June 2004 Bulletin

NOLC focuses on medical liability, specialty hospitals

By Susan A. Nowicki, APR

Nearly 200 orthopaedic surgeons attended the 2004 National Orthopaedic Leadership Conference (NOLC) in Washington, D.C., April 28-May 1. Participants heard presentations by top-level speakers, participated in a lively and hard-hitting Board of Councilors (BOC) meeting and visited members of Congress. Attendees also received intensive training on grassroots lobbying techniques and working with the media – with a special focus on medical liability reform issues. In addition, the Council of Musculoskeletal Specialty Societies (COMSS) held a planning session and the Leadership Fellows Program (LFP) held a training session.

Among the leadership taking part in the meeting were members of the AAOS Board of Directors, the Orthopaedic Political Action Committee Executive Committee and representatives of state orthopaedic societies. AAOS President Robert W. Bucholz, MD, and Second Vice President Richard F. Kyle, MD, outlined their visions for the AAOS and their ideas for BOC and COMSS activities for the coming year.
Stuart L. Weinstein, MD, chair of the AAOS Medical Liability Reform Oversight Committee, told NOLC attendees, “The crisis in the availability and affordability of medical liability insurance continues to escalate.”

AAOS CEO Karen L. Hackett, FACHE, CAE, was also present to update attendees on the business of the Academy.

Panel discussions were held on a variety of timely topics such as the future of specialty hospitals and ambulatory surgical centers and the pros and cons of dropping out of Medicare and other health plans.

Stuart L. Weinstein, MD, AAOS first vice president and chair of the AAOS Medical Liability Reform Campaign Oversight Committee, also provided an in-depth presentation on the medical liability crisis and the AAOS’s efforts on this issue. He told attendees that member participation in the AAOS medical liability reform campaign was key to its success. “We’ve come a long way in the 11 months,” he said, “but we need everyone to be involved.” (See special insert for a complete report on the campaign.)

Rick Wilkerson, DO, an Iowa-based orthopaedic surgeon who recently served in Iraq, talked about orthopaedic care and educational needs in Iraq, including his experience in Baghdad with the Iraqi Medical Specialty Forum—the first international medical conference held in Iraq in more than two decades. (See related story on page 34.)

In addition, NOLC participants attended a special reception honoring the “Legacy of Heroes” exhibit, which went on display for a week in the rotunda of the Russell Senate Office Building in Washington. Sen. John Warner (R-Va.), chairman of the Senate Armed Services Committee, was the featured speaker at the reception. The display was made possible by a grant from Sanofi~Synthelabo.

Health policymakers speak

Several members of Congress and a candidate for the House of Representatives were featured speakers during the NOLC. On the first evening, Tom Price, MD, an orthopaedic surgeon and Republican candidate for the House in Georgia’s 6th district, addressed attendees on how to prepare for their Capitol Hill visits. He was introduced by Rep. Charlie Norwood (R-Ga.), who encouraged attendees to get involved and support Dr. Price in his bid to become the first orthopaedic surgeon to serve in the U.S. House of Representatives.

Rep. Pete Stark (D-Calif.), a tough critic of physician-owned specialty hospitals, headlined a panel discussion on the “Future of Single Specialty Hospitals and Ambulatory Surgical Centers.” Lowry Jones, MD, chair of the Healthcare Delivery Committee, who moderated the discussion, talked about self-referral bans and the moratorium on new specialty hospitals.

Rep. Stark noted that physician ownership of other health care services led to problems such as over-utilization and kickbacks, resulting in the first Stark Law. He said, “When Stark laws were first drafted, ambulatory surgical centers (ASCs) didn’t exist. At the time, doctors turned away when there was an opportunity to impact hospital management and lots of services were farmed out. If ASCs had existed, physician ownership would have been prohibited.”

