April 1996 Bulletin

Across the President's Desk

Time to act and counteract

It is truly an honor and privilege to send you this initial message as your Academy president. In my First Vice Presidential address I focused on the concerns we all have about how the rapidly occurring changes in health care are affecting our ability to continue to provide quality care to our patients. The problems that loom before us may seem insurmountable, but I believe that when we look back on this period of turmoil, it has the potential of being a time when our actions did make a difference in shaping our future.

There is no denying that the problems that stretch before us are real. We're faced with impending Medicare and Medicaid reforms on federal and state levels. There are proposed cuts in funding for research that could curtail the flow of medical advances, and continued regulatory constraints that divert our attention from our patients. At the same time as these problems loom before us, two profit-driven engines are dramatically changing the health care system: corporations that need to cut health care costs and managed care organizations that desire to make profits.

Time to act

While I agree that there are many reasons for concern, I do not believe there is reason for despair. This is the time for us to act and counteract.

We have already taken steps to ensure that the Academy is strong and strategically positioned to address the problems of the fellowship. We want to provide the tools for all of us to use to overcome the problems of change and to succeed in the new health care delivery environment. We have formulated a strategic plan that sets a well thought-out course for today and the future. We are constantly monitoring our strategic plan to be sure it stays in tune with the ever-changing environment.

The presidential line remains committed to the principle of continuity of leadership. We all fully participate in the planning and implementation discussions that feed into the strategic planning process. This helps assure a smooth transition from year to year without abrupt and disruptive changes in direction for the Academy which could be particularly disastrous in these perilous times. We also have strengthened our financial position through a major fiscal initiative that enhanced revenues while reducing costs throughout the Academy. This is providing more resources for the programs and initiatives which support our strategic priorities.

Education top priority

In my address I singled out four things we can do to make a difference in our future. First and foremost is education, which, quoting from the Strategic Plan, "remains the fundamental endeavor of the Academy which allows us to deliver the highest quality, cost-effective patient care and to advance the profession." We all must remain committed to our own continuing education.

Second, we must better document the quality and value of our services. The changes in both private and public sectors are cost-driven, and quality is considered too difficult to define and measure. But we're proving it can be done.

Two and one-half years ago the Academy launched an ambitious outcomes program. Working with many of the COMSS specialty societies we have developed and extensively tested four generic musculoskeletal outcomes instruments-one each, for upper extremity, lower extremity, spine and pediatric problems. A successful pilot study of our Outcomes Data Collection program has proven that it is feasible to use these instruments in a wide variety of practice settings, and to successfully transmit data to a central data base.

This year the data collection program also will begin to collect cost data and will be expanding its capacity so additional practices will be able to participate. By next year's Annual Meeting we expect to have an operational outcomes data management system capable of linking quality and costs in individual episodes of care. This will substantiate our successes with valid data, and will provide the basis for making any changes necessary to improve the quality and cost-effectiveness of the care we provide. It also will enhance our ability to negotiate individually with insurance companies.

Third, we must maintain and enhance our public education and advocacy programs. The Patient Access to Specialty Care Coalition, which was co-founded by our Washington office, has had remarkable success. During the past year we also have worked with state orthopaedic societies to develop similar coalitions to more effectively address these issues at the state level. We will continue to support these efforts.

Our public education and advocacy efforts are being refocused and expanded in the area of managed care. We are not against managed care per se. In fact, some managed care programs are providing quality, cost-effective care, and administrators, patients and physicians are satisfied. However, there are onerous aspects of other managed care programs. The Academy will work to better educate the public and government about the adverse impact of the outrageous profits which are being taken in some plans at the expense of providing appropriate care, the continuing economic incentives for physicians to withhold care, and provider "gag" rules.

'Bridge building'

Fourth, we must take the steps necessary to have greater influence on the future delivery of musculoskeletal health care. The major strategy is to work with other organizations that represent physicians who provide musculoskeletal health care, reinforcing the importance of the "bridge building" concept articulated by Jim Strickland in his First Vice Presidential address last year. The goal of the "bridge building" effort is to jointly develop models to provide coordinated care for populations of patients with musculoskeletal problems-models which will address patient needs, emphasize a team approach, insure physician control of clinical decision-making, are of high quality and are cost-effective.

We are working towards a conference of all organizations that represent physicians who provide musculoskeletal care later this year. The objectives are to promote and develop cooperative efforts in patient care models, research, outcomes, education, and advocacy. As this column is being written, 23 professional organizations have accepted our invitation to participate in a one-day Forum on Musculoskeletal Outcomes at the end of March.

As long as we keep the needs of our patients our first priority, I believe we can and will make a difference. Access to the physicians of their choice continues to be extremely important to the American public, and once quality is measured and shown to also be cost-effective, I believe it will return to its rightful place in the health care equation. Your effort and support in combination with the hard work of your Board of Directors is necessary to make this all happen.

I am eager to work with our new board which, as you may be aware, was slightly restructured this year as a result of bylaws changes adopted at the Annual Meeting. The position of Third Past President was eliminated and another Member-at-Large was added to provide a greater voice to the fellowship at large. In addition, the
at-large members will begin serving two-year terms which will help them become even more effective board members.

Meeting first-rate

I'd like to briefly shift the focus now to the Annual Meeting in Atlanta which was simply one of the best. The educational content was exceptional as the symposia, instructional courses, scientific papers and exhibits were all first-rate. Two of the symposia (Orthopaedic Challenges in the Aging Population and Chondrocyte Transplantation) were particularly timely and were enthusiastically received. Guest speakers William Bennett, Rep. Newt Gingrich (R-Ga.), Ricardo Martinez and King Constantine gave our fellows and guests a wide range of provocative thought. Social arrangements also were outstanding, capped off by Diana Ross' sensational performance at the inaugural President's Concert to Benefit OREF. All the hard working volunteers and Academy staff should be proud of what they accomplished.

This wonderful Annual Meeting was a fitting finale for Jim Strickland's presidential year. I know you all join me in expressing our heartfelt appreciation to him. He provided exceptional leadership all year, combining strong visionary talents with a steadfast commitment to always strive to do what's right, a wonderful sense of humor, and the compassion of a true friend. He and Sandy are a tough act to follow.

Finally, in closing, Jean, Kathleen and I want all of our orthopaedic family to know that we deeply appreciate your sympathy and support following the recent loss of our David.

Kenneth E. DeHaven, MD


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