June 2002 Bulletin

By Lawrence E. Rosenthal, PhD

In the middle and late 1990s, the American Academy of Orthopaedic Surgeons (AAOS) was enjoying growth in its membership; growth, and expansion of products and services to its members; and strong financial growth. All seemed to be in order with the universe.

However, those whose job it was to scan the horizon began to notice certain disturbing conditions and emerging trends that, if not understood and addressed, could quickly change the picture from pleasant weather to disruptive storms. Among the impending organizational storm clouds–challenges and threats–approaching the AAOS were the following:

• Change in future generations’ perceptions of and the value they attach to organizations like the American Academy of Orthopaedic Surgeons.
• The impact of new technology and external competitive forces on the continued well-being of professional associations such as the AAOS.
• Limited revenue sources that were basically stable or growing only slightly each year.
• A highly vertically-integrated organization that was beginning to experience significant lags between concept development and the time a product or service went to market.
• Concern that in the future, the ability to attract member volunteers to the various AAOS committees and councils might become a problem.

As a result, in 1999, the then second vice president, Richard Gelberman, MD, and I presented a strategy to address these concerns to the AAOS Presidential leadership. A think tank would be convened, and through a series of conferences and research activities, would study these threats and challenges and their potential impact on the AAOS.

A name was needed to identify the initiative and quickly present an image to those hearing about and seeing its activities and details. Thus was born the name The AAOS in 2005. The then Presidential leadership and the Board of Directors charged Drs. Gelberman and myself with carrying out the goals of the AAOS in 2005 initiative.

From this direction we embarked on an 18-month process. The result was no less than a reinvention of your AAOS so it would be positioned to continue to meet your needs as a member as well as making your membership a more valuable asset to your practice and to the profession of orthopaedics.

The concept for AAOS in 2005 was detailed in the October 2000 issue of the Bulletin. Between May 2000 and February 2001, a series of formal implementation and business plans were developed and presented for Board approval to launch the programmatic vision of The AAOS in 2005. Following is a summary of the accomplishments achieved since then by the project team and the Board of Directors in implementing AAOS in 2005.

In the education domain, the Board of Directors made a major commitment to providing continuing education for orthopaedists through the Internet and authorized the development of an Internet-based knowledge base for physicians. This concept became "Orthopaedic Knowledge On-line" (OKO), which was launched in October 2001,18 months after its authorization.

Its design concepts incorporated the principles of interactive and adult learning requirements, provision of evidence-based research through a rich integration of printed reference sources, and the integration of audio and visual media through slides and streaming video.

The Internet was also selected as the best means of disseminating information regarding practice management knowledge. However, the question that remained was what specific practice management products and services were needed by the Fellowship. The Marketing Department was directed to conduct a series of focus groups and an in-depth market survey to further test the focus group results to answer this question.

Results of this survey showed that almost 90 percent of AAOS members wanted information on marketing a medical practice, more than 70 percent wanted to know more about CPT coding and more than 75 percent wanted to better understand compliance with the fraud and abuse policies of the Centers for Medicare and Medicaid Services.

Based on the research as well as input from practicing orthopaedic surgeons and BONES administrators, the Internet-based Practice Management Center will be launched on the AAOS Website. The first phase of the Center, to be rolled out during the fourth quarter of 2002, will include the following:

1. A wire service containing information about newsworthy events that related specifically to the day-to-day practice of orthopaedics.
2. A database of frequently asked questions and answers, updated monthly, relating to CPT coding.
3. Bulletin boards offering the capability for peer-to-peer counsel.
4. Guidance for orthopaedic surgeons making the transition from graduate medical training to practice.
5. A compendium of white papers, articles and other materials containing information that will assist orthopaedic surgeons with their day-to-day operations.
6. A series of articles on issues faced by orthopaedists in academic practice.
7. Guidance regarding compliance with HIPAA and other government regulations.

During 2003, additional content will be added to the Center in areas such as third party contracting, benchmarking, best practices and technological advances. In addition, sample forms, policies and procedures will be made available that orthopaedists can download and tailor for their own use.

Four major research initiatives will build upon the Academy’s role as the leading authority on musculoskeletal conditions and improve the care of patients. They seek to operationalize the concept of the AAOS being THE data and information resource on orthopaedic care and disease management and include the following:

1. Variations in orthopaedic care. Identify the reasons behind variations in a particular practice or disease treatment so as to narrow the variations in practice and to improve patient care are underway. A study is being developed to explore the unmet need for joint replacement in patients with hip and knee osteoarthritis in the U.S. It will also look at racial disparity in knee and hip replacements.
2. Shared decision-making. Enhancement of shared decision-making between patients and physicians to achieve increased patient and physician satisfaction, improve outcomes and decrease liability expense and cost of care. Two shared decision-making videos on total knee arthroplasty and total hip arthroplasty are now in development
3. Improving Musculoskeletal Care in American (IMCA). This effort will define through a systematic evidence-based approach the true burden of musculoskeletal disease. The initial focus of IMCA will be on osteoarthritis and work has begun on developing a series of fact sheets on osteoarthritis of the knee; the fact sheets summarize etiology, diagnosis and risk factors, emerging new knowledge, treatment alternatives, evidence-based resources, AAOS resources and links to clinical trials and research.
4. National total joint registry. Establishment of a joint registry to study outcomes for the purpose of improving patient care and satisfaction. A major step towards accomplishing the goal was taken in December 2001, when the AAOS co-sponsored with the US Agency for Health Research and Quality the Total Joint Registry Workshop in Washington, DC.

