AAOS Bulletin - October, 2006

AAOS Board sets direction for future

Adopt 2007 preliminary budgets, position statements, on-call coverage, conduct strategic discussions

Participating in a lively discussion during the September Board meetings (left to right): Second Vice President E. Anthony Rankin, MD; First Vice President James H. Beaty, MD; Chief Executive Officer Karen L. Hackett, CAE, FACHE, and President Richard F. Kyle, MD.

By Mary Ann Porucznik

Members of the Board of Directors (Board) for the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) were focused on the future during their meeting Sept. 15-16, 2006, in Rosemont, Ill..

From the initial reports on unity to the adoption of 2007 preliminary budgets and plans for the next member needs assessment survey, the emphasis was on moving forward to serve AAOS members and the orthopaedic community as well as patients and the public

A united front on reimbursement
President Richard F. Kyle, MD, reviewed the joint efforts by the AAOS and the American Association of Hip and Knee Surgeons (AAHKS) to retain current work values for total hip arthroplasty (THA), total knee arthroplasty (TKA) and hip fracture. In late June, the Centers for Medicare and Medicaid Services (CMS) proposed reducing the work relative value units (RVU) for these procedures, a move that would have resulted in payment cuts of approximately

10 percent for THA, 6 percent for TKA and 4 percent for hip fracture treatment. Dr. Kyle noted that studies conducted by the AAOS and AAHKS showed no evidence for changing the work values of these procedures, and that the American Medical Association/Specialty Society Relative Value Update Committee (RUC) agreed with those finding. CMS, however, did not accept the RUC’s recommendations in this area.

Representatives of the RUC, the AAOS and the AAHKS met with CMS officials to review the method used to develop the work RVUs for these procedures and clarify any misunderstandings. The AAOS will continue to cooperate with CMS to ensure that the concerns of orthopaedic surgeons regarding quality and access are heard and will notify members as soon as a final decision is reached.

Dr. Kyle also reviewed the results of the Unity Initiative stemming from the Specialty Society Summit in 2004. Since then, the number of AAOS continuing medical education (CME) courses cosponsored with an orthopaedic specialty society has nearly tripled (from four in 2004 to 11 in 2006), and the CME Courses Committee intends to have joint sponsorship for 75 percent of specialty-focused courses by 2008. Efforts to solicit specialty society involvement in various areas of the Annual Meeting, as well as in public relations and diversity efforts, have also increased. Partnerships with specialty societies for developing clinical practice guidelines, publications and international educational efforts continue to be pursued.

Dr. Kyle said he was “most excited” about new initiatives involving regional orthopaedic societies and increased involvement with state orthopaedic societies. Unity efforts, he said, should not focus just on specialty societies but on all orthopaedic organizations.

“2005—a very good year”

In his treasurer’s report, William L. Healy, MD, noted that “2005 was a very good year” for the AAOS. (The complete treasurer’s report can be found on page 44.) Total assets of $81.4 million at year-end 2005 represented an increase of $7 million from year-end 2004 and resulted from the operating income and investment gains for the year. Total net assets grew $6.4 million, from $57.2 million at the end of 2004 to $63.6 million at the end of 2005. Operating income for 2005 was $3.3 million, compared to $1.3 million of operating income in 2004. The long-term investment portfolio grew by $2.7 million and was valued at $40.7 million at the end of 2005.

Dr. Healy presented 2007 preliminary operating, capital and product development budgets for approval. The preliminary operating budget projects operating revenues of $50.5 million, investment income of $1.9 million and operating expenses of $52.4 million.

The preliminary capital budget is $1.6 million, with $482,000 proposed for the product development budget. Final budgets will be presented for approval at the December Board meeting.

Due to the recent change in the composition of the Board, a change in the composition of the Finance Committee may be necessary. The Board discussed several alternatives, and a final decision will be put forward as a bylaws amendment, to be voted on after the 2007 Annual Meeting.

Position statements approved
Upon the recommendation of the AAOS Trauma Care/On-Call Coverage Project Team, the Board voted to approve a position statement on on-call and emergency care services in orthopaedics. The complete position statement appears on page 32, as part of this issue’s special section on trauma care/on-call coverage.

David A. Halsey, MD, chair of the Gainsharing Project Team, presented the team’s final report. He noted the need to refocus discussions on “gainsharing” to emphasize the importance of putting the patient’s interests first. The proposed position statement, which the Board approved, reads in part,

“The AAOS is opposed to supply-based purchasing arrangements where the cost savings obtained are disbursed directly to physicians rather than used to enhance patient care…The AAOS is opposed to any gainsharing or similar arrangements that deny physicians the opportunity to select and utilize appropriate supplies and devices. The clinical judgment of the surgeon, in concert with the patient’s unique needs and preferences, should drive patient care decisions, not the financial gain of the facility and surgeons. Health care decisions should always be achieved through cooperation among the orthopaedic surgeon, the patient (and family) and a coordinated health care team…As part of a collaborative effort, orthopaedic surgeons within a hospital can cooperate in developing cost-containment strategies as long as patient care is never compromised, the proper safeguards are in place and any compensation for this work is fair and reasonable and not directly tied to revenue gains.”

Advocacy efforts
Dr. Halsey presented the first draft of a Unified Advocacy Agenda for the AAOS. The broad agenda is designed to be flexible and fluid to respond to changing legislative priorities. All relevant topics—from academic advocacy and access to care through EMTALA, medical liability reform, Medicare reimbursement and patient safety—are included and ranked to indicate the AAOS level of involvement, from monitoring to full engagement on the issue. Dr. Halsey also presented plans for a comprehensive musculoskeletal legislative package—a planned bipartisan bill focusing on a variety of issues.

Reporting for the Orthopaedic Political Action Committee (PAC), Stuart L. Weinstein, MD, noted that as of July 31, 2006, the PAC had received nearly $2.2 million in contributions and had achieved a 22 percent participation rate among AAOS members.

Needs assessment survey
Second Vice President E. Anthony Rankin, MD, reviewed the results of the first member needs assessment survey, conducted in 2004 as part of the “AAOS in 2010” initiative. At that time, 95 percent of respondents cited the Academy as their primary source of print educational material and 73 percent cited the Academy as their primary source of online educational material. Dr. Weinstein, who was second vice president when that first survey took place, pointed to the value of the responses in identifying unmet member needs and providing a measure for allocating resources among various issues. Plans are to conduct a shorter, more focused survey in 2007.

Other actions
In other actions, the Board approved funding for a one-day follow-up symposium on Extremity War Injuries and a symposium on Implant Wear; heard reports from the Council on Research, Quality Assessment and Technology, and the Future Member, Content and CME Project Teams; and participated in strategic discussions on orthopaedics and industry.


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