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Wednesday, March 15, 2000

AAOS will hold fall meeting of national organizations on hip fracture care reform

The American Association of Orthopaedic Surgeons (AAOS) will convene a meeting this fall, bringing together leaders from national organizations involved in hip fracture care to develop new models of care for hip fracture care.

The AAOS Board of Directors Tuesday approved a proposal of the Health Policy Council to invite from 15 to 20 national organizations to a meeting in Chicago to get consensus on the root of the delivery system problems facing hip fracture patients and to determine solutions as a unified group.

The mission of the meeting is to ultimately improve the continuum of care pathway for hip fracture patients, find the best management model with the best outcome and to im-plement the model throughout the nation. The meeting will be developed under the umbrella of the Bone and Joint Decade initiative, said Alan Morris, MD, chairman of the Health Policy Council. The Bone and Joint Decade is an international effort to raise awareness of the burden of musculoskeletal conditions and increase research in the disorders.

The council became interested in the care of hip fracture patients as part of its "populations at risk" initiative. A work group produced a statement, "Hip Fracture in Sen-iors: A Call for Health System Reform" which was adopted as an official AAOS Position Statement in May 1999.

The Position Statement asserts that hip fracture in seniors is a serious and costly health problem, ac-counting for 350,000 hospital admissions each year. More than 4 percent of hip fracture patients die during their initial hospitalization, 14 percent die within one year of injury and 50 percent lose they ability to walk independently.

AAOS believes incentives created by Medicare payment system and hospital utilization management activities are causing medical care organizations and hospitals to reduce lengths of stay for hip fracture patients in an effort to control health care costs.

The statement points out that reducing the length of stay for hip fracture leads to fragmentation of hip fracture care because the acute hospital phase is cut without enhancing and coordinating the post-acute phase including rehabilitation and home sup-port. The AAOS position is that "a coordinated approach to the prevention, treatment and rehabilitation of hip fracture patients is necessary to reduce morbidity, mortality, loss of independence and the overall costs to society."

The board also approved a Position Statement on "Surgical Care of the Lower Extremities." The state-ment was devel-oped in recognition that "efforts are being made by some health care providers to ex-pand their scope of p ractice beyond the limits of their education, training and experience. State laws and local practice standards frequently do not take these limits into account when establishing law and credentialing standards. In many areas of the country, practitioners with inadequate training are performing reconstructive surgery despite the risk of harm to patients."

The AAOS believes that it is in the best interests of public safety and good patient care to establish a basic set of qualifications for any health care provider performing musculo-skeletal reconstructive surgery on the foot, ankle and lower extremities. These minimum qualifications are:

AAOS believes that orthopaedic surgeons are the most qualified providers of musculoskeletal patient care. Consistent with an orthopaedic surgeon's education, training and experience this includes operative and nonoperative foot and ankle. Also, orthopaedic surgeons can function as cost-effective primary care providers for foot and ankle care in any health care delivery models.

The Position Statement outlines the attributes of board-certified orthopaedic surgeons and states that any specialty or provider group seeking surgical privileges should have one national surgical board and a uniform certification process, with examinations, like that found in orthopaedic surgery. Also, AAOS believes that the official surgical board should be recognized by the American Board of Medical Specialties, or equivalent, for the given specialty or provider group.

The AAOS position is that any specialty or provider group seeking surgical privileges should, through its nationally-recognized accrediting body, possess uniform surgical residency requirements, and a system of accredited residency programs leading to Board certification, like that found in orthopaedic surgery. Further, AAOS believes the official surgical board should be recognized by the American Board of Medical Specialties, or equivalent, for the given specialty or provider group.

The statement says that any specialty or provider group seeking surgical privileges should through its nationally-recognized accrediting body, possess uniform surgical residency requirements, and a system of accredited residency programs, leading to Board certification, like that found in orthopaedic surgery.

A Position Statement on "Health Care Plan Accountability," also approved by the board, observes that some federal protections are necessary to restore the physician-patient relationship, preserve the patient's choice of physician a nd enhance access to specialty care. Equally important, AAOS believes that all health care plans must be held accountable for their actions, plan procedures and requirements and coverage deci-sions that may adversely affect their enrollees. The AAOS supports requiring every health plan to provide for, or submit to, a binding expedited, independent external appeals mechanism or review for coverage deci-sion-mak-ing and grievances against the plan.

The board also approved becoming sponsoring member of the Intersocietal Commission for the Accreditation of Magnetic Resonance Laboratories (ICAMRL). This will give orthopaedic surgeons an alternative to the accreditation program of the American Col-lege of Radiology (ACR). AAOS learned that Aetna Insurance company was considering making the accreditation and credentialing under the ACR program, a precondition for receiving reimbursement. A review of the ACR program, indicated that it would be very difficult, if not impossible, for nonradiologists to pass.

The board also revised the Position Statement "Performance and Interpretation of In-Office Radiographic Studies by Orthopaedic Surgeons," to include alternative imaging techniques, including CT, DEXA and MRI.

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Last modified 15/March/2000 by IS