AAOS Bulletin - April, 2005

Members raise concerns during 2005 Town Hall

Expert witness, specialty hospitals, imaging services among issues

By Carolyn Rogers

AAOS fellows made their voices heard on a wide range of issues affecting orthopaedics at this year’s Town Hall Meeting, held during the 2005 Annual Meeting in San Francisco. The gathering took place on Friday, Feb. 25, immediately following the Business Meetings.

AAOS President Stuart L. Weinstein, MD; Richard F. Kyle, MD, first vice president, and Robert W. Bucholz, MD, first past president, as well as Council chairmen and AAOS staff members were on hand to answer members’ questions and respond to comments on a number of topics, ranging from medical liability reform and standards of care to medical saving accounts and direct-to-consumer advertising by drug companies.

The session had no set agenda and was moderated by Robert H. Haralson III, MD, MBA, executive director of medical affairs.

(Left to right) First Vice President Richard F. Kyle, MD; President Stuart L. Weinstein, MD, and First Past President Robert W. Bucholz, MD, responded to member concerns during the 2005 Town Hall Meeting.

Expert witness

Brian S. Ziegler, MD—who earned a standing ovation at last year’s Town Hall for an impassioned statement that called on the AAOS to implement an expert witness review board—spoke this year as well.

A much happier Dr. Ziegler stepped to the microphone this time, primarily to commend the AAOS leadership for responding to members’ needs, and to express his support for the Academy’s new Expert Witness Program and the proposed Standards of Professionalism.

“I want to thank the Academy leadership for all the excellent work they’ve done in developing the Professional Compliance Program,” he said. “I think this program will be extremely effective in eliminating false and misleading expert testimony, which I believe is [partly responsible] for the malpractice situation that we have today.”

Acknowledging this year’s somewhat lower turnout, Dr. Ziegler suggested it might be due “not to a lack of interest among the membership, but rather is reflective of members’ happiness that there is no ‘hot button’ issue that is not being addressed at this time.”

Richard J. Sternberg, MD, expressed concern about the “unintended consequences” that could arise from the program. “We do not want standards of care to be based on malpractice cases,” he said.

Dr. Bucholz agreed. “The purpose of the expert witness program is not to set standards of care, because they may shift as technology and education evolve. Rather, the program hopes to ensure that testimony provided is fair, impartial, and within generally accepted norms.”

David A. Halsey, MD, chair of the Council on Health Policy and Practice, pointed to the 20-year-old program of the American Association of Neurological Surgeons, noting that defining standards of care has not been a problem there.

Other issues

The discussion of standards of care led to a need for evidence-based guidelines and cultural competence in treating patients of different backgrounds. Dr. Weinstein pointed out that Level 1 studies (the highest level of evidence-based studies) were rare, and noted that good practice guidelines are based on “the synthesis of best research evidence with clinical experience and patient values.”

The fate of specialty hospitals and the current moratorium on their construction was another topic raised by fellows. Peter J. Mandell, MD, past chair of the Board of Councilors, reinforced the AAOS commitment to supporting the development of specialty hospitals, and Dr. Bucholz discussed a joint workshop with the Board of Councilors that was held on the topic.

Another member raised the issue of health savings accounts and their importance in moving the health care system to a more market-based approach. David J. Lovett, JD, director of the Washington office, responded that efforts are underway to expand the availability of health savings accounts and empower patients.

Imaging services

The ongoing efforts by radiologists to prevent other physicians from providing X-rays and other imaging services in their offices was also raised. The issue, according to one member, is still “under the radar screen” of most orthopaedists.

Lovett explained that the radiology community is trying to position itself as the most appropriate imaging providers and is attacking the motives of physicians who provide these services in settings other than an imaging facility or hospital. He noted that 91 percent of readings are already done by radiologists, with all other physicians accounting for only 9 percent of readings.

Proposals to curb imaging by non-radiologists have surfaced in several states, and the radiologists are using legislative, regulatory and media channels to give this issue national importance. (See “From the States” on page 22.)

In addition, “the American College of Radiology has been going to Capitol Hill to convince legislators that non-radiologists are over-utilizing imaging services,” Lovett said. “We’ve been responding by going to the Hill as well. We’ve also created a coalition of 26 medical groups, ‘Physicians for Patient-Centered Imaging,’ which is meeting regularly.”

The coalition aims to preserve physicians’ right to perform imaging tests for their patients, and is actively refuting the radiologists’ claims by providing information about the appropriate use of imaging in managing patient care to legislators, payer organizations, and the public.

Unfortunately, “this issue, and their claims about over-utilization, is undermining our efforts to correct the Medicare payment formula,” Lovett said.

Like last year, several members were still lined up at the microphones—questions in hand—when the session drew to a close.

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