December 2004 Bulletin

Board approves group purchasing program, advisory/position statements; discusses enduring educational materials

By Susan A. Nowicki, APR

The Boards of Directors (BOD) of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) met October 8-9 in Rosemont, Ill., and took the following actions:

Group purchasing program approved. Upon recommendation of the Council on Health Policy and Practice, the Board approved a proposal for establishing a group-purchasing program that would enable fellows to purchase medical, surgical, office and other supplies at discounted prices. Members of BONES, the national society for orthopaedic practice administrators, will help to develop the initial formulary, which will be modified as participants identify products they use most frequently. The program is designed to be a service to AAOS members and participation will be voluntary. There will be no up-front charges or member fees to program participants. Negotiations with a potential outside vendor will now move forward; final details of the program will be presented to the fellowship early in 2005.

Professional Compliance Program. David A. Halsey, MD, chair of the Professional Compliance Program/Expert Witness Project Team and chair of the AAOS Council on Health Policy and Practice, presented the charges for the new Judiciary Committee and the Committee on Professionalism, which fall under the AAOS Professional Compliance Program. The BOD approved the charges. It will be the responsibility of these committees to hear and adjudicate alleged violations of the AAOS Bylaws and Standards of Professionalism. The proposed Standards of Professionalism, including one dealing with expert witness testimony, will be presented to the fellowship for discussion at the 2005 Annual Meeting and for approval shortly thereafter. In a related matter, Dr. Halsey also reported that one-third of the AAOS membership (5,993 fellows) have signed the Expert Witness Affirmation Statement. Through this document, orthopaedic surgeons acknowledge their duty to act professionally when testifying as expert witnesses in civil or administrative proceedings.

Communications Skills Mentoring Program will continue. John R. Tongue, MD, chair of the Communications Skills Mentoring Program (CSMP), presented the results of the three-year project. This program, which was established in February 2001, has achieved all of its goals with outstanding results. More than 100 communications skills workshops were held, 25 Academy members were trained as Communications Skills Mentors and three educational video vignettes were produced. Approximately 1,350 orthopaedic surgeons, residents and allied health workers participated in the workshops.

This project was done in cooperation with the Bayer Institute for Health Care Communications. Its objective is to enhance orthopaedists’ communications skills to achieve improved patient and physician satisfaction, better patient adherence to treatments and better outcomes. Dr. Tongue noted that, while the program has already been successful, it will be especially important in the future because of several factors: (1) patient/physician communication will be an Accreditation Council for Graduate Medical Education/Residency Review Committee requirement for each residency program beginning September 2005; (2) the American Board of Orthopaedic Surgery Maintenance of Certification process will require a voluntary patient satisfaction survey; and (3) medical liability insurance companies are beginning to offer discounts for communications education. For these reasons, the CSMP recommended continuing the program. The BOD voted to approve, in concept, continuation of the Communications Skills Mentoring Program for three more years, pending development of a business plan.

Position Statement on Direct-to-Consumer Advertising approved. At the recommendation of the Project Team on Direct-to-Consumer (DTC) Advertising of Pharmaceuticals and Devices, led by Peter Mandell, MD, the BOD approved a new “Position Statement on Pharmaceutical and Device Company Direct-to-Consumer Advertising.” Since the late 1990s, DTC advertising has become a multi-billion dollar enterprise. Understandably, drug and device companies want to be sure that patients recognize the availability of their products. However, DTC advertising also has the potential for negative consequences. For example, advertising may confuse patients by implying that minor differences among competing products represent major therapeutic advances.

The position statement reads in part:

The American Academy of Orthopaedic Surgeons believes Direct-to-Consumer advertising that is presented in a responsible and ethical manner may be of some value to patients. Such information should be scientifically substantiated, accurately presented and free of false or misleading claims. Direct-to-Consumer advertising and marketing of pharmaceuticals, devices or surgical procedures may create patient safety concerns if they lead patients to seek health care solutions without consulting with a physician.

The full text of the statement is posted on the AAOS Web Site.

Advisory Statement on Communicating Adverse Outcomes approved. The BOD approved an Advisory Statement on Communicating Adverse Outcomes developed by the Patient Safety Committee, under the direction of David A. Wong, MD. The responsibility to inform a patient or his/her family of an adverse health care outcome is an inevitable part of the practice of medicine. Adverse events or disappointing outcomes do not necessarily occur as a result of an error or negligent care; these results occur for multiple reasons, including uncorrected “unreasonable” expectations, complicating biological factors and courses of treatment or surgery that don’t work out as anticipated.

When such an event happens, a patient often wants acknowledgement and understanding, an assurance that the physician will take steps so that the event will not occur again or risks of similar occurrence will be minimized, and an apology (if appropriate) and consideration of the financial impact on the patient.

