Issue 28, Spring/Summer 2025

Stay up to date on the latest regulatory proposals, congressional developments, and political activity relevant to musculoskeletal care with this quarter’s Advocacy Insights.

In this edition, we examine the Trump Administration’s second‑term healthcare agenda—including proposed HHS restructuring, deregulatory efforts coordinated with the Department of Government Efficiency (DOGE), and the release of the FY 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) PPS proposed rule. Additionally, we provide key insights from MedPAC’s recent meetings and its reports on Physician Fee Schedule (PFS) reform.

As Congress continues its budget reconciliation process, we also offer an overview of text from the House and Senate Finance Committees—most notably, the Senate version excludes the first permanent physician payment update since MACRA. The OrthoForum will continue monitoring major policy developments as the Administration advances its health priorities and Congress’s budget reconciliation process moves forward, with a focus on changes to federal healthcare programs and initiatives that impact both physicians and patients.

ANNOUNCEMENTS

AAOS Leadership Recognition

The OrthoForum proudly congratulates Alexander Vaccaro, MD, PhD, MBA, FAAOS, of Rothman Orthopaedics, on his appointment to the 2026 AAOS Nominating Committee. This prestigious position plays a pivotal role in shaping the future leadership of the Academy, and Dr. Vaccaro’s selection marks a significant milestone for the representation of independent orthopaedic physicians within national governance. His presence on the committee ensures that the voices and concerns of private practice groups will be well-represented at the highest levels of the AAOS. We also congratulate Wilford K. Gibson, MD, FACS, FAAOS, FAOA, of Atlantic Orthopaedic Specialists, who continues his service after being named First Vice President of the AAOS earlier this year. Dr. Gibson’s appointment reflects his decades of service and leadership and positions him to become AAOS President in 2026. These recognitions underscore the growing influence of OrthoForum members in steering the future of musculoskeletal care.

DC Fly-In Recap: Advocacy in Action Ahead of Reconciliation Vote

In May, just one day before the House passed its sweeping reconciliation bill, OrthoForum leaders were on the ground in Washington, D.C., meeting with lawmakers and key health staff to advocate for sustainable physician reimbursement and to defend independent orthopedic practice. Dr. Jeff Racca (OrthoForum Advocacy Chair), Joel James (Signature Health), Alexina Arthur (A. Arthur & Co.), and the Todd Strategy Group team focused on Medicare payment reform and prior authorization relief, ensuring orthopedic voices were heard on new CMMI models. They met with:

  • Rep. Greg Murphy, M.D. (R-NC) – Lead sponsor of H.R. 879 and member of the House Ways and Means Committee
  • Rep. Tim Moore (R-NC) – Freshman legislator and former NC Speaker with deep policy ties
  • Staff of Rep. Richard Hudson (R-NC) – Senior Republican on Energy and Commerce
  • Catherine Hayes – Chief of Staff for the GOP Doc Caucus
  • Alec Aramanda – Trump Presidential Appointee, CMS Principal Deputy Director of Medicare

 

These meetings were especially timely, as the House moved forward with a reconciliation bill that includes the first baseline-linked Medicare physician payment update since MACRA. OrthoForum emphasized the need for ongoing reforms and warned against Medicaid policies that could limit patient access and burden physicians. This fly-in built strong momentum for OrthoForum’s legislative priorities and reinforced the critical role that orthopedic physicians and practice leaders play in shaping national health policy.

Understanding Medicare Advantage Plans – A Resource for Your Patients

In case you missed it, The OrthoForum shared a powerful new video conversation between Dr. Jeff Racca and Dr. Eric Bricker, on the real impact Medicare Advantage plans are having on our patients, from delays and denials in care to increased administrative burdens that ultimately hurt outcomes and access.

We believe this is an important tool for helping patients and the broader public understand what’s at stake. If you’re looking for a way to educate and empower your patients, consider:

  • Playing the video in your waiting rooms or lobbies
  • Including it in practice newsletters or websites
  • Sharing it through social media or patient education materials

 

The future of independent musculoskeletal care depends on our ability to raise awareness and advocate not only within our professional circles, but also directly to the people we serve. Here is a direct link where you may download that video by clicking the “Download” icon beneath the title.

