AAOS Bulletin - August, 2006

When you talk, we listen

Richard F. Kyle, MD

As your president, I am constantly looking for ways to communicate the goals and activities of your Academy. Through face-to-face meetings, direct dialogues, e-mail and letter correspondence, telephone calls and conferences, I want you to know what the Academy is doing on your behalf, and I want to hear what you think we should be doing.

Recently, I received a letter from Jeryl G. Fullen, MD, a fellow in Salina, Kan. Dr. Fullen eloquently expressed many of the concerns I’ve heard from other fellows, and I want to share his letter—and my response—with Bulletin readers

Dear Dr. Kyle:

I appreciate the e-mail communications policy that has been adopted by the Academy. As a full-time practicing orthopaedic surgeon at a community regional hospital in central Kansas, I am frustrated by the same concerns generally shared by the Academy membership.

Our costs keep rising [and will soon] meet our reducing income. I am having difficulty paying my medical liability premium. It is quite problematic to know what to do. One concern is the Centers for Medicare and Medicaid Services (CMS) policy of reduced reimbursement. Our only leverage would be to not perform CMS-covered surgery, but most of us, I suspect, would be very reluctant to take this step.

Other concerns are the loss of control over critical elements in our medical life including encroachment by paramedicals, slow progress with tort reform, lack of influence on hospital policy decisions regarding quality of care, and the general attitude by physicians to function as individuals rather than as a team to effect important policy decisions. Contrary to public perception, physicians DO NOT work together, but they should. In spite of the Stark regulations, we must be proactive, get our political house in order and work to convert our local medical society from a social club to a vibrant entity to effect positive change for our patients and physicians.

I am trying each day to promote a positive exchange of information with my patients. There is so much nonevidence-based promotion that my patients, at least, are confused. Perhaps this is our last great opportunity—to educate our patients/consumers about what orthopaedic surgery [is and does] and to provide informed options.

I would encourage the Academy to investigate legitimate “revenue replacement activities” for its membership that are synergistic for the orthopaedic surgeon and his or her daily workload, [and] that can have a positive impact on our patients. Beyond surgical centers and MRI ownership, there are a number of opportunities that are consistent with the above statement. Thanks for your time.

Dear Dr. Fullen:

Thank you for your recent letter concerning the problems facing Academy members. As you say, orthopaedic surgeons must unite in our efforts to counteract the issues that negatively affect our practice. CMS did accept many of the recommendations made by the Relative Value Update Committee (RUC) that were based on AAOS input, including many codes for orthopaedic trauma, wrist, hand and finger services. The AAOS, however, was both surprised and disappointed that CMS—in direct contradiction of the RUC’s recommendations—proposed decreasing the value of codes for total knee and total hip arthroplasty, and open treatment of femoral neck fractures. We are partnering with the American Association of Hip and Knee Surgeons, The Knee Society and The Hip Society in formulating a response to CMS. We plan to meet with appropriate officials to address this issue before the final rule is promulgated later this year. My e-mail on these recent actions was in response to member requests for improved communications on such important topics.

The Academy is committed to educating our members, our patients and other audiences—including legislators—about the value of orthopaedic surgery and the importance of adequate compensation for the efforts of orthopaedic surgeons. We are addressing the problems faced by orthopaedic surgeons in the rapidly changing practice management and health policy landscape in several ways.

Our unified approach to advocacy will enable us to speak with one voice in Washington, D.C., and in the states to affect policies and rules that impact both general and specialty orthopaedists. Under the recent reorganization of the volunteer structure and the AAOS staff, a team of 12 employees are focused on federal and state advocacy efforts. David Lovett directs the AAOS Washington office, and Kathy Pontzer heads up federal legislative efforts. Susan Koshy oversees state relations and Bob Jasak focuses on subspecialty issues in Washington, D.C., with the orthopaedic specialty societies.

On the top of their to-do lists are efforts to pass tort reform and maintain fair reimbursement. Tort reform is absolutely essential to ensure that all patients have access to medical care. As you know, many high-risk subspecialtists are leaving regions of the country where medical liability insurance premiums are reaching all-time high levels. The AAOS is working at the federal and state levels for tort reform and has contributed more than $382,000 in grants to state orthopaedic societies. These efforts have had a positive impact in states such as Florida, Mississippi, Missouri, Nevada and Texas.

Our political action committee (PAC) is working to support political candidates and legislation that uphold our efforts nationwide. The Orthopaedic PAC targets key states where we may have a positive impact by contributing funds to political candidates and legislative efforts. It is an important organization that can effect change on many of the issues you outlined. (More information on the PAC can be found online or obtained from the AAOS Washington office, 317 Massachusetts Avenue, N.E. Suite 100, Washington, D.C. 20002, Telephone: (202) 546-4430.)

The public perception of physicians must be enhanced. The AAOS is working to unite all orthopaedic surgeons to ensure that we promote our profession and our services in the best possible light. We must speak with one voice on our concerns. The days of the “social club” are gone.

To be a vibrant, proactive organization, the AAOS will provide timely information to its members so that you can use this information in your daily life to improve your patients’ lives as well as the quality of your own life. That’s one reason we have reorganized our communication efforts to provide more information on issues of concern. As part of this effort, the Bulletin will be redesigned for easier reading, with greater focus on practice management, reimbursement, health policy and educational opportunities.

To balance the impact of direct-to-consumer advertising, the Academy has established a public education Web site, Your Orthopaedic Connection. We have allocated more than $400,000 to make this peer-reviewed site the premier source of information on musculoskeletal disease and injury for our patients and the public. We are working on a campaign to make sure our members, our patients and the public are aware of this valuable information. I urge you to refer your patients to the site and to use its materials in your own patient education programs. When patients understand the value of orthopaedic surgery and the contributions orthopaedic surgeons make to improving health care, they will become our allies and help us advocate for change.

I agree that our members need more information on revenue replacement. We intend to cover this topic in the practice management section of the Bulletin. We hope to include stories from members about the positive impact different initiatives have had on their practices. These synergistic efforts will have a positive impact on both access to and quality of patient care, as well as improve the lives of orthopaedic surgeons.

I truly appreciate your concerns and the efforts that you and other AAOS members make to provide excellent care for patients. Because of the extensive educational experience and personal sacrifice of orthopaedic surgeons, patients have unparalleled access to treatment of musculoskeletal disease, increasing their mobility and quality of life. We must bring that message to the public and to governmental agencies. Thank you again for your letter. It is right on target and we are listening.

Richard F. Kyle, MD
AAOS President


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