American Association of Hip and Knee Surgeons

Advocacy, Education, Research

Washington Update

By Julie Williams, Senior Manager, AAOS Senior Manager of Government Relations

August 2015

Meaningful Use/Senate Hearing on Information Blocking

There has been momentum in terms of the effort to delay Meaningful Use (MU) Stage 3 implementation.  Rep. Renee Ellmers (R-NC) has introduced H.R. 3309, which AAOS supports, to delay Stage 3 implementation until one of two things happens:  1) 75% of eligible hospitals and providers have attested to MU Stage 2 requirements; or 2) the MIPS final rules are promulgated.  It also harmonizes reporting requirements for MU, PWRS, IQR to remove duplicative measurement and streamline requirements from the Centers for Medicare & Medicaid Services (CMS); institutes a 90-day reporting period for each year; encourages interoperability among electronic health record (EHR) systems; and expands hardship exemptions.

On the Senate side, the Committee on Health, Education, Labor and Pensions (HELP) recently held a hearing on the practice of “information blocking” and raised the question of whether the federal government, through its program to encourage adoption of EHRs, played a role in encouraging the practice.  Chairman Alexander suggested that the committee push to delay implementation of MU Stage 3 saying, “…let’s not go backward on EHRs, but let’s not impose on physicians and hospitals a system that doesn’t work and which they spend most of their time dreading.”

Comprehensive Care for Joint Replacement

On July 9, the CMS proposed a new payment model that would bundle payment to acute care hospitals for hip and knee replacement surgery.  While supportive of the concept of bundling, AAOS has some concerns about the proposal and is submitting a comment letter to CMS which will be circulated through the BOS SPDR process.

ACA Repeal Efforts

The Senate voted down an effort to repeal the Affordable Care Act (ACA) along party lines on July 26.  This will not be the last effort to repeal the ACA.  Majority Leader McConnell is committed to using budget reconciliation this fall to repeal the ACA.  Budget reconciliation is an expedited floor procedure that allows for a simple majority vote.  Ironically it is the same mechanism that was used to pass the ACA.  It is unlikely that the Senate would have the votes to override a presidential veto.

21st Century Cures/Innovation for Healthier Americans

The Senate is likely to introduce its companion to the House 21st Century Cures proposal in September.  The House measure, which passed on July 10 by a vote of 344-77, seeks to provide better, faster, safer and more innovative approaches to treat diseases.  It includes increased funding for the NIH, expedited device approval, a centralized IRB, interoperability language, telehealth provisions, improvements in LCD’s, a national pediatric research network and much more.  The Senate companion is expected to be similar but with more of a focus on interoperability.  Floor action is expected after the first of the year.  Both the House and the Senate are negotiating with the White House and the appropriate agencies, so there is a significant chance this will become law.


Reps. Price (G-GA) and Blackburn (R-TN) introduced a bill that would allow both ICD-9 and ICD-10 to be used for 180 days after ICD-10 is implemented.  While AAOS is supportive of this approach, it continues to advocate for H.R. 2126 introduced by Rep. Ted Poe (R-TX) that would prevent the implementation of ICD-10 completely.


The recent Medicare trustees report indicated that the IPAB would be triggered in 2017 – earlier than thought.  This increases the momentum to repeal the IPAB.  A bill to repeal the IPAB passed the House on June 24 by a bipartisan vote of 244-154.  The strategy now moves to the Senate where a companion bill has 41 cosponsors.


Rep. Brad Wenstrup (R)-OH), a podiatrist, introduced a bill that would define podiatrists as physicians under the Veterans Administration (VA) medical system.  AAOS has partnered with AOFAS in opposing the bill and initiated a strong grassroots effort targeting the House VA Committee.  The bill was scheduled to be considered by the full VA Committee on July 29 but the mark-up was cancelled –a positive sign.

Women’s Health Research

Report language regarding women’s health research was included in last-years omnibus appropriations bill and this year’s Labor/HHS funding bill. Report language is non-binding language that accompanies a bill. Though non-binding, it sends a message to Congress.  This year’s language, among other things, asked for the National Institute of Health to ensure the analysis of data by sex and other subgroup demographics are a part of the grant progress reporting and to fund studies on sex differences and conditions that predominately impact women.