Organizationally the leadership recognized that it was necessary to streamline and update the AAOS structure to make it more responsive to member needs as well as to increase your participation and involvement in the organization. The AAOS in 2005 team proposed the following innovations:

1. Broaden the opportunities for individual members who wish to participate as volunteers in specific task-oriented activities through the creation of project teams. These new opportunities will permit members to volunteer and give back to orthopaedics for very defined short periods of time without having to commit to extended service on AAOS committees and councils should they not wish to do so.
2. Develop and implement a mentoring program for young orthopaedic surgeons in order to prepare them for future leadership. The Board of Directors approved the Leadership Fellows program in late 2001 and the first class of Fellows was formed and organized at the 2002 Annual Meeting.
3. Revise and streamline the resolution and bylaw amendment process to broaden member participation and voting without having to necessarily attend the annual business meeting in order to vote. Members approved a bylaws amendment in February 2002 that will allow member decision-making on resolutions and bylaws by either mail or electronic balloting, thus further democratizing the process. Beginning in 2003, all such resolutions and bylaw amendments will be submitted to the entire Fellowship for voting. Initially this voting will take place via a mail ballot. When we acquire a greater percentage of member e-mail addresses, you will also have the option of casting your votes via email.

Fellows’ opportunities to serve the AAOS will be further enhanced because of the organizational principle adopted by which member volunteers will be appointed to serve on councils, committees and project teams by virtue of their skills, interest and experience in the activity in which the organizational unit is engaged. Fellows will now be able to apply for these volunteer opportunities via the Internet, because the positions will be announced and posted on the AAOS web site, along with the necessary application activities.

This new system is known as Knowledge, Experience and Interest (KEI). It was developed to streamline the selection process to more precisely identify volunteers with the expertise and time to devote to AAOS activities. All future committee openings will be posted on the AAOS home page with a detailed set of expectations and time commitments, as well as the skills and experience needed for the position. The system was launched in May 2002 and is in full operational use for the 2002-2003 committee appointment cycle.

In addition to the innovations having a direct bearing on you, the members, the AAOS in 2005 project team recommended several enhancements to our internal and governance structure, including:

• Restructuring the Board of Directors
• Restructuring the Finance Committee
• Review of the council organizational units
• Updating the Board of Directors’ duties and responsibilities

Actions taken to implement these changes include the following:

• The "AAOS Principles of Organization" was approved by the Board of Directors at its Spring 2001 workshop
• In May 2001 the Board of Directors approved the Horizontal Integration Operational Plan, which defines those operational considerations that will ensure that the concepts of horizontal integration become an integral part of the organization.
• The AAOS Fellowship approved a bylaws amendment restructuring the Board of Directors in February 2002 to make it more competency-based and within suggested optimal numbers. Changes include the elimination of the positions of Secretary and Second Past President and addition of the Secretary of the Council of Musculoskeletal Specialty Societies (COMSS), an ex officio position of Treasurer-Elect and a lay member. These changes will be phased in at different times over the next four years.
• The AAOS Fellowship approved a bylaws amendment in February 2002 that restructures the Finance Committee to also make it more competency-based.
• In recognition of the importance of orthopaedic academic centers as a priority for the survival of the specialty, the Board approved creation of the Council on Academic Affairs in May 2001 to specifically address those issues vital to orthopaedic academic centers. The Council held its first meeting in October 2001.
• The Board of Directors approved appointment of a layperson to its ranks and began a search to identify candidates for this position.
• At it’s May 2001 meeting the Board of Directors approved sunseting and disbanding the clinical committees.

Assessment of how well the AAOS in 2005 initiative has succeeded in transforming the organization for the early 21st Century is key to the success of similar efforts in the future. Such assessment could be based upon:

• Member growth and satisfaction
• Position of the AAOS in relation to the world orthopaedic community
• Financial growth and stability of the AAOS
• Level of influence of the AAOS in the areas of advocacy
• The participation level of the potential young and new leaders in the affairs of the AAOS and organized orthopaedics.
• Members’ judgment as to the effectiveness of the AAOS programmatic endeavors that resulted from the AAOS in 2005 initiative.

The assessment process should begin to take place in 2004 or 2005.

One thing is fairly certain. There will be different challenges, opportunities and threats than those in 2002. It will be incumbent on the 2004 leadership to begin to consider what to do to prepare and position the AAOS for the end of the first decade of the 21st Century.

This model used by the leadership in 1999 and 2001, with variations on it to accommodate the future, might be a good template with which to start the initiative of the AAOS in 2010.