ADMINISTRATION UPDATE

The Trump Administration’s transition has brought changes to the federal health policy landscape. HHS is streamlining operations from 28 divisions to 15, while implementing new program integrity rules and audit tools in coordination with DOGE. President Trump has released a flurry of executive orders and memoranda, including a memo directing action on the growth trajectory of State Directed Payments (SDPs). HHS is continuing to take shape as it appoints new leadership, with FDA Administrator Dr. Marty Makary, NIH Director Dr. Jay Bhattacharya, CMS Administrator Dr. Mehmet Oz, and HHS Deputy Director Jim O’Neill all recently confirmed and ready to advance the Administration’s “Make America Healthy Again” agenda.

In April, CMS released the FY 2026 Hospital IPPS and LTCH PPS Proposed Rule to update Medicare FFS payment rates and policies for inpatient hospitals and LTCHs for FY 2026. Reflecting the Administration’s deregulatory focus, the FY26 IPPS rule included a request for information (RFI) seeking input on streamlining Medicare regulations and reducing participant burdens. In May, HHS and FDA continued the momentum by issuing an RFI to determine how the Administration can eliminate unnecessary regulatory obligations and paperwork requirements, aiming to “allow health care providers to devote more time and resources to patient care.” Finally, CMS released an additional RFI to promote Medicare beneficiaries’ access to innovative health technologies, inviting input on how CMS can reduce administrative burdens while accelerating progress toward value-based, patient-centered care. As rules season approaches amid ongoing deregulatory efforts, The OrthoForum will track developments and provide updates on key policy changes in next quarter’s newsletter.

Federal Advisory Update

This quarter, there have been several notable federal advisory updates, including key MedPAC public meetings and the release of the Commission’s March and June reports to Congress. The OrthoForum will continue to track the Commission’s work leading up to the next public meeting in September and provide members with relevant updates, particularly as it relates to physician payment policies.

MedPAC March Public Meeting

During the March Public Meeting, commissioners discussed reforming PFS updates and improving the accuracy of relative payment rates, voicing concerns about whether current-law updates to Medicare’s PFS will continue to be adequate given inflation trends. The meeting included extensive discussion on replacing dual PFS updates based on Advanced Alternative Payment Model (A-APM) participation with an update based on a portion of MEI growth, the inclusion of a minimum update floor or update ceiling, and potential impacts posed by private equity-owned practices on the MEI. Additionally, the meeting featured extensive discussion on reducing beneficiary cost sharing for outpatient services at CAHs. Notably, commissioners unanimously approved the chair’s draft recommendation to shift outpatient cost sharing from 20 percent of charges to 20 percent of the CAH’s payment rate, with a cap on CAH outpatient coinsurance equal to the patient deductible.

MedPAC March Report to Congress

On March 13, MedPAC released its March 2025 Report to Congress: Medicare Payment Policy. In the report’s 13 chapters, the commission reviews analyses and recommendations on factors contributing to Medicare spending growth, FFS Medicare payment rate updates, Medicare Advantage (MA) program trends and issues such as coding intensity and market concentration, and FFS beneficiaries’ access to care in ambulatory surgical centers. For 2026, MedPAC recommended that Congress implement FFS payment updates above current law for acute care hospitals and for physician and other health professional services; enact payment reductions for skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities; and target additional resources to Medicare safety-net hospitals and to clinicians who furnish care to FFS Medicare beneficiaries with low incomes.

MedPAC April Public Meeting

During the April Public Meeting, commissioners unanimously approved the chair’s draft recommendation to replace current-law updates to the PFS with an annual update based on a portion of the growth in the MEI—such as MEI minus 1 percentage point—which would increase spending by between $15 billion and $30 billion over five years. Commissioners also approved the chair’s second budget-neutral recommendation to improve the accuracy of Medicare’s relative payment rates for clinician services by collecting and using timely data that reflect the costs of delivering care. The meeting featured continued discussion on the impact of MA on rural hospitals’ volume and profitability, as well as challenges related to covering and paying appropriately for software-as-a-service (SaaS).

