AAOS Bulletin - June, 2005

2005 National Orthopaedic Leadership Conference

Focus on key issues: The uninsured, tort reform, technology assessment

Welcome to the AAOS Councilors' Report. This new section of the AAOS Bulletin will appear twice a year, replacing the Councilors' Report newsletter.

Report from the Chairman

Each spring, in Washington, D.C., the AAOS Board of Councilors (BOC) convenes for our biggest event of the year, the National Orthopaedic Leadership Conference (NOLC). However, this meeting is by no means limited to only the BOC.

As the NOLC has evolved over the past 20 years, it now involves a broad cross section of the leadership of organized orthopaedics, including the Council of Musculoskeletal Specialty Societies (COMSS), state orthopaedic society representatives, AAOS Board members and younger orthopaedists who are being trained for future AAOS leadership positions through our Leadership Fellows Program.

AAOS Board of Councilors Chairman Frank B. Kelly, MD,(right) and his wife, Lawson, made a Hill visit to Rep. Lynn A. Westmoreland (Ga.) during the National Orthopaedic Leadership Conference.

As BOC chair, I think it’s a real privilege to work with all of these groups in planning and participating in the NOLC. We all see facets of organized orthopaedics debate and discuss common concerns during an intense, but highly enjoyable, three-day meeting in our nation’s Capitol.

As I work with the leadership of the AAOS and other organizations, I cannot help but be impressed with the dedication of so many of our colleagues who take time out of their busy practices and personal lives to work so hard on our behalf and for our profession.

Often, when you think of the AAOS, you might think of the headquarters building in Rosemont, Ill., or the professional staff members, who work hard on our behalf and are highly committed to our mission and goals.

However, when you participate in an AAOS function like the NOLC, you discover what the AAOS really is. It’s we, the orthopaedists in the trenches, who are taking care of patients and dealing with the familiar, everyday hassles. It’s we, the folks taking call in the ER and covering charity clinics. It’s really we, the AAOS members, supporting our organization and our profession by paying dues, attending meetings and training the orthopaedists of the future. It’s also our organization’s leaders, volunteering so much of their time to ensure that the AAOS maintains its place as one of the premier medical organizations in the world.

So, I hope that as you read this report and the rest of the Bulletin, you’ll remember that AAOS is all of us, working together on behalf of our organization, our profession and our patients. I also hope you’ll take ownership and pride in what your association has done and continues to do through education, political advocacy, research and so many other ways to promote our profession and to improve the care we provide.

Frank B. Kelly, MD

Hill visits target key issues

More than 200 orthopaedists, many with their spouses, visited their Congressional representatives to discuss this year’s key legislative issues, including the need for federal medical liability reform, the importance of correcting the Medicare payment formula, the advantages for patient care in allowing orthopaedists to provide imaging services and the need for Medicare patients to see physicians before they are treated by physical therapists.

Before they made their way to the “Hill,” participants heard from Sen. Tom Coburn, MD (R-Okla.); Rep. Nancy Johnson (R-Conn.); and Rep. Nathan Deal (R-Ga.). Dr. Coburn spoke about the rising costs of health care, stating that one-third of every dollar spent on health care does not directly benefit health care. In addition, he expressed concern about the number of medical residents going into high-risk specialties, such as orthopaedic surgery and obstetrics. All three spoke about the health care issues that participants were meeting about with their members of Congress, including pay-for-performance within the Medicare program, problems with the Medicare physician payment formula, Medicaid reform and specialty hospitals. All three spoke about the likelihood of Congress again focusing on comprehensive health care reform.

The Alabama delegation visited Rep. Jo Bonner during their Hill visits. Shown here are (from left): Russell A. Hudgens, MD; Rep. Jo Bonner; Albert W. Pearsall IV, MD; and John R. Payne, MD.

Presidential Line reports

Stuart L. Weinstein, MD, AAOS president, talked about the AAOS in 2010 initiative. This project involves evaluating the current environment to ensure that AAOS meets the ever-changing needs of its members in the future. Dr. Weinstein also spoke about a new initiative aimed at making “patient-centered care” a greater part of the orthopaedic practice culture.

