April 2001 Bulletin

AAOS approves 6 statements

The AAOS Board of Directors, meeting in San Francisco Feb. 26-27, 2001, approved the following Position Statements.

Professional Liability: Federal Tort Reform. The American Academy of Orthopaedic Surgeons believes that in order to promote the equitable treatment of injured patients throughout the country, tort reform at the federal level should be a priority. The Academy believes that injured patients have the inalienable right to seek relief through the court system, and in states that lack effective tort reform, the court-based system for handling medical malpractice claims has not served the public well. Reforms should be proposed to reduce the number of frivolous suits and those of questionable merit.

Medicare Joint Replacement Demonstration Project. The American Academy of Orthopaedic Surgeons has concerns about several aspects of the HCFA demonstration project for total joint replacements. These include restrictions on choice and access for Medicare beneficiaries, the limited potential for cost savings, the type of payment arrangement being used and the marketing abuse of the term "participating centers of excellence. Because of the negative effects that the Medicare Joint Replacement Demonstration Project will have on patient care and all the other concerns outlined in this Position Statement, the American Academy of Orthopaedic Surgeons urges that the demonstration project be canceled.

Prescription Drug Coverage Under Medicare. The American Association of Orthopaedic Surgeons believes that Medicare should provide outpatient prescription drug benefits for beneficiaries in financial need who otherwise cannot afford any coverage, especially those with catastrophic, life-threatening, and/or chronic conditions requiring on-going, costly drug therapies. In particular, AAOS strongly supports Medicare outpatient prescription drug benefits for beneficiaries with debilitating arthritis, severe and chronic inflammatory conditions and osteoporosis.

The Board of Directors also approved revised Advisory Statements on:

Recommendations for Preventing the Transmission of Blood Borne Pathogens. The update was deemed necessary because many of the recommendations in the 1991 AAOS Advisory Statement on HIV are too stringent. The 1991 statement also only covers HIV, not Hepatitis B and C. The statement notes that Hepatitis B is a well- recognized occupational risk for health care workers and Hepatitis C "is the most common chronic blood borne infection in the United States. The statement lists 11 recommendations for safety during procedures and examinations.

Cell- and Tissue-Engineered Products. The status of the regulation of cell- and tissue-engineered products is evolving. As a result, such products are currently under varying degrees of regulation. Because the safety and efficacy of treatments involving less regulated cell- and tissue-engineered products may not be fully known before they are available, orthopaedic surgeons should exercise caution in using these products and similar emerging technologies. For all developing technologies including those with the highest degree of regulation, the Academy supports continued long-term monitoring of outcomes for confirmation of safety and effectiveness.

Use of Musculoskeletal Tissue Allografts. The American Academy of Orthopaedic Surgeons believes that for appropriate patients musculoskeletal allografts represent a therapeutic alternative. These tissues should be acquired from facilities that demonstrate compliance, use well-accepted banking methodology and good tissue practices. The Academy urges all tissue banks to follow rigorous national guidelines and standards. The Academy supports informed consent, for both the donor family and the recipient of human tissue, in accordance with local, state and federal laws and regulations.

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