MedPAC June Report to Congress

On June 12, MedPAC released its June 2025 Report to Congress: Medicare and the Health Care Delivery System. In the report’s seven chapters, the commission reports on improvements to Medicare payment systems and issues affecting the Medicare program, including reforming PFS updates, enhancing the relative accuracy of PFS payment rates, measuring rural provider quality, and revising FFS beneficiary cost sharing for outpatient services provided at CAHs. Most importantly, the commission recommended replacing the current-law updates to the PFS, suggesting that policymakers consider pairing updates of MEI minus 1 percentage point with a minimum update floor or ceiling, and asserted that incentivizing A-APM participation via differential payment-rate updates is a flawed approach. Also of note, the commission recommended improving the accuracy of relative values under the fee schedule by advising Congress that Medicare could better account for indirect practice expenses, update the data used to calculate the aggregate allocation of RVUs, and address overvaluation of global surgical codes.

Congressional Update

As Congress approaches its annual August recess, budget reconciliation and FY 2026 appropriations remain top of mind on Capitol Hill.

On May 22, the House passed an expansive budget reconciliation bill by a single vote, with potential implications for Medicare physician payment policy and Medicaid eligibility standards as it moves to the Senate for further consideration. While the package does not reverse the 2.8 percent payment cut that took effect on January 1, it includes inflationary updates to the Medicare Physician Fee Schedule (PFS). Under H.R. 1, the One Big Beautiful Act, physicians would receive an update equal to 75 percent of the Medicare Economic Index (MEI)—currently estimated at 2.25 percent—in 2026, and an increase equal to 10 percent of the MEI annually beginning in 2027. This legislation marks the first permanent, baseline-tied physician payment update since the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, a move strongly supported by the American Medical Association (AMA) and consistent with recommendations from MedPAC.

Still, H.R. 1 falls short of comprehensive reform, as it retains the budget neutrality requirement and fails to address the ongoing payment instability created by temporary fixes. The AMA and The OrthoForum support the bill’s MEI-linked approach as a foundational step toward long-term payment stability. However, The OrthoForum continues to advocate for more robust reforms that reflect practice costs and support physician-led care models.

On Medicaid and CHIP coverage, the House-passed legislation includes funding cuts and tighter eligibility requirements, including community engagement mandates and increased administrative burdens for enrollees. These provisions could result in coverage disruptions. The AMA has voiced strong opposition, warning that the changes would lead to coverage losses, harm continuity of care, and increase burdens on physicians and hospitals. In a letter dated May 20, the AMA urged Speaker Mike Johnson (R-LA) and Minority Leader Hakeem Jeffries (D-NY) to reconsider. The OrthoForum Advocacy Committee shares these concerns and is closely monitoring ongoing Senate negotiations.

On June 16, the Senate Finance Committee released draft text for inclusion in the Senate Republicans’ budget reconciliation bill, notably excluding the proposed “Doc Fix.” This omission diverges from both MedPAC’s recommendation to link Medicare payment updates to the MEI and Section 44304 of the One Big Beautiful Act, which would permanently tie annual PFS updates to the MEI. In a June 20 letter to Majority Leader John Thune (R-SD) and Minority Leader Chuck Schumer (D-NY), the AMA expressed strong opposition to the omission—a concern shared by The OrthoForum.

The reconciliation process will continue to evolve in the coming days, with negotiations ongoing ahead of the July 4 deadline set by House and Senate GOP leaders. The OrthoForum will continue to engage with lawmakers to promote sustainable reforms that protect patient access and preserve the viability of physician-led practices.

Oregon Sets National Precedent with Toughest Law Yet Against Private Equity in Healthcare

The Coalition for Patient Centered Care (CPCC), an advocacy partner of the OrthoForum, applauds recent action in Oregon to limit private equity influence in healthcare. In June, Governor Tina Kotek signed Senate Bill 951, the nation’s strongest state-level law prohibiting non-physician ownership of medical practices. The legislation aims to close longstanding loopholes that allowed corporations to exert control by nominally listing physicians as owners. With a three-year adjustment period and exemptions for hospitals and tribal health systems, this law addresses concerns about declining care quality, access, and physician autonomy following private equity takeovers. CPCC views Oregon’s action as a critical model and urges other states and federal lawmakers to consider similar protections that prioritize patient interests over investor profits.

For more information on any of the topics discussed in the newsletter, please contact either the chair of the OrthoForum Advocacy Committee, Dr. Jeffrey Racca (jracca@theorthoforum.com) or The OrthoForum’s CEO, Karen Simonton (ksimonton@theorthoforum.com).