Richard F. Kyle, MD, AAOS first vice-president, spoke about the opportunities that the AAOS and musculoskeletal specialty societies have to work more closely together for the common good of all orthopaedists.

James H. Beaty, MD, AAOS second vice-president, talked about current and future American Board of Orthopaedic Surgeons’ (ABOS) requirements for maintenance of certification. He also mentioned the need for more communication between the AAOS and ABOS regarding joint products to facilitate the new certification program.

(Above) The Florida delegation marches on Capitol Hill. Pictured are (front, left to right): Councilors Andrew M. Wong, MD; Mary I. O'Connor, MD; and Brian S. Ziegler, MD; (rear, left to right) Florida Orthopaedic Society (FOS) Executive Director Fraser C.A. Cobbe; Tanya Jones, FOS staff; Cynthia Halphen, Dr. Ziegler's spouse.

The uninsured/health care reform

To help the AAOS determine how to position itself on health care for the uninsured, NOLC participants explored several approaches to health care reform.

James H. Herndon, MD, AAOS second past president, discussed the impact of skyrocketing costs of health care and uninsured patient demographics. He noted that U.S. out-of-pocket spending on health care is higher than in any other country. In 1950, he said, the cost of health care represented 4 percent of GDP; in 2004, that figure had risen to 15 percent of GDP.

One in six Americans is uninsured. However, contrary to common belief, 80 percent of the uninsured are employed, but either their employers don’t offer coverage or the employee cannot afford to pay their portion of the premium. The impact on the country as a whole as well as on individuals has been severe, Dr. Herndon pointed out. He said that the lack of adequate health care coverage has resulted in 18,000 preventable deaths. More than two out of five adults with medical debts depleted their savings to pay for health care. The lost economic value to the economy of providing care to the uninsured ranges between $65 billion and $130 billion.

In addition, Dr. Herndon said, access to specialty care for the uninsured is problematic. There is no easy referral for specialty care so patients often wait until their condition becomes an emergency before seeking care. Despite these issues, Dr. Herndon expressed his belief that the federal government is not ready to tackle the problem.

Next, Mary Grealy, JD, president, Healthcare Leadership Council, presented possible solutions to help make health insurance more available, including tax incentives for workers and small businesses, state flexibility to use federal funds for private coverage, removing enrollment barriers to Medicaid for the working poor and an information campaign to help workers and employers make better coverage decisions.

Charles Granatir, MD, of Physicians for a National Health Program, argued for a national health insurance program that would maintain a free market for medical services but have all medical expenses paid by the government. Moderator Lowry Jones Jr., MD, chair of the AAOS Health Care Delivery Committee, then asked participants for feedback on these approaches. They found elements of each approach appealing, but no single option was supported by the majority of participants.

Role of the judiciary

To help state orthopaedic societies preserve medical liability reforms once they are passed on the state level, councilors with experience dealing with their state judiciaries taught participants about the role of the judiciary in upholding or defeating medical liability legislation. They also gave participants strategies for participating in state judicial elections.

Chris J. Dangles, MD, councilor from Illinois, noted the number of liability reform bills that passed only to be struck down by the judiciary. He then discussed strategies for electing pro-medical liability reform judges. John R. Kean, MD, councilor from Ohio, talked about similar experiences in Ohio and noted the importance of finding and partnering with allies who are also concerned with reforms, such as businesses and chambers of commerce. John K. Drake, MD, former councilor from Mississippi, advised participants to work with their state medical associations as much as possible during judicial elections.

(Left) Sherwin Ho, MD (at microphone) questions a speaker. Listening are Matthew L. Jimenez, MD (standing), and David D. Teuscher, MD (seated).

Proposal for acute trauma care specialty

Thomas Russell, MD, executive director, American College of Surgeons, stated that there is a growing shortage of physicians who take call. He said that if this trend continues, the workforce will not be there to care for emergency patients and wondered if “we are creating gaps in health care that will come back to bite us?”

