So, I just wanted to start with this quote. I think it helps to kind of define advocacy. Despite widespread acceptance of advocacy as a professional obligation, the concept remains problematic because it exists as an undefined concept and scope and practice. If advocacy is to be a professional imperative, then medical schools, graduate medical programs must deliberately train physicians as advocates, and I think that brings up a lot of points. So how does ANA train advocates? Well, we have a dedicated advocacy fellowship program. The fellows are appointed as a member of the Advocacy Committee for two years. They participate in a healthcare policy research project. They attend the National Orthopedic Leadership Conference, as well as the AAOS Coding, Coverage, and Reimbursement Committee. ANA maintains two positions on the Coding, Coverage, and Reimbursement Committee for the Academy. We also have an Advocacy Committee that's dedicated to addressing both state and national payment and policy issues. We also have two positions on the Advisor Circle, which is kind of a grassroots advocacy program for the Academy. The dedication to advocacy is also reflected in the mission statement. The mission statement states that the Arthroscopy Association of North America is dedicated to advancing the art and science of arthroscopy through surgery, education, skills assessment, and advocacy. So the top three issues, and these issues change frequently from year to year. It's kind of hitting a moving target. The three that we've been focusing on are E&M changes, prior authorization reform, and commercial insurance development of CPGs. Just to give you guys a little taste of what the Advocacy Committee's involved in, I thought I'd do a brief discussion on each of these. So the E&M changes came into play in January of this year, and in March, the AMA issued some initial guidance, which we found some major flaws with. So just to summarize the issue, the plan was to consolidate the codes and decrease documentation burden, but there was also a secondary goal, and that was to increase payment for office codes and therefore increase some payment to primary care doctors. The problem is CMS has to maintain budget neutrality, so increased RVU codes equals decreased surgical code values. So if you look here, how much did the E&M codes increase? So the RVUs are low, but the percentage increase is significant, and when there's millions of these performed each year, the money really adds up. So E&M code for office visit established level two increased by almost 50%. So the ANA response to this, we saw major flaws in the new descriptions that impact surgeons and ancillary service owners. So we've worked with the Academy to come up with a plan to develop this. We've submitted a formal code change request to the CPT editorial panel, and ANA members participated in that process. We're also working with the Academy to develop grassroots political response. The next issue we've been addressing in the last year is prior authorization reform. The process of prior authorization is very burdensome for providers, and electronic processing of claims could be an area to save money. According to the Council on Affordable and Quality Health Care, approximately $355 million per year could be saved in direct cost by providers. So this is a big potential for cost savings. So the solution here is House Resolution 3173. It's a legislative bill sponsored by the Academy with bipartisan support, creates a standardized electronic process for claims. It creates a timeline to compliance, requires increased transparency in the industry and physician oversight in the prior authorization policies, and ANA would be a direct participant in development of these. And finally, commercial payer denials. This is another clinical practice guideline-type issue. Basically the commercial payers have developed their own clinical practice guidelines, and we see this as a very conflicted process. Our position on this is Category 1 codes have been vetted and valued by the medical community through the CPT editorial panel in the RUC. They're the gold standard for procedural documentation. Commercial payers have to, by state and federal statute, use the most updated CPT code set. So our position on this is that payers should defer to the expertise of the practicing physician to determine the most appropriate procedure for the individual patient. How we've acted on this, we've communicated with AIM, which is a subsidiary of Blue Cross Blue Shield, which has responded for more formal collaborative efforts in developing their CPGs. We're participating in a task force with other representatives from the Academy. We've started monthly meetings with AIMs in response to the clinical practice guidelines, and we feel that the best way to protect members may be to participate in the process. So that's kind of a summary of the top three issues and a little bit of what the Advocacy Committee does in ANA.

advocacy

medical profession

physicians

Arthroscopy Association of North America

E&M changes