Rep. Stark pointed out that, “Only one third of orthopaedic hospitals have emergency rooms and they treat fewer Medicaid patients. I don’t care about where doctors provide care. I am concerned about kickbacks and over utilization, however, and these hospitals show a higher number of referrals than other facilities. I also worry that the current trend will lead to the de-structuring of community hospitals.”
NOLC participants had a heated exchange with Rep. Pete Stark (l) after his presentation on specialty hospitals.

Looking to the future, Rep. Stark noted that, “Congress doesn’t have the technical staff or data to help them make decisions about specialty hospitals and the Centers for Medicare and Medicaid Services will be making the decisions.”

There was a heated exchange between NOLC participants and Rep. Stark after his presentation. Many expressed concern that he and his colleagues were operating on out-of-date data and that the move to curtail building of more specialty hospitals was more about restraint of trade than patient protection.

BOC member Richard F. Santore, MD, took Rep. Stark to task for asserting that Congress’ job is to protect Medicare/Medicaid rather than to assure the quality of patient care. Dr. Santore said, “This issue needs more common sense applied. The quality of orthopaedic care is being impacted. Nowadays, physicians don’t have control over patient treatment like in the past. Owners of hospitals are business driven, not patient driven, in their decision-making.”

Capitol Hill visits

Congressional visits help AAOS and its fellows build important relationships on Capitol Hill, which is a crucial element in effective legislative advocacy. During the conference, NOLC participants visited their representatives and senators to discuss legislative efforts to address the medical liability crisis and to correct the Medicare physician payment formula.

Fraser Cobbe, executive director of the Florida Orthopaedic Society (center), and Brian S. Ziegler, MD, BOC representative from Florida (left), discussed medical liability reform with Rep. Dave Weldon, MD (R-Fla.)( far right) and his staff.
Orthopaedic surgeons visited more than 200 congressional offices. They asked representatives and senators to write the Centers for Medicare and Medicaid Services (CMS) Administrator, Mark McClellan, MD, PhD, asking for administrative changes in the Medicare physician fee schedule formula.

They also requested that the legislator sign the Doctors for Medical Liability Reform (DMLR) Pledge in support of federal liability reform legislation that includes an effective cap on noneconomic damages. Several members of Congress signed and returned the DMLR pledge during the office visit; others are mailing in their signed pledges. AAOS will continue to track the letters to CMS and the number of pledges signed.

Several legislators indicated that they would support comprehensive medical liability reform with a cap on noneconomic damages, regardless of whether they decided to sign the pledge. Senators supporting medical liability reform expressed frustration because consideration of reform legislation has been blocked under the cloture rule.

Representatives and senators from both parties agreed that the current Medicare physician fee schedule formula is flawed and that both administrative and legislative action is necessary to fix it. Several senators and representatives—including Sens. Debbie Stabenow (D-Mich.), Jeff Bingaman (D-N.M.), Jon Kyl (R-Ariz.) and Blanche Lincoln (D-Ark.), and Reps. Sherrod Brown (D-Ohio) and Phil Crane (R-Ill.)— are in the process of circulating bipartisan “Dear Colleague” letters supporting administrative changes.

COMSS meeting

COMSS held a morning-long session that included a strategic discussion on its future directions, facilitated by an outside expert on organizational development from RSM McGladrey. Additional discussions focused on opportunities for specialty society involvement in the AAOS Annual Meeting and on opportunities for public education and media partnerships.

LFP training

Members of the AAOS LFP participated in selected NOLC events and attended a dedicated program that included a session on physician-patient communications, led by John Tongue, MD, and S. Terry Canale, MD, of the Communications Skills Mentoring Program. Also included was a discussion on understanding how groups make things happen. Congressman Phil Gingrey, MD, (R- Ga.), an obstetrician/gynecologist, led a panel on how to get involved in political leadership positions. In addition to Rep. Gingrey, speakers included Michael Suk, MD, JD, MPH, White House Fellow; and Mark D. Brown, MD, and Stuart Hirsch, MD, LFP mentors. For more about the LFP, see the related article on page 32.

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