Today's News

Saturday, March 13, 2004

Aging population means new challenges for orthopaedists

By Mary Ann Porucznik

It isn't only the elderly who comprise the "aging population," as the AAOS Committee on Aging knows. According to Eldon Strauss, MD, committee chair, "aging begins in the pediatric ward."

Addressing issues such as obesity and the need for exercise early can help prevent problems later, he noted. And the graying of America, as the "baby boomers" reach retirement age, presents "a major problem of enormous complexity that will not go away."

Although orthopaedists may not be the primary health care providers for aging patients, they do have a role in that care, usually as a consultant in a multidisciplinary approach. But, said Dr. Strauss, orthopaedists need to be aware of how problems such as depression and polypharmacy can affect patients.

The Committee on Aging helps raise that awareness among AAOS members. At the Annual Meeting, fellows can stop at the committee's interactive kiosk in Moscone West and test their knowledge on the treatment of older patients. As an example, Dr. Strauss noted that the emphasis in treating geriatric patients with fractures should be on functionality rather than on "a good-looking X-ray."

Medicare reimbursement
The featured speaker at the breakfast, which was cosponsored by the American Geriatrics Society, was Peter Hollmann, MD, medical director for Blue Cross and Blue Shield of Rhode Island. Dr. Hollmann said the major challenges with Medicare reimbursement included:

Dr. Hollmann reinforced the need for advocacy in this area, because the Medicare for-mula is based on the general economy, not social needs. "America is about business," he said. Regulations requiring Medicare changes to be budget-neutral limits the number of resource-value units (RVUs). He compared it to a pie that is cut in various ways, when what is really needed is a bigger pie.

Developing technologies, he said, enable more procedures to be performed on an outpatient basis. Unfortunately, monies are not shifted from Part A Medicare to Part B Medicare, because fees are not related to the work, but to the device.

Don't forget number one
He encouraged physicians to be more aware of coding, billing and claims systems to ensure that they get all the funds they are entitled to. "Make sure you code for all you do, don't forget to bill for supplies when you can, and read your contracts with payers," he advised.

"If there's one thing I've learned as a medical director for a major insurance, it's that the claims system rules," he said. He encouraged those present to get to know their medical directors and work with them, saying that he often had physicians send claims directly to him and he would "walk" them through the claims system to ensure payment.

Finally, he addressed politics. Because Medicare is part of the federal budget and "fixing" it has a definite price tag, access and availability will be key drivers. When voters can't find a physician or get access to health care, they will agitate for change. "Doctors need to lead the way, fighting for their patients. We can no longer be whiners or whipping boys," he said.

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Last modified 13/March/2004