The advisory statement says:

Consistent with the Joint Commission on Accreditation of Healthcare Organizations standards and the American Academy of Orthopaedic Surgeons’ Principles of Medical Ethics and Professionalism, the AAOS believes that an orthopaedic surgeon should put the interests of the patient first and communicate directly with a patient/family member in an honest, compassionate manner as soon as possible after an adverse event occurs. …

If an error is the cause of the adverse event, the orthopaedic surgeon should coordinate with the risk manager or legal counsel to determine the amount of detail that should be provided in any discussion. Some information, such as peer review matters, root cause analysis material, results of disciplinary actions and legal counsel communications are privileged and should not be a part of the discussion with the patient. Similarly, if the event could escalate to a claim, in certain states expressions of sympathy relating to the pain, suffering or death of a patient made to the patient/family member are not admissible in court as evidence of an admission of liability, whereas statements of fault are considered admissible evidence.

The physician-patient relation is built upon trust and honesty. The AAOS Code of Medical Ethics and Professionalism reinforces these principles in section II.A., which states: “The orthopaedic surgeon should maintain a reputation for truth and honesty. In all professional conduct, the orthopaedic surgeon is expected to provide competent and compassionate patient care, exercise appropriate respect for other health care professionals and maintain the patient’s best interests as paramount.” Consistent with these principles, the AAOS urges orthopaedic surgeons to behave in a manner consistent with these recommendations when communicating about adverse events with patients and their family members.

The full text of the statement is posted on the AAOS Web Site.

Position Statement on Evidence-Based Guidelines approved. At the recommendation of the Council on Research and Scientific Affairs, the BOD approved a “Position Statement on Evidence-Based Guidelines.” The main goal of the statement is to improve clinical performance and the quality of care by closing the gap between knowledge and practice. Although many organizations, including the AAOS, have turned to the development of clinical practice guidelines to improve the quality of care, the Council noted that practice guidelines have often generated conflict and controversy.

The position statement reads in part:

With the current trend toward developing physician performance measures for quality improvement and accountability, it must be remembered that evidence-based performance measures can only be derived from evidence-based guidelines. The AAOS supports the development of evidence-based practice guidelines by the Academy and other organizations, and encourages the implementation of evidence-based guidelines by regulatory and accrediting agencies to improve physician performance and ensure the quality of care for orthopaedic patients. The AAOS believes that implementation of evidence-based guidelines will result in improved quality of care for patients by reducing over- and under-utilization of diagnostic tests and treatment modalities.

The full text of the statement is posted on the AAOS Web Site.

2005/2006 LFP class approved. James N. Weinstein, DO, chair of the Council on Academic Affairs, presented the list of candidates for the 2005/2006 class of the Leadership Fellows Program (LFP), which was approved by the BOD. Of 91 applicants, 15 were selected to participate in the leadership training and mentorship program. The new LFP fellows include: Alexander Blevens, MD; Joseph A. Bosco III, MD; Craig R. Bottoni, MD; David L. Cannon, MD; Thomas M. DeBerardino, MD; Daniel W. Green, MD; Alan S. Hilibrand, MD; Richard L. Illgen II, MD; Douglas W. Lundy, MD; Paul A. Manner, MD; Albert W. Pearsall, IV, MD; Vincent J. Silvaggio, MD; Brett A. Taylor, MD; Kimberly J. Templeton, MD; and Kristy L. Weber, MD. A more detailed report about the LFP class of 2005/2006, including their mentors, can be found on page 52.

Volunteer appointments approved. The BOD approved a number of committee and council appointments recommended by the Committee on Committees. Among those actions, Alan M. Levine, MD, was appointed as the new chair of the Council on Education; he replaces Joseph D. Zuckerman, MD, whose six-year appointment will conclude in February 2005. This necessitated Dr. Levine’s resignation as editor of the Journal of the American Academy of Orthopaedic Surgeons; a search for a new editor is underway. James H. Herndon, MD, was appointed the AAOS representative to the Board of Trustees for the Journal of Bone and Joint Surgery.

Annual Meeting. The BOD agreed with the recommendation to hold the 2009 AAOS Annual Meeting in Las Vegas, Nev.

New class of fellows. The BOD approved the Class of 2005, a total of 547 new active fellows.

Strategic discussion on competition in enduring materials. Highlighting the meeting was a strategic discussion on the competitive threats impacting the Academy’s enduring materials (educational) products. The session included an in-depth presentation by representatives of an outside firm that had been retained to perform an analysis of the Academy’s publishing program. The consultants made a number of recommendations and provided strategies the Academy can use in reinforcing its position in the marketplace, as well as in expanding its market share in the non-Academy market. The Competition Study Report was referred to the Publications Committee and the Council on Education for review and action. The Board asked the council to prepare an action plan for responding to the recommendations and report at the February 2005 Board Meeting.

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