Short Town Hall Meeting long on issues

From left, Richard F. Kyle, MD, Stuart L. Weinstein, MD, and James H. Beaty, MD, fielded question from the fellowship during Friday’s Town Hall Meeting

By Carolyn Rogers

The central themes of Dr. Kyle’s presidential address, “Together we are one,” were echoed by the Academy fellowship during an abbreviated Town Hall Meeting yesterday. The members’ comments—which centered on the need for the AAOS to advocate on behalf of orthopaedists—underscored the importance of unity not only in orthopaedics, but within the House of Medicine.

On hand to respond to members’ questions and concerns were AAOS President Richard F. Kyle, MD; James H. Beaty, MD, first vice president; and Stuart L. Weinstein, MD, immediate past president; as well as council chairs and senior AAOS staff members. Robert H. Haralson III, MD, MBA, executive director of medical affairs, served as moderator.

A number of AAOS fellows urged the Academy to take a position on matters such as pay-for-performance initiatives; direct access to physical therapists and physicians’ right to employ physical therapists; as well as various issues surrounding hospital-physician relationships.

Drs. Kyle, Beaty and Weinstein assured the audience that the Academy is investigating these issues, and is developing—or has already published—appropriate position statements and resource materials. They also detailed other advocacy efforts the Academy is carrying out on behalf of orthopaedic surgeons, as well as their patients.

Scott B, Scutchfield, MD, of Kentucky, wanted to know what actions the Academy is taking on pay-for-performance, citing concerns that it will lead to further regulations and may reward physicians for “cheaper performance” rather than “quality performance.”

The AAOS is working “very aggressively” in Washington, Dr. Weinstein responded, and is meeting with various senators and representatives to advocate for a strong role by physicians in developing any program.

“In these meetings we’ve make it clear that we’re very much in favor of improving the quality of care,” he said. “We’ve stressed that these measures must be developed by the people who deliver the care, and that they must be evidence-based, pilot-tested, phased-in and risk-adjusted.”

He added that a pay-for-performance program under Medicare should not be punitive against physicians. Instead, an incentive fund should be added to reward physicians for quality performance.

Physical therapists
An orthopaedist from Brighton, Mich., stated that “physical therapists are waging war against our using physical therapy services in our offices.” He also expressed concern about efforts to prevent orthopaedists from employing athletic trainers in their practices.

“What is the Academy’s action plan?” he asked.

“We’ve always maintained that physicians are in the best position (as well as legally, ethically and professionally responsible) to decide what type of care is required for the patient, as well as which health care professional should provide that care,” Dr. Weinstein responded.

AAOS leaders recently met with the American Physical Therapy Association, as well as the National Athletic Trainers Association to address these issues directly, said Dr. Weinstein. He also reported that the Academy will be filing an amicus curiae brief in a South Carolina physical therapy access case. In addition, AAOS wrote a letter to the Centers for Medicare and Medicaid Services (CMS) earlier this year that specifically addressed this issue.

“This is really a patient care issue,” Dr. Kyle added.

Laith A. Farjo, MD, of Ann Arbor, Mich., shared concerns about direct access to physical therapists and the right of physicians to employ physical therapists in their offices.

Orthopaedic PAC
Nearly all of the questions and concerns posed during the Town Hall underscored the fact that politics has an immediate impact on patient care and the practice of medicine. Differences among physicians on issues such as reimbursement, on-call trauma coverage and hospital negotiations need to be resolved within the medical community so they cannot be used as divisive wedges, Dr. Weinstein said. Fortunately, the AAOS has a long history of building coalitions and consensus within the medical community.

There’s also a growing recognition among physicians that we need to have a presence when decisions are being made that affect the practice of medicine, said Dr. Weinstein.

“There’s a change in the culture,” he said. “If you’re not at the table, you don’t have a voice.”

Although orthopaedics leads all other medical specialties in PAC donations, only 16 percent of AAOS members have contributed to the Orthopaedic PAC.

“It’s not in the physician culture to be politically involved, but that has to change, Dr. Weinstein said. “Donating to the PAC has to become a part of our yearly culture: You pay your dues and you pay your PAC fees.”

Some members may have doubted the PAC’s ability to be successful in its efforts, and were therefore hesitant to make a contribution, Dr. Kyle suggested.

Kathleen Weaver, MD, of Mexico, Mo., expressed the concerns of orthpaedic surgeons serving rural areas.

He hoped that recent victories—such as the $7.5 million in defense funding for orthopaedic extremity trauma research secured by the Washington office late last year—will make a difference.

“Now that we’ve demonstrated that we can be successful in Washington, I would expect that more members will be inspired to contribute,” he said.

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