AAOS Bulletin - December, 2005

Boards approve practice management education program, benchmarking project, amended position statements

By Susan A. Nowicki, APR

At their Sept. 23-24 meeting in Rosemont, Ill., the Boards of Directors (Board) of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) approved the Class of 2006 for membership and gave the go-ahead for several new projects. The meeting also featured presentations and discussions on issues surrounding pay for performance and intellectual property/indemnification.

The Board approved a new position statement on “Consensus Standards for Medical Devices,” an updated version of the “Advisory Statement on the Importance of Good Communications in the Physician-Patient Relationship,” and amended versions of the AAOS Opinions on Ethics and Professionalism regarding “Health Research in Orthopaedic Surgery,” “Sexual Harassment and Exploitation,” and “The Orthopaedic Surgeon’s Relationship with Industry.”

In addition, the Board discussed the impact of Hurricane Katrina on members and the AAOS, and appointed a project team to assess how the AAOS might best help members affected by the recent hurricanes. Board members appointed to the project team include Matthew S. Shapiro, MD, chair; Oheneba Boachie-Adjei, MD; and Joseph C. McCarthy, MD. Mark Wieting, AAOS chief education officer, will serve as the staff liaison.

The Board also heard progress reports on several key AAOS activities and projects. Meeting highlights are summarized below.

Class of 2006 approved

The Board approved the Class of 2006, which totaled 714 new members, for AAOS membership. The class includes 581 Fellows; 121 Associate Members – Osteopathic; eight Associate Members – Orthopaedic; two Associate Members – Basic Science, and two Associate Members – Allied Specialty.

Professional Compliance Program

As the final step in moving the AAOS Professional Compliance Program (PCP) forward, the Board approved the Professional Compliance Procedures and Grievance Report. The Committee on Professionalism and the Judiciary Committee are well-established; their members have received training on the program’s procedures and are ready to begin fully implementing the program. The Board also voted to disband the Expert Witness Project Team, with commendation.

Phase II of MLR Campaign

AAOS President Stuart L. Weinstein, MD, provided a preview of the launch of Phase II of the Medical Liability Reform (MLR) Campaign. The campaign rollout occurred on Oct. 6 with a national media roundtable held in Washington, D.C., and a radio broadcast blitz in Maryland and Washington state.

This effort is sponsored by Doctors for Medical Liability Reform (DMLR), a nationwide coalition of more than 230,000 physicians dedicated to advancing meaningful federal medical liability reform. The AAOS is a founding member of DMLR and Dr. Weinstein is its current chairman. The campaign goal is to keep liability reform at the forefront of the national debate and to build a grassroots network in key states.

The campaign launch introduced a redesigned, interactive Web site that encourages both physicians and patients to engage in the effort to pass medical liability reform legislation. The Web site includes educational information about the medical liability crisis and updates on reform efforts across the country. It also features a series of animations that uniquely illustrate the effect of the crisis on patient care.

Visitors to the site can sign and submit petitions that highlight the need for reform on a federal level. Citizens committed to medical liability reform can use the site to make their views known in Congress. Although primarily geared to patients, the site includes a separate section for physicians.

Academic practice benchmarking project

The Board approved an Academic Practice Benchmarking project at the recommendation of the Council on Academic Affairs. The Academy will work with the University Health System Consortium’s Family Practice Solutions Center to develop clinical benchmarks for nine musculoskeletal subspecialties utilizing CPT data. The goal is to establish these benchmarks by 2008. (See related article)

New practice management education program

The Board approved a joint proposal from the Council on Health Policy and Practice and the Council on Education to establish an AAOS Practice Management Education Program. The plan calls for the AAOS to expand its practice management education efforts and to become involved in an array of new activities, including a multi-day review and update course, audio programs, articles delivered via e-mail and a self-assessment examination.

Contribution to Tipton fund

In recognition of the accomplishments and unique character of former AAOS Executive Vice President William W. Tipton Jr., MD, the Board approved a $50,000 contribution to the William W. Tipton Jr., MD, Orthopaedic Leadership Endowment, a permanent endowment maintained through the Orthopaedic Research and Education Foundation. The endowment will recognize and nurture outstanding orthopaedic leaders. An award of $5,000 will be presented each year at the AAOS Annual Meeting. To learn more, visit: www.oref.org/inmemoriam.html.

Pay for Performance

Joshua J. Jacobs, MD, chair of the Council on Research and Scientific Affairs, and David A. Halsey, MD, chair of the Council on Health Policy and Practice, made a joint presentation to the Board about the issue of Pay for Performance (P4P). They provided an overview of both the short- and long-term issues facing orthopaedic surgeons.

