January 1996 Bulletin

Across the President's Desk

The 'Bridge Building' begins

"Thus out of small beginnings, greater things have been produced...."

William Bradford,
Plymouth Plantation [1620-1647]

During this year's strategic planning process, the Academy's Board of Directors has clearly and unanimously indicated an almost urgent need for the Academy to begin to develop strong, cooperative relationships with other organizations who represent providers of musculoskeletal services. The strong commitment to begin to develop these relationships was evident when the final prioritization of the Academy's 1996 objectives ranked this objective - under the "Patient Care" category - near the top of the list:

"Work with other organizations representing providers of musculoskeletal services to develop systems of patient management that will be physician-controlled, cost-effective, and preserve timely access to specialty care. These cooperative efforts may include research, provider education, patient education, advocacy, and patient care models and tools."

The Board optimistically believed that if all such organizations can work in unity to develop integrated systems for providing high quality, cost-effective patient care, the opportunity to maintain or even regain physician control of musculoskeletal care would be greatly enhanced.

I believe that the emphasis on interorganizational, interdisciplinary dialogue, and collaboration was further strengthened by the superb report from the Academy's Work Group on the Role of Orthopaedic Surgeons in Future Delivery Systems for Musculoskeletal Care which was extremely well-received by the Board at its December meeting. After conducting an exhaustive and comprehensive "environmental assessment," the work group submitted an insightful and compelling report that should be of great interest to all orthopaedic surgeons and particularly valuable to the Academy's Board as it tries to establish policies which will best prepare our specialty for the future. The following are a few selected excerpts from that report which illustrate key findings and implications relative to the "bridge building" initiative:

"Open and easy communication that fosters the timely, appropriate exchange of patients and patient information between primary care providers and orthopaedists will be essential for the success of orthopaedists in managed care organizations regardless of system or payment method.

"Musculoskeletal providers, both MDs and allied professionals, will need to work together to enhance communication to provide the most cost-effective, value-added medical care in the evolving systems. The improved communication will be for the benefit of the patients.

"Orthopaedists must build good communication and strong working relationships with the first contact musculoskeletal providers.

"Orthopaedic surgeons will need to be more 'customer service' oriented, and to demonstrate 'team player' attitudes and behaviors. These will determine their success with patients and colleagues, when managing the musculoskeletal needs of populations of patients.

"Orthopaedic surgeons should be leaders in educating musculoskeletal providers at the national, regional and local levels."

Some of the "bridge building" recommendations of the Work Group on the Role of Orthopaedic Surgeons in Future Delivery Systems for Musculoskeletal Care include:

"Sponsor and/or stimulate an 'External Summit' of musculoskeletal providers to address patient care to populations under managed care, to develop a shared forum, and to plan for future communications and interaction among musculoskeletal providers.

"Develop mutually-beneficial educational programming with primary care and other first contact providers at regional, local, and on-site locations."

Obviously, initiating such cooperative dialogue with the leadership of other organizations will involve breaking down some historic suspicions and protectionistic boundaries. We believe that the time is right to make every effort to dissolve these interorganizational barriers and efforts to do that are now underway. As of this writing, Ken DeHaven, Doug Jackson, Bill Tipton, Larry Rosenthal, and myself have held extensive exploratory meetings with the leadership of:

American Academy of Pediatrics

American Academy of Family Physicians

American College of Physicians

American Physical Therapy Association

By the end of end of January 1996, we anticipate that we will have also met with officials of:

American Geriatric Society

American Academy of Physical Medicine and Rehabilitation

American College of Emergency Physicians

American College of Rheumatology

While there are many other organizations whose members provide at least some component of musculoskeletal care, these would seem to be the most important organizations with whom to begin the development of the cooperative efforts which we envision.

Very optimistic

All of us who participated in the initial discussions with the first four organizations came away feeling very optimistic about our "bridge building" efforts. Without exception the leaders of the other groups were very enthusiastic about the concept of working together to address the development of integrated systems of musculoskeletal patient care for populations under managed care. They also appeared to be very agreeable towards working together on educational projects and to plan for future communication and interaction among all musculoskeletal providers.

