Members pose questions, get answers at Town Hall Meeting

Members pose questions, get answers at Town Hall Meeting

By Jennie McKee

A spirited discussion centering on pay-for-performance, utilization review physicians, and reimbursement took place during Thursday’s Town Hall Meeting.

On hand to respond to members’ questions and concerns were AAOS President James H. Beaty, MD; Anthony Rankin, MD, first vice-president; Richard F. Kyle, 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.

Dr. Haralson provided ground rules for participating in the meeting. “You can ask a question or make a statement,” said Dr. Haralson, adding that comments should be kept to less than three minutes.

Richard F. Kyle, MD, James H. Beaty, MD, and E. Anthony Rankin, MD, hosted a Town Hall Meeting for AAOS members.


“In a very challenging health care environment, there are a variety of inter-related issues that impact upon access to our care,” said Gary Friedlaender, MD, of New Haven, Conn., who then asked the panel to comment on the Academy’s position on pay-for-performance.

Dr. Kyle, who has recently visited the Centers for Medicare and Medicaid Services, said that the development of the guidelines for pay-for-performance was one of the major topics discussed. He stated that the Guidelines Oversight Committee is currently prioritizing which guidelines to review first, and that the Academy is interested in being in sync with CMS’ efforts. He noted that the Academy is involved in shaping the guidelines, rather than the government doing this on its own.

Joshua J. Jacobs, MD, chair of the Council on Research, Quality Assessment and Technology, which oversees the Guidelines Oversight Committee, said that the Academy’s approach to pay-for-performance is that if orthopaedic surgeons have performance measures, they “have to be evidence-based performance measures developed from evidence-based guidelines.” Dr. Jacobs added that “the Board of Directors has invested a lot of money in building up the evidence-based portion of the research department.”

Brian S. Parsley, MD, of Houston, Texas also spoke about pay-for-performance, stating that many members don’t have a good understanding of this subject and that an analysis of the incentives versus the costs involved in pay-for-performance is warranted.

Communicating through local media outlets

Another issue brought up was the need to create a Web site of articles to serve as a resource for members to use when responding to articles about orthopaedic issues that appear in their local publications. Relevant articles could be posted online so that orthopaedists can reference them and provide “meaningful, evidence-based responses” to articles that may be written by malpractice attorneys or others who do not share the same perspectives as members.

Dr. Kyle stated that although there is usually a response to these kinds of articles from someone in the presidential line, some opportunities to offer the Academy’s perspective in these publications can be missed. Dr. Kyle said that the Academy is in the process of revamping some of its communications efforts and considering new Web site efforts, adding that he feels that constructing this kind of communications mechanism would be beneficial.

Review physicians

The question of the Academy’s stance on utilization review physicians was raised by Craig Alan Zeman, MD, of Oxnard, Calif., who feels that issues related to review physicians require the same sort of attention that the Academy recently gave to establishing standards of professionalism (SOPs) for expert witness testimony. Dr. Kyle responded that the Council on Advocacy, which established the SOPs for expert witness testimony, is growing and that the issue of review physicians is one that it could evaluate to make sure that professional standards are established.

Other issues brought up were funding for advocacy issues and educating patients about the need to advocate on behalf of their physicians, as well as the need for support of non-operative orthopaedic surgeons.

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