The short-term strategy of the AAOS is to comment on the four performance measures for orthopaedic surgery proposed by the Centers for Medicare and Medicaid Services (CMS) and provide input for two alternative performance measures. The four published measures are:

1. Documentation that there was thromboembolism prophylaxis.

2. Documentation that prophylactic antibiotics were administered within one hour of the incision.

3. Documentation that the Foley catheter was removed within 24 hours of the procedure.

4. Documentation that that there was respiratory prophylaxis.

Following a conference call among selected AAOS members to discuss the four measures, it was agreed that the first two were acceptable but that a surgical “time-out” and “follow-up of fragility fractures” should be substituted for the second two. These recommendations were forwarded to CMS.

The long-term strategy is to develop treatment guidelines that contain evidence-based information and to develop performance measures where appropriate. However, this is a costly process and a cadre of physicians specializing in evidence analysis will need to be trained. Both council chairs will present a formal proposal for developing guidelines at the December 2005 Board meeting. Although the start date for P4P depends on the legislation that is enacted, it will likely occur sometime in 2006.

Indemnification/intellectual property

Alan M. Levine, MD, chair of both the Council on Education and the Indemnification/Intellectual Property Issues Project Team, provided a list of recommendations regarding member contributions to AAOS publications, courses and scientific sessions. In early 2005, Academy-wide concerns arose when course presenters and authors were reluctant to sign non-exclusive license and assignment of rights forms because of the indemnification clause in these agreements, which they believed placed an undue burden on the presenter or author. Under these clauses, the author agreed to indemnify the AAOS and be responsible for all claims that might arise from the Academy’s use of the material.

Dr. Levine noted that when the AAOS Board of Directors and the Council on Education reaffirmed the use of such indemnification clauses in 1997, it was felt the indemnification clause “gave teeth” to the warranty by each author that the material is original, does not infringe copyright and is not libelous or injurious to another’s property or person. In addition, the Project Team discussed this issue with outside attorneys, underwriters and insurance brokers. The inclusion of an indemnification clause is seen by multimedia insurance companies as a preventive measure that helps protect the Academy against intellectual property claims.

After reviewing copyright/intellectual property policies from the AAOS, other national medical societies and other medical publishers, the Project Team developed six recommendations, which were approved by the Board:

1. Continue to require the use of non-exclusive license for materials presented in courses or scientific presentations.

2. Continue to require an assignment of rights for enduring materials, with ad hoc exceptions for certain illustrations.

3. Eliminate the indemnification clause in AAOS licenses and assignments of rights forms and replace it with an explicit warranty statement that includes the author’s or presenter’s acknowledgement and understanding of copyright principles, and acceptance of responsibility and consequences for knowingly making false statements.

4. Create a comprehensive education plan so that all authors and presenters understand their intellectual property rights and responsibilities.

5. Develop a Standard of Professionalism on “Research and Academic Responsibilities,” including provisions dealing with plagiarism, for vote of the Fellowship after the 2006 Annual Meeting.

6. Solicit multimedia insurance for 2006 in the amount of $5 million.

Statements approved

The Board approved a new position statement, “Consensus Standards for Medical Devices,” advanced by the Council on Research and Scientific Affairs and the Biomedical Engineering Committee. According to the statement, it is important that the Academy state its support for the development of standards that will help ensure a minimum level of quality and performance for medical devices, regardless of their country of origin. The statement notes in part, “The AAOS supports the continual, ongoing involvement of orthopaedic surgeons in monitoring national and international standards important to the practice of orthopaedics for clinical relevance, revising them as clinical evidence and technology warrant.” The entire statement can be found at AAOS Web site.

Upon recommendation of the Ethics Committee, the Board approved revisions to the “Advisory Statement on the Importance of Good Communications in the Physician-Patient Relationship.” The revised statement has been enhanced with additional material concerning the informed consent process. It can be found online.

The Board also amended the current Opinion on Ethics and Professionalism on “Gifts and the Orthopaedic Surgeon’s Relationship with Industry.” It was renamed “The Orthopaedic Surgeon’s Relationship with Industry” and changes were made to further clarify the section on consulting arrangements.

The Board further approved the amended Opinions on Ethics and Professionalism regarding “Health Research in Orthopaedic Surgery” and “Sexual Harassment and Exploitation.” All of the opinions can be found online.


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