October 2000 Bulletin

AAOS has multifaceted advocacy activity

The primary mission of the AAOS is education—education of its members (fellows). Some of our members believe this, coupled with research, should be our only mission. Others believe that we don’t participate enough in health policy and advocacy.

Most of our members, in some form or fashion, such as in the AAOS CME endeavors, are aware of our commitment to excellence in education. However, many of our members are not informed about the AAOS’s role in health policy and advocacy. Therefore, I thought this would be an opportune time and excellent forum to inform the entire membership of our health policy and advocacy endeavors.

The AAOS’s advocacy initiatives are developed and conducted by the Council on Health Policy and Practice, Board of Councilors, 10-member department of health policy in the AAOS headquarters office in Rosemont, Ill. and the five-member Washington D.C. office. The Council supervises, coordinates and advises six committees whose charges range from advocacy on federal and state legislative issues to coding. The committees are Professional Liability, Health Care Delivery, Health Care Financing, Occupational Health, CPT-ICD Coding and Volunteer Orthopaedic Care.

The Board of Councilors keeps its state representatives aware of legislative and regulatory issues of importance to orthopaedic surgeons and is active in the annual National Orthopaedic Leadership Conference (NOLC). The NOLC includes face-to-face meetings with legislators in Washington, D.C. where councilors can express the orthopaedic surgeons’ position on important issues.

The health policy department and the Washington office work closely to:

  1. Identify and analyze health policy issues of importance to orthopaedic surgeons and their patients.
  2. Assist the AAOS leadership to formulate official AAOS positions on these issues, when appropriate.
  3. Pursue strategies to communicate our positions on issues to federal officials and other government and nongovernment health care policymakers, through testimony, comments and/or Position Statements and face-to-face conversations.
  4. Educate AAOS fellows about health policy issues through the AAOS home page at www.aaos.org, the Bulletin, AAOS Report and periodic updates and alerts.

Some of the major topics the health policy department deals with are Medicare payment policy and health care financing issues, in general; CPT and ICD coding; workers’ compensation and occupational health; and managed care’s affect on patients and medical practice, including managed care contracting issues.

The health policy department also manages AAOS’s relations with state orthopaedic societies. The department provides products and programs to help the state societies deal more effectively with state legislative and regulatory issues and other member interests on the local level.

The AAOS Washington office was established in 1980 to primarily work for increased funding for musculoskeletal research. Over the years, this focus has expanded to advance the interests of the orthopaedic community, our patients and our profession. Today, the Washington office engages in a full range of legislative, regulatory, lobbying and health policy activities, involving numerous federal agencies, departments and congressional committees.

The Washington office, working with the department of health policy and the department of research and scientific affairs, spearheads our continued prominent role in the political, legislative and regulatory arena. The AAOS frequently provides testimony before congressional committees and regulatory bodies, and comments on governmental proposals.

In the last several months, the AAOS testified before the Department of Labor, holding field hearings on proposed federal ergonomics regulations. On August 2, the AAOS participated in an all-day conference, sponsored by the Food and Drug Administration (FDA), regarding "Human Bone Allograft: Manipulation and Homologous Use in Spine and Other Orthopaedic Reconstruction and Repair."

As a co-founder of the NIAMS Coalition, the AAOS is actively engaged in the third year of a five-year effort to double the funding for the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The AAOS currently has a representative on the board of directors of the Medical Technology Leadership Forum, which is committed to promoting technological innovation.

The Washington office has played an active role in drafting and supporting patient protection legislation, as well as the bill introduced by Rep. Tom Campbell (R-Calif.) and Rep. John Conyers (D-Mich.), which would allow physicians to collectively negotiate with a health plan without having to join a union or violating the antitrust laws. This legislation was approved by the full House of Representatives on June 30, 2000.

The AAOS is a member of the Health Care Liability Alliance which is pushing for medical liability reform. The AAOS also is a founding member of the Practice Expense Coalition, which seeks fair Medicare reimbursement.

Working closely with the American Orthopaedic Association (AOA), the AAOS was one of the first medical societies to reach out and improve relationships with the FDA. The result was the creation of the Orthopaedic Device Forum, which meets four times a year, and includes representatives from the Orthopaedic Surgical Manufacturers Association, the Orthopaedic Research Society, American Society for the Testing of Materials, AOA, AAOS, FDA, NIAMS and the Health Care Financing Administration.

In addition, the AAOS Washington office is the home of the Political Action Committee of the American Association of Orthopaedic Surgeons, which is actively engaged in supporting candidates for the U.S. House of Representatives and the U.S. Senate, who support our profession’s goals, listen to our concerns and share our viewpoint. In this two-year election cycle, the PAC has received more than $400,000 for contributions. This year, the PAC participated in both the Democratic and Republican national conventions.

As you can see, our efforts may seem extensive but in actuality are only modest in comparison to large medical associations and large lobbying groups. It takes forming alliances and coalitions with other groups and also a Herculean effort to change bureaucratic opinion and influence legislation. Regardless, our Academy members and our AAOS staff who are involved, work hard at these endeavors.

Finally, don’t ever forget that while we may have one eye on Washington, our main vision stays firmly fixed on educating our fellowship for the ultimate well being of our patients.

S. Terry Canale, MD

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