AAOS Bulletin - August, 2006

AAOS Boards approve workforce project team and advocacy efforts, repeal position statement

The Boards of Directors of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) met in Rosemont, Ill., June 9–10, 2006, and approved AAOS participation in several advocacy efforts, participated in strategic discussions on gainsharing and musculoskeletal education at the medical school level, and voted to rescind a position statement on reprocessed single-use devices.

Advocacy projects approved

At the recommendation of the Council on Advocacy, the Board approved AAOS participation in a new American Medical Association (AMA) survey on Medicare practice expense, which will be conducted during 2007. The Centers for Medicare and Medicaid Services (CMS) is proposing a change to the methodology used to determine the practice expense portion of the physician fee schedule. Current practice expense data for orthopaedics are derived primarily from the former AMA Socioeconomic Monitoring System (an outdated data source). The AMA has been asked to coordinate this survey and plans to conduct a multispecialty practice expense survey.

The Council on Advocacy also recommended, and the Board approved, signing with some caveats the Principles for Reform of the U.S. Health Care System as developed by the American Academy of Family Physicians and other medical societies.

Paying careful attention to the Board meeting reports are (from left): David A. Halsey, MD; Ken Yamaguchi, MD; and Norman Y. Otsuka, MD.

Orthopaedic workforce

Frances A. Farley, MD, chair of the Orthopaedic Workforce Project Team, presented a proposal to create an ongoing project team on the orthopaedic workforce under the Council on Research, Quality Assessment and Technology (CORQAT). Based on research and the results of a recent symposium, it was determined that the AAOS needed to continuously monitor orthopaedic workforce issues and provide timely updates to the CORQAT and the Board of Directors as necessary. The proposal was approved.

Research projects approved

At the urging of the Board of Councilors, the AAOS Board agreed to perform a technical assessment of percutaneous therapeutic disc procedures in collaboration with other interested organizations, such as the American Association of Neurological Surgeons. The project will be led by the CORQAT. In addition, the CORQAT has also been charged with the development of comprehensive physician performance indicators to document the technical quality of care, patient safety, resource management and professionalism.

The CORQAT also requested, and the Board approved, funding for publication of Phases I, II, III and IV of Musculoskeletal Conditions in the United States, which will be used in AAOS advocacy efforts to help increase funding for musculoskeletal research.

Position statement rescinded

Upon the recommendation of the Biomedical Engineering Committee and CORQAT, the Board voted to rescind the AAOS “Position Statement on Reprocessed Single Use-Devices,” which had become out-of-date after passage of the Medical Device User Fee and Modernization Act of 2002.

Technology assessment

Joshua J. Jacobs, MD, chair of the CORQAT, presented the report of the Technology Assessment Project Team. He reported that 98 percent of members surveyed believe the AAOS should offer some form of technology assessment, which he defined as “the process of systematically reviewing existing evidence and providing an evaluation of the effectiveness, cost-effectiveness, safety and impact on the patient’s health and the health care system, of medical technology and its use.”

Three out of four respondents indicated they wanted summary reviews of current evidence and more than half (58 percent) requested treatment guidelines. Nearly eight out of 10 (79 percent) said they would be very or extremely likely to use reports on surgical techniques.

Dr. Jacobs noted that there are increasingly complex new technologies on the market, and marketing techniques tend to blur the lines of evidence and hype. While there are some concerns with implementing a technology assessment program, the project team felt it would be important to develop a Rapid Response Team to address timely issues and rapidly create evidence-based information documents for AAOS members and their patients.

PAC success continues

The Orthopaedic Political Action Committee (PAC) continues to have unprecedented success in its fund-raising activities, reported David Lovett, JD, director of the AAOS Washington office. As of April 30, 2006, the PAC had received $1,981,628 in contributions during the 2005-2006 election cycle. The funding came from a total of 3,304 contributors with an average contribution of $569; the overall member participation rate is 19 percent.

