come to truly understand how crucially important the NJOS is to the practicing orthopaedic surgeon in New Jersey. With over 500 members we are fortunate to have one of the country’s largest and most active specialty societies. The NJOS serves the orthopaedic community through its missions of education and advocacy.
By way of introduction, I have been a practicing orthopaedic hand surgeon in Gloucester County since I completed my training at the Hospital of the University of Pennsylvania and the Indiana Hand Center in 1996. I have served in leadership positions at my two surgical centers and have been involved in the Medical Society of New Jersey having previously served on their Board of Trustees for over 10 years. I am currently Vice President of the Medical Staff at Inspira Medical Center in Woodbury, New Jersey.
Each spring, our annual educational symposium brings several nationally known thought leaders in for a Saturday morning session to share their insight on the cutting edge and controversial issues in orthopaedics. In addition, in the afternoon prior to the symposium, we sponsor Dr. Vincent McInerny’s annual residents’ research and complications conference. I believe this is unique to New Jersey in that it brings together orthopaedic residents from every single residency in the state to present their research or complicated case reports to each other, the state’s orthopaedic community, and the visiting professors in a very collegial forum. Most past faculty have shared with me how rare this experience is in comparison to what they see as they travel the country lecturing.
I am also pleased to announce that we are collaborating with The Eastern Orthopaedic Association for their upcoming annual meeting (October 19-22, 2016) in New Orleans. NJOS members will be able to attend the meeting at the EOA member rate. In addition, several members of NJOS will be moderating sessions and the NJOS has awarded two travelling fellowships to New Jersey resident physicians to presents their research papers. Finally, The Society has invited Dr. Thomas E. Price to speak. Dr. Price is a six term congressman from Georgia who was, for twenty years, a practicing orthopaedic surgeon. I look forward to hearing his perspective on the myriad of federal programs including the ACA and MACRA that impact our lives on a daily basis.
While most of us believe our residency and fellowship training prepared us for the clinical practice of orthopaedics, we soon realize that the practice of medicine is profoundly impacted by the business practices of hospital systems and the insurance industry as well the legislative and regulatory environments they are so good at influencing. We frequently may feel that our livelihoods and our ability to treat our patients are beyond our control. With active participation in the New Jersey Orthopaedic Society, however, I realize that you do have a voice to influence these decisions that are being made around you. Our advocacy team of lobbyists and legal counsel help to organize the orthopaedic opinion on the impact of many of the issues currently being debated in the New Jersey Legislature (Out of Network, Narrow Networks, Ambulatory Surgical Center Issues, Opioid legislation and regulation, Scope of Practice Issues). Through our purchasing Alliance that provides a significant discount for malpractice coverage with MD Advantage, we have been able to have significant visibility and clout in Trenton to help have our concerns heard.
The New Jersey Orthopedic Society Board and I value the perspective and experience of each of our members. We truly want to make sure that the society is focused on what the members need and want us to do. Please feel free to contact me at firstname.lastname@example.org with any questions or concerns.
Bruce Monaghan, MD
This is a reminder of the CMS rule that will impact NJ practices starting from July 1st. Below are two links that also talk about the G-Codes issue.
On Wednesday, November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. CMS finalized a number of new PFS policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment conditions.
In the proposed rule, CMS recommended collection of post-operative data in three ways. The first prong would collect claims-based data on the number and level of visits in 10-minute increments from all physicians who perform Global Code (G-code) procedures. The second method would be a survey pf physicians and the third would be data collection from the accountable care organizations (ACOs). The claims-based universal data gathering proposal was deemed extremely burdensome on our surgeons and not in line with the intent of the Medicare Access and CHIP Reauthorization Act (MACRA) statute. AAOS commented to CMS explaining these issues as well as joined other surgical specialties in legislative and regulatory advocacy efforts to urge CMS to reverse this proposal.
Subsequently, in the final rule with comments [Regulation No. CMS-1656-FC] (available online at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26515.pdf), CMS finalized three major flexibilities in reporting requirements as follows:
1. CPT code 99024 can be used to collect data on the number of post-operative visits (as suggested by AAOS and others). Further, at this time, CMS will not require time units or modifiers to distinguish levels of visits to be reported.
2. Instead of required reporting on all codes, CMS is just collecting data on the number of visits for codes that are reported annually by more than 100 practitioners and with high volume or high allowed charges (furnished more than 10,000 times or have allowed charges of more than $10 million annually as recommended by the RUC (AMA RVS Update Committee) and many other commenters including AAOS).
3. Instead of collecting data from all physicians who perform global code procedures, CMS has finalized reporting requirements for a geographic sample of practitioners located only in the following states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island.
Moreover, the start date for implementation of such data collection has been postponed from January 1, 2017 to July 1, 2017. At this time, CMS is not implementing the statutory provision that authorizes a 5 percent withhold of payment for the global services until claims are filed for the post-operative care, if required. The proposals regarding the physician survey and data collection in ACO has been finalized as proposed.
“CMS is hopeful that use of the existing CPT code for reporting these services will be significantly less burdensome than the proposal to require time-based reporting using the G-codes,” the agency wrote in a summary. “[W]hile practitioners are encouraged to begin reporting post-operative visits for procedures furnished on or after January 1, 2017, the requirement to report will be effective for services related to global procedures furnished on or after July 1, 2017. To the extent that these data result in proposals to revalue any global packages, that revaluation will be done through notice and comment rulemaking at a future time.”
Since reporting via the 99024 CPT code will only provide information on the number of visits, CMS will explore whether a survey would provide data on the level of visits (needed to value surgical services correctly) as mandated by the MACRA statute. AAOS will continue to monitor future rule making on this issue.
If you have any questions, please contact the AAOS.