AAOS Bulletin - December, 2005

A potpourri of issues and initiatives

Stuart L Weinstein, MD

In this column, I would like to address a few issues on the “AAOS plate.” The first issue on the minds of most members is Medicare reimbursement and Pay for Performance (P4P). As I write this article, the budget reconciliation process is under way. By the time you read this, that process may or may not have been completed.

Under the leadership of Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) of the Senate Finance Committee, the Senate has introduced a 1 percent update to the Medicare physician fee schedule for 2006.

However, it has tied this increase to the introduction of a value-based purchasing system, commonly known as “pay for performance.”

The Senate bill does not address the flawed Sustainable Growth Rate (SGR) formula for determining Medicare payments. It does not insure that the “quality measures” applied under the “pay for performance” requirement are determined by the physicians in each specialty area. It does not insure that the measures are pilot-tested, phased-in and risk-adjusted by demographics, co-morbidities or any other factors to prevent cherry picking. In 2007, the scheduled cuts in physician reimbursement will once again come into play, in addition to a 2 percent penalty for physicians who do not report on the “performance” measures. As a result, physicians could face a 6 percent or greater cut in fees in 2007.

On the House side, Rep. Nancy Johnson (R-Conn.) has introduced a bill that addresses the key issue—the flawed formula. There is widespread acknowledgement on the Hill that the formula is flawed, but there is some reluctance to address the expensive task of fixing it in these times of budgetary strain. The House bill would replace the SGR formula with the Medicare Economic Index (MEI) and provide a 1.5 percent update for 2006. This bill would also give physician specialty groups the responsibility of developing specific measures to be used in the P4P value-based purchasing initiative and would not penalize non-participation.

The AAOS and our Alliance for Specialty Medicine partners have been speaking to key members of the House and Senate on this issue. We have stressed to Senate leaders that if the formula isn’t fixed, access to care for Medicare beneficiaries is at risk. We have also stressed that we support the concept embodied by value-based purchasing and want to be a part of the solution. The AAOS has been a leader in this area for the last 15 years and is putting in place the infrastructure to develop guidelines and then performance measures that can be used by the Centers for Medicare and Medicaid Services (CMS). We have stressed that these measures must be relevant, evidence-based, valid, practicable, not overly burdensome, pilot-tested, phased-in and risk-adjusted.

We want to avoid the problems that followed the rapid deployment of legislation mandating use of the Resource-Based Relative Value System (RBRVS) and the Diagnosis-Related Groups (DRGs). We have emphasized that we (the physicians) are the ones who deliver the care and who will be judged by the system; therefore, we must be a part of the process.

We want to have a system that reimburses physicians for the cost of caring for Medicare patients and gives the government assurance that Medicare beneficiaries are receiving quality health care. If you have not already done so, please call your congressman and senators and voice these concerns. This is your responsibility. Just imagine the positive effect of 19,000 phone calls from the orthopaedic community!

AAOS Mission

Several issues ago, I wrote about the new AAOS Mission and Vision. At the December Board meeting, we addressed the governance structure that will help staff and volunteers fulfill our mission and deliver to you the programs, products and services you indicated that you want and need. You will be reading about this new structure in future issues of the Bulletin.

I want to emphasize an important aspect of the new AAOS goals. In the past, goals were ranked by the Board in order of importance. This year, for the first time, we have determined that all of the goals are of equal importance to our mission. The two goals of Diversity and Unity will apply to all aspects of the Academy. These goals will be woven into the fabric of the AAOS. Each structural unit of the AAOS—whether it be a Council, Committee or Project Team—will have to objectively demonstrate in its measures of success how it will address these two issues in tangible and “achievement-focused” ways. All business plans must similarly address these two issues. The Board felt that only through this total organizational commitment could these two goals be achieved. Both are essential for the vitality of our specialty.

Patient-centered care

Lastly, I want to mention our new Patient-Centered Care (PCC) initiative. The AAOS definition of patient-centered care is: the provision of safe, effective and timely medical care achieved through cooperation among the physician, an informed and respected patient (and family) and a coordinated health care team.

Although many physicians may think they practice PCC, there is a considerable amount of hard evidence that a disconnect exists between the physician’s and the patient’s perceptions in this area. I believe the best way to think about PCC is to put yourself in the shoes of a patient.

PCC is the kind of care process and interaction you expect for yourself and your family. If your spouse or child were confronted with a serious illness or injury, what would you expect from the doctor, the clinic staff or the hospital staff? That is patient-centered care in a nutshell.

Patients who are involved in their care decisions and management have better outcomes, lower costs and higher functional status. Physicians involved with PCC have greater job satisfaction, decreased liability risk, increased patient loyalty (leading to more patients) and increased efficiency of practice.

You will soon be seeing our new PCC logo, “Getting better together,” on many AAOS materials. Watch for new developments in this important area in the next few months.

Stuart L. Weinstein, MD
President, AAOS

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