AAOS Bulletin - April, 2006

BOC serves as “the pulse of the AAOS”

By Elaine Fiedler

When it comes to issues that have a day-to-day impact on the practice of orthopaedics, you can turn to the AAOS Board of Councilors (BOC) to hear just about every point of view.

Comprised of representative fellows from all 50 states, Puerto Rico, Canada and the military, the BOC is set up to gather and convey the viewpoints of the fellowship to the AAOS leadership.

“The BOC serves as the ‘pulse’ of the Academy,” says 2005–2006 BOC Chairman Frank B. Kelly, MD. “It is the grassroots of the Academy. Our most important contribution is to give feedback and input on the issues and problems that most concern the orthopaedist.”

During the 2006 AAOS Annual Meeting in Chicago, the Board of Councilors elected new officers for 2006-2007. They are (from left): Dwight W. Burney III, MD, chairman; Matthew S. Shaprio, MD, chairman-elect; John T. Gill, MD, secretary; and Frank B. Kelly, MD, past-chairman.

The issues are growing more alarming and complex with the advent of pay-for-performance, the emphasis on evidenced-based guidelines and the continuing clash between increasing costs and decreasing reimbursements. As Dr. Kelly sees it, physicians need to understand the ramifications of all these changes and find better solutions. “All of this makes the work of the BOC that much more important,” he says.

The BOC works directly with the AAOS Board of Directors, councils, cabinets and committees to identify critical issues that concern the AAOS fellowship. It plays a crucial role in developing and promoting the Academy’s policies and programs. It serves as a conduit for communication from individual orthopaedists to the AAOS leadership, and from there to the larger community that includes other medical specialties, state and national legislators and officials and the public.

“The BOC is the voice of the practicing orthopaedic surgeon and a forum for arriving at consensus on major issues addressed by the Board of Directors,” says Past BOC Chairman Blair C. Filler, MD. He notes that over the years, the BOC has become vital to the structure of the AAOS.

How the BOC works

The BOC’s work begins by identifying issues, with input from councilors and individual fellows. The councilors discuss the issues and consider options or solutions. They develop recommendations on AAOS resolutions and proposed amendments to the AAOS bylaws. The BOC cooperates with the AAOS leadership during the resolutions process to develop policy, position statements and specific actions, which are communicated to the fellowship.

Officers of the BOC also serve on the AAOS Board of Directors, and councilors participate in various AAOS committees and task forces to help implement AAOS initiatives.

To better understand the role that the BOC has played in the life of the AAOS—and in the life of each member orthopaedist—consider what the BOC has brought to the Academy in recent years: broad communication and outreach from leadership to individual members, the establishment of the American Association of Orthopaedic Surgeons and its affliated Orthopaedic Political Action Committee (PAC), the development of a Professional Compliance Program and expert witness Standards of Professionalism, increased involvement with musculoskeletal specialty societies and increased efforts to tell the orthopaedic story on Capitol Hill.

Political advocacy and legislation

The BOC’s role as advocate—for musculoskeletal patients and for the profession of orthopaedic surgery—may be one of its most far-reaching and relevant contributions.

The National Orthopaedic Leadership Conference (NOLC)—which was the brainchild of the BOC—and the AAOS political advocacy agenda are particularly significant today. During the past 20 years, the NOLC has developed into a cross section of organized orthopaedics that includes the Board of Specialty Societies/Council of Musculoskeletal Specialty Societies (BOS/COMSS), state orthopaedic society representatives, AAOS board members and younger orthopaedists who are training to become future AAOS leaders through the Leadership Fellows Program.

The NOLC agenda generally includes discussions and strategy sessions on a number of issues, ranging from how to correct the flawed Medicare payment formula to addressing scope-of-practice legislation, direct access and imaging services. For an extensive report on the past year’s NOLC, see the June 2005 issue of the AAOS Bulletin at www.aaos.org/bulletin

The NOLC enables many councilors to get involved in the political process. Combining their interests in advocacy and activism, councilors have formed close working relationships with congressional representatives. At the past year’s NOLC, members of the Georgia contingent personally visited 13 of the 15 congressional offices from their state. Dr. Kelly was among those who actively supported fellow Georgian Tom Price, MD, who in 2004 became the first orthopaedic surgeon ever elected to Congress. Representative Price has spoken at the NOLC and at the PAC Luncheon at the AAOS Annual Meeting and continues to maintain a strong working relationship with Dr. Kelly, the BOC and the AAOS.

