State legislative and regulatory activities play a major role in the daily practice of medicine for orthopaedic surgeons. The American Association of Orthopadic Surgeons (AAOS) promotes and represents the viewpoint of the orthopaedic community at the state level and assists state orthopedic societies in their grassroots advocacy efforts. Below is a list of AAOS state specific advocacy accomplishments.
The California Orthopaedic Society was awarded $20,000 to work to preserve the option of integrated physical therapy services in the state. The society spent $13,200 of grant funds sending PTs employed by physicians to Sacramento for hearings, $4,225 on legal services, and $1,300 on a mailing to members. The COA maintains about $1,275 in reserve to continue this advocacy effort. Thus far, compromise legislation has passed the state Senate but is awaiting a hearing in the House. The compromise would relax limitations on direct access to physical therapy but add PTs to the list of health professionals that are able to be employed by medical practices.
The Florida Orthopaedic Society was awarded $2,500 to contribute toward the defense of a Florida Supreme Court challenge to the state's cap on non-economic damages. The society used all $2,500 toward legal fees in order to draft and file an amicus brief in the case (total cost was $8,181). The AAOS joined a separate amicus brief in the same case, filed with other national medical societies.
The Hawaii Orthopaedic Association received a $2,000 grant to work for tort reform. Funds were used for a legislative reception at the capitol, held in conjunction with the Hawaii Medical Association and Save Our Doctors. However, legislation that would create a "medical claims and conciliation panel" has passed both chambers in different forms and is currently in conference committee to work out the differences between the two chambers' versions.
The Minnesota Orthopaedic Society was awarded $6,100 to fight a comprehensive expansion of chiropractic scope of practice. All funds were spent on bills from the Minnesota Medical Association's in-house lobbyist. The measure died in committee.
The Oregon Association of Orthopaedists received an emergency grant of $10,000 in July 2011 to begin laying the groundwork for future legislative initiatives that will protect orthopaedists from the expansion of the state's public employee benefits board's value-based insurance design (VBID) system to other public payment mechanisms. To date, the OAO has held a fundraiser for a state senator who serves on the public employee benefit board and planned four legislative town halls and a handful of other meetings and meals with legislators. The OAO has spent $3,600 on these events and plans to spend the remainder on a seminar on Changes in Oregon's Health Care System and meetings to educate members in rural parts of the state about legislative issues. The VBID has not yet been expanded beyond the public employee benefit programs.
The South Carolina Orthopaedic Association received a grant of $75,000 to file a declaratory judgment with the SC Supreme Court, in order to urge the Court to permit integrated physical therapy services in the state. To date, the SCOA has spent $10,000 of the grant funds on legal services and $8,000 in funding from other sources. The SCOA retains the remaining $65,000 for ongoing legal costs, as the declaratory judgment was just filed in April 2012.
In 2014, South Dakota voters approved Initiated Measure 17, a measure providing patients the ability to see their doctor of choice regardless of network status as long as the doctor was willing to accept the terms and conditions of physicians already in the network. Two of the three sponsors were orthopaedic surgeons, Peter Looby, MD and Stephen Eckrich, MD. The AAOS, through the BOC State Legislative and Regulatory Issues Committee, provided a grant to the South Dakota Orthopedic Society in support of this initiated measure.
The New York State Department of Health has revised its Medicaid coverage policy regarding knee arthroscopy in response to a letter from the AAOS. Based on an incorrect interpretation of an AAOS Clinical Practice Guideline, the department had originally planned to discontinue coverage for all arthroscopic knee surgery. AAOS immediately responded, citing the error and recommending that non-coverage decisions should be applied only to arthroscopic lavage and debridement when the primary diagnosis is symptomatic OA of the knee, as stated in the AAOS guideline. The department subsequently adopted the AAOS recommendations and will continue to cover other knee arthroscopy procedures.