During the past few months, the PAC has sponsored several events including a fund-raiser in Washington, D.C., for Sen. Mel Martinez (R-Fla.) hosted by a delegation of Florida orthopaedic surgeons attending the National Orthopaedic Leadership Conference. The PAC also hosted three fund-raisers in conjunction with the Alliance of Specialty Medicine—for Rep. Nathan Deal (R-Ga.), chair of the Subcommittee on Health of the House Energy and Commerce Committee (SHHECC); Rep. Charlie Norwood (R-Ga.), also a member of the SHHECC; and Rep. Joe Schwarz, MD (R-Mich.).


David A. Halsey, MD, chair of the Council on Advocacy and chair of the AAOS Project Team on Gainsharing Arrangements, provided an interim report on gainsharing. Dr. Halsey pointed out that there is no single, uniform definition of gainsharing, although the term is generally used to refer to an arrangement between a hospital and a physician to share in any cost savings resulting from a specific action to improve health care delivery.

Kathryn Pontzer, deputy director of the AAOS Washington office, had prepared a white paper on gainsharing, which the Board discussed. The Ethics Committee also developed comments on the white paper. The primary focus should always be the patient’s best interest, and the AAOS can help refocus the conversation to keep patients’ interests paramount.

Musculoskeletal education in medical schools

Joseph Bernstein, MD, and Martin I. Boyer, MD, presented information on the state of musculoskeletal education in medical schools. Dr. Bernstein reviewed the results of “Project 100,” a U.S. Bone and Joint Decade initiative aimed at ensuring that all medical schools incorporate musculoskeletal education in their curriculum. Currently, only half do so, and about 80 percent of students graduating from medical school are not familiar with musculoskeletal medicine.

Dr. Boyer noted that the AAOS has published a text on Musculoskeletal Medicine and that he and Kim Templeton, MD, currently serve on the National Board of Medical Examiners. Between them, they plan to submit up to 400 orthopaedic questions for use on the development of future exams.

Revised Grade of Recommendation standards

Upon the recommendation of the Evidence-Based Practice Committee and the CORQAT, the Board approved revised Grades of Recommendations Standards that parallel those currently being implemented by The Journal of Bone and Joint Surgery. The grades will be applied to all evidence-based guidelines that are developed. The new grades are:

A—Good evidence (Level I studies with consistent findings) for or against recommending intervention

B—Fair evidence (Level II or III studies with consistent findings) for or against recommending intervention

C—Poor quality evidence (Level IV or V) for or against recommending intervention

I—Insufficient or conflicting evidence not allowing a recommendation for or against intervention

Change in Annual Meeting schedule

The Board approved a change in scheduling of the annual ceremonial and business meetings held during the 2007 Annual Meeting. The business meetings will be held on Thursday morning to allow for simultaneous specialty-focused education on both Friday and Saturday.

Communications Cabinet changes approved

As a follow-up to the Communications Workshop in April, the Board approved publishing the AAOS Bulletin on a monthly basis, beginning in 2007. Increased coverage of subspecialty issues, committees, practice management education and advocacy issues—as well as a redesign to make the Bulletin easier to read—will be addressed in the shift to a monthly publication.

James H. Beaty, MD, AAOS first vice president, presented the report of the Trauma Call Project Team as CEO Karen L. Hackett, FACHE, CAE, looked on

In addition, Frank B. Kelly, chair of the Communications Cabinet, proposed changes to the charges and structure of the cabinet, including the formation of a Member Communications Oversight Group and a Public and Media Relations Oversight Group. The new structure includes the cabinet chair and vice chair, the chairs of the oversight groups, liaisons to all councils and advisory boards as well as to the Board of Councilors and the Board of Specialty Societies.

Volunteer appointments

The Committee Appointment Committee recommended, and the Board approved a number of volunteer appointments. In addition, the Board appointed James H. Herndon, MD, to serve as chair of the 2007 AAOS Nominating Committee, which will select the some of the members of the 2008 Board of Directors.

Finally, Alan M. Levine, MD, chair of the Council on Education, announced that Thomas Johnson, MD, of Billings, Mont., had been selected as the new editor of the AAOS patient education Web site, Your Orthopaedic Connection.

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