The “conscience” of the Academy

The councilors have always firmly believed that the issue of medical ethics is critical to the orthopaedic community. Promoting ethical standards, identifying emerging concerns and keeping AAOS position statements consistent with current ethical standards, the councilors agree, are fundamental aims.

Dwight W. Burney III, MD, 2006–2007 BOC chair, and other BOC members are especially proud of the AAOS’s Professional Compliance Program, which resulted from a BOC resolution. “This program,” says Dr. Burney, “has replaced an aspirational set of guidelines with Standards of Professionalism for AAOS members, the violation of which can result in expulsion from the organization. We had very high standards for achieving membership, but minimal—if any—standards for continuing membership, and that has changed for the better with the Professional Compliance Program.”

The Professional Compliance Program grew out of a BOC Advisory Statement and open microphone session about the issue of inappropriate expert witness testimony. A project team, under the leadership of former BOC Chair David A. Halsey, MD, was established and, during the next two years, developed the first three Standards of Professionalism (SOPs). The Professional Compliance Program and the initial SOPs were approved by an overwhelming vote of the fellowship in April 2005.

The unpredictable “open mike” sessions at BOC meetings are opportunities to discuss many issues, and ethical questions are often debated. Recently, participants discussed the issue of conflicts of interest (for example, physicians receiving fees in exchange for using products promoted by specific companies) and the related issue of gainsharing (for example, a surgeon might share with a hospital profits that result from implanting a less expensive prosthesis). The debate is sometimes intense but necessary.

A new sense of urgency

Dr. Kelly senses more urgency in the practice of medicine today. “The issues we are facing today are much more frightening and much more complex [than in the 1970s when the BOC was founded]. All of which makes the work of our BOC that much more important,” he says.

“The constant threat of malpractice litigation, the increasing control by governmental agencies and managed care organizations, the increasing expectations of our patients, the significantly decreasing reimbursement for our care coupled with the ever-escalating rise in our expenses—these and many more obstacles have all made the practice of medicine much more difficult now,” he adds.

Dr. Kelly is especially eager to actively involve more councilors in BOC projects. In the past year, the BOC established eight different “work groups” so that councilors could become involved in the development and resolution of such issues as physician stress, ER and trauma call, alternatives to conventional medical liability insurance, and e-mail communication, among others. These groups involve more councilors in the process to gather information and take action.

Looking ahead, the BOC plans to publicize and promote the AAOS patient-centered care initiative. It will also be encouraging financial support for advocacy initiatives, especially in view of the approaching November elections. The BOC plans on calling attention to local, state and national candidates who support orthopaedic surgeons’ views.

And there are bound to be more topics up for discussion, given the BOC’s directive. As Dr. Burney puts it, “I consider the BOC to be both a think tank and a beta tester for new ideas and programs for AAOS.”

No shortage of ideas or energy

What is perhaps most extraordinary about the members of the BOC, past and present, is their deep concern, commitment and sheer hard work on behalf of AAOS members. They each have their own practice or position but feel so strongly about the critical issues facing orthopaedists that they take the time and make the effort to do something. The councilors hope that other orthopaedists and members of the AAOS will also participate—whether it’s with a comment or idea in an e-mail on the AAOS Web site, or with further involvement, through the Leadership Fellows Program, the state orthopaedic societies or political advocacy.

AAOS fellows can contact councilors easily anytime via e-mail by visiting the BOC section of the AAOS Web site. Whatever the topic—criticism, new idea, concern or question—member contact is always welcome.

Current BOC projects

• Advocating for appropriate physician reimbursement from government (Medicare) and nongovernment payors (commercial insurance) so that patients continue to have access to quality musculoskeletal care

• Advocating for medical liability reform at the state and federal levels

• Promoting orthopaedic surgeons as the primary providers of musculoskeletal care and educating legislators as to why orthopaedic surgeons are better prepared to deliver this care than some other health care providers

• Averting a crisis in the delivery of emergency room and trauma care and advocating for reasonable reimbursement for trauma care

• Ensuring that the AAOS fellowship is informed about current issues under discussion

• Encouraging support of the Orthopaedic PAC and other advocacy-related campaigns such as the Doctors for Medical Liability Reform

• Ensuring that pay-for-performance measures are evidence-based and effective

Enhancing patient care and promoting the public interest by helping to develop new SOPs for AAOS fellows


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