Dr. Russell proposed the idea of a shift-work emergency surgeon who would be available to perform many of the less complicated procedures and to stabilize patients who would then be treated later by specialists. He is aware that many specialists, including orthopaedists, will not be enthusiastic about this, but he indicated that either these physicians need to be willing to take call themselves, or stop complaining if someone else does it.

Thomas Barker, chief attorney, Centers for Medicare and Medicaid Services (CMS), talked about the work of a new CMS technical advisory group on the Emergency Medical Treatment and Active Labor Act (EMTALA), new provisions to pay for EMTALA-mandated care of undocumented immigrants and the need to determine medical necessity of a claim based on what the physician actually knew at the time, and not on what the condition is later determined to be.

Michael J. Bosse, MD, president-elect, Orthopaedic Trauma Association, discussed the role of orthopaedic surgeons in emergency room coverage. He pointed out that emergency care for musculoskeletal injuries should be provided by orthopaedists and that a lack of qualified physicians to take call results in poorer patient care, a bigger burden on willing providers and a care void that will be filled by others. Moderator Andrew N. Pollak, MD, COMSS chair, solicited feedback from participants to help AAOS leadership determine the AAOS position on emergency coverage issues and the proposed new emergency care specialty. Most participants expressed opposition to the proposed new specialty.

Health technology assessment

The purpose of this NOLC session was to determine what role, if any, participants think the AAOS should have in health technology assessment. David A. Wong, MD, chair of the AAOS Patient Safety Committee, spoke about patient safety concerns relating to new technology. Michael J. Goldberg, MD, chair of the AAOS Evidence-Based Practice Committee, discussed the difficulties of using evidence-based techniques to assess new technology due to a lack of evidence to use in the process.

John S. Kirkpatrick, MD, chair of the AAOS Biomedical Engineering Committee and Roy D. Crowninshield, PhD, professor of orthopaedic surgery, Rush University Medical Center, Chicago, each discussed the pros and cons of AAOS doing technology assessment, including the costs, benefits and potential risks to the AAOS itself, patients and industry. Naomi Aronson, PhD, executive director, Blue Cross and Blue Shield Association, talked about her organization’s experience doing technology assessment and her desire to partner with medical organizations such as the AAOS.

BOC recommendations

The BOC considered and then passed three recommendations to the Board of Directors. The first calls for the AAOS to explore the possibility of offering a medical liability insurance product to orthopaedists. The second calls for the AAOS to provide more resources to orthopaedists to help them deal with on-call coverage issues and to advocate for hospitals to pay physicians to take call. The third recommendation calls for the AAOS to develop guidelines for orthopaedists that are involved in gainsharing arrangements with their hospitals for implant purchases. The recommendation also calls for the AAOS to oppose hospital-forced vendor programs that do not give the treating surgeon final authority to select the implant for a particular patient.

New BOC leaders, members

The BOC elected its new leaders for 2005-06 at the AAOS Annual Meeting in Washington, D.C. The new BOC Chair is Frank B. Kelly, MD (Ga.). The new Chair-Elect is Dwight W. Burney III, MD (N.M.), and the new Secretary is Matthew S. Shapiro, MD (Ore.).

New members of the BOC include: Dirk H. Alander, MD (Mo.); Michael C. Albert, MD (Ohio); Richard J. Barry, MD (Calif.); Alexander Blevens, MD (Miss.); William W. Brien, MD (Calif.); Christopher C. Carruthers, MD (Ontario, Can.); William J. Dowling Jr., MD (N.J.); Brian J. Galinat, MD (Del.); Jonathan L. Grantham, MD (Mo.); David R. Hootnick, MD (N.Y.); Charles N. Hubbard, MD (Ga.); Patrick M.J. Hutton, MD (Fla.); Andrew J. Hvidston, MD (N.D.); Mark C. Leeson, MD (Ohio); Jeffrey Lozman, MD (N.Y.); Scott T. McMullen, MD (Neb.); H. Del Schutte Jr., MD (S.C.); J. Steven Shockey, MD (Ky.); William M. Strassberg, MD (Maine); and Theodore L. Stringer, MD (Colo.).

To contact BOC members via e-mail, visit the BOC section of the AAOS Web site. Your input on any topic is always welcome.

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