The first major effort to involve other organizations who represent musculo-
skeletal providers in discussions that pertain to future systems of health care delivery will be an Outcomes Research Forum, hosted by the Academy in early 1996. This meeting will allow some 20 organizations to share their activities in the area of outcomes instrument development and to seek ways to cooperate and collaborate.

The Board is also very excited about the concept of a "Musculoskeletal Summit," although we fully realize that the meeting will have to be very carefully planned and orchestrated. The Work Group on the Role of Orthopaedic Surgeons in Future Delivery Systems for Musculoskeletal Care has provided a preliminary implementation strategy for the "Summit" and a strong organizing committee, including representatives from the major participating organizations, external consultants, outside sponsors, foundations, and government agencies will need to convene to work out the list of participants, funding, and the format of this critically important assembly.

We are particularly gratified by the enthusiasm that outside agencies interested in preserving quality care have shown for the concept of collaborative projects between different musculoskeletal provider groups. In particular, the National Committee for Quality Assurance (NCQA) has indicated interest in assuming a role to facilitate the development of a "National Collaborative Project," in cooperation with the Academy. They are particularly interested in the development of musculoskeletal guidelines by various provider groups. NCQA would like to be "significantly" involved in planning and facilitating a meeting of these provider groups and is willing to help seek funding sources. Cary Sennett, MD, MPH, NCQA's Vice President of Performance Measure, stated that, "what the Academy is doing is right on target," and suggested that we "align with NCQA" to accomplish our objectives.

It would certainly seem that the "bridge building" concept is gathering tremendous enthusiasm by provider groups, organizations and agencies dedicated to patient protection and the preservation of quality care. If these bridges are built with interorganizational respect and consideration and, if the best interests of the musculoskeletal patient are kept as the guiding interest of all such deliberations, then we can achieve the meaningful integration which can prevent the continued erosion of physician and patient freedom and maintain or restore high quality, cost-effective care for those we treat.

Final thoughts

This will be my final opportunity to express my thoughts in the Across the President's Desk column of the Bulletin. It has been a unique opportunity to be able to personally address a few of the very complex and challenging issues that orthopaedic surgeons and the Academy face in these tumultuous times of rapid health care change. I am extremely proud of the Academy's accomplishments this year and feel certain that the new administration will be even more productive.

I feel particularly pleased to yield the presidency of the Academy to Ken DeHaven who has already demonstrated exceptional leadership skills and a tremendous dedication to the affairs of the Academy and the needs and concerns of the membership. Doug Jackson will succeed Ken and is equally skilled and dedicated. The three of us have functioned as a remarkably synergistic team because we share similar convictions and vision for the Academy. I feel certain that the continuity of policy will be smooth and consistent.

I am tremendously indebted to this year's superb Board of Directors who have blended their considerable talents and leadership skills into a hard working, highly cooperative group, totally committed to the best interests of orthopaedic surgeons and their patients. Bill Tipton, our executive vice president, and Larry Rosenthal, our deputy executive vice president, give the Academy what I firmly believe is the best administrative leadership of any medical professional organization. Their diligence, together with the superb Academy staff, gives us the best possible implementation of Board policy and an extremely strong presence with outside organizations and agencies. In addition, Nick Cavarocchi and Dave Lovett are recognized to be among the most influential representatives of any medical organization in Washington.

Thanks also to the nearly 1,000 Academy members who unselfishly donate their time, effort, and expertise to the tremendous spectrum of Academy affairs. Without your efforts, there is no way the Academy could function so successfully.

For Sandy and myself, this year has been an incredible adventure. We have been on the road a great deal but each trip, each experience has been wonderful. Most of all, we feel fortunate to have met so many terrific individuals along the way and to have made so many new friends. The entire experience has reinforced my long-held contention that all orthopaedic surgeons are good people. Or, to paraphrase Will Rogers:

"I never met an orthopaedic surgeon that I didn't like."

Thank you all for the privilege of representing you and the patients we serve.

James W. Strickland, MD


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