AAOS Bulletin - April, 2006

Project team addresses on-call issues

By James H. Beaty, MD

In response to members’ concerns about orthopaedic on-call issues developing around the country and their impact on the quality of patient care, the AAOS Board of Directors established a Project Team on Orthopaedic Trauma/

On-Call Issues in June 2005. The members of the team represent orthopaedic surgeons from across the country, from many types of practices and orthopaedic specialty societies.

Over several months, the team has investigated, discussed and deliberated on how the AAOS can best represent the interests of orthopaedic surgeons in the growing crisis in emergency-care services. Its recent report included recommendations that the AAOS:

1. Issue a position statement on the role of the orthopaedic profession in providing emergency-care services, and the responsibilities of hospitals, payers and government to support orthopaedists and other physicians who provide these services.

2. Seek state legislation, modeled after laws in Texas and Florida, to raise the burden of proof in medical liability lawsuits involving physicians who provide emergency orthopaedic care.

3. Oppose plans by general surgery to create a new, acute surgical care specialty that would provide emergency-care services, including fracture care, to patients with musculoskeletal problems.

4. Examine the negative effects that shorter resident work hours might be having on emergency-care services.

5. Continue efforts to improve regulations covering the care and transfer of emergency patients through the Academy’s participation in the Trauma Advisory Group, the government advisory body on the Emergency Medical Trauma and Active Labor Act (EMTALA).

The project team also recommended that the AAOS publish information to help orthopaedists negotiate with their hospitals for (1) payment for being on-call and/or caring for emergency patients without insurance and (2) support services, including operating room time, well-trained personnel and appropriate equipment.

The Academy’s efforts at medical liability reform will continue at the state and federal levels, and these could have a significant effect on the on-call issue.

To keep our members informed and involved concerning these important issues, upcoming issues of the Bulletin will include information on negotiating with hospitals for operating-room time, high-quality equipment and personnel and reimbursement for being on-call. Subsequent Bulletins will also include up-to-date information on EMTALA and delineate the official AAOS position on many of the project team’s other recommendations.

We hope our members will be able to use these articles to begin or continue discussions with their institutions concerning on-call and emergency-care services, and that they will help keep members informed of the latest developments concerning on-call issues.

James H. Beaty, MD, is AAOS first vice president and chair of the AAOS Board Project Team on Orthopaedic Trauma/On-Call Issues. He can be reached at beaty@campbellclinic.com

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