Looking at the Past, with Enthusiasm for the Future

John R. Tongue, MD, reflects on his term as AAOS president

Peter Pollack

As AAOS president, John R. Tongue, MD, has served during an era of change and challenge to healthcare delivery in the United States. The ongoing implementation of the Patient Protection and Affordable Care Act (PPACA), proposed alterations to the structure of the Medicare system, the gradual shift away from the fee-for-service pay structure, and other advocacy issues were certainly dominating factors during his term as president.

John R. Tongue, MD

But ask Dr. Tongue what he believes is the most exciting aspect of his term in office, and his thoughts turn almost immediately to education—specifically, the application of new technologies to the educational process.

The core mission
“Education is really the Academy’s core mission,” he explained, “and the key to our continued success. It’s where we gain our reputation. Our educational efforts improve the quality of care for patients and help support our advocacy efforts. And when we engage in advocacy, we also educate—providing legislators and policymakers with background information so they may make more effective decisions.”

Dr. Tongue points to the continued development of the OrthoPortal as an ongoing achievement of his own and several previous presidential terms.

“The OrthoPortal was just a dream during my first term on the Board of Directors, 12 years ago,” he said. “Now, it includes practically all of the Academy’s resources—from videos and eBooks to the Orthopaedic Knowledge Online Journal, the Journal of the AAOS, and the Journal of Bone & Joint Surgery. The newest initiative is to add third-party journals so that it becomes a true portal, where AAOS members will be able to access the great majority of orthopaedic content available online through one source.”

In addition, Dr. Tongue is enthusiastic about electronic educational opportunities, which will not only make learning more convenient for AAOS members, but potentially extend the impact of the Academy’s educational outreach to surgeons in many other countries.

“One of the things I learned in my travels,” he said, “specifically in Europe and also while attending the Japanese Orthopaedic Association meeting early in my term, is that the AAOS and American medicine as a whole are recognized as exceptional. That position opens doors for us to present our best teachers with their best content.

“We have the content, the cachet, and the volunteer capacity to teach culturally appropriate musculoskeletal care all over the world,” he continued. “And the idea that we will soon have the capacity and the technology to teach orthopaedic surgery world-wide from our new Orthopaedic Learning Center (OLC) is terribly exciting.”

A valuable resource
As a surgeon working in private practice, Dr. Tongue agrees that advocacy is an issue of personal importance to himself and many of his colleagues. The ongoing rollout of PPACA has presented the medical community with challenges and opportunities, and the American Association of Orthopaedic Surgeons office of government relations (OGR) has become a leading source of information for regulators seeking the best ways to implement the provisions of PPACA.

“As orthopaedic surgeons, we can anticipate a very disruptive time over the next few years,” he said. “We are all working hard to add value to healthcare and to reduce the unsustainable increases in healthcare costs. This administration now recognizes what a valuable resource the OGR can be in helping them to implement this incredibly broad and impactful legislation. AAOS is viewed nationally as a positive and supportive resource to regulators and decision makers.

“I recently met with the director of the U.S. Government Accountability Office (GAO),” continued Dr. Tongue, “about a federal study on in-office ancillary services. I was given the opportunity to explain some of the limitations of the government’s study, but in a positive way so the door stays open for GAO to discuss such topics with us in the future.”

Dr. Tongue explains that during his tenure on the Board of Directors and as president, he has gained a great appreciation for AAOS advocacy efforts.

“I’ve signed off on literally dozens of requested comment letters to various federal agencies,” he said, “giving them specific helpful information to assist with the administration of this complex legislation. That level of spadework is something our fellowship doesn’t usually get to see.”

More than simply cost-effective
Another initiative Dr. Tongue has overseen is an ongoing study on the societal value of orthopaedics.

“I’m very excited about this,” he said. “The direct costs and the burden of musculoskeletal care have been well-studied, but the indirect benefit of what we do has not been investigated in-depth. Orthopaedic care reduces costs to society, by getting people back to work so they’re paying taxes and not on disability and by allowing them to live independently instead of being institutionalized. Those benefits have not previously been quantified and linked to the care we provide.

“Over the coming year, we’ll be taking that information to the media as part of our A Nation in Motion® campaign. We’ll be able to supply hard data to support all the wonderful stories. We’ll be able to show that orthopaedic care is not just cost-effective; it’s cost-saving to society,” he added. “Making those arguments will help society to make better choices about investing in care that is appropriate and delivers value for the cost.”

Dr. Tongue is also a strong supporter of evidence-based medicine, and cites AAOS efforts to compile clinical practice guidelines and appropriate use criteria as examples of recent AAOS initiatives to advance quality.

“These important documents are the result of a tremendous amount of work,” he acknowledged. “If we, as orthopaedic surgeons, don’t generate our own criteria for clinical practice and appropriate use, others will do it for us. They will not have had the benefits of our experience, and that would threaten patient access to appropriate care.”

Long-term strategic benefits
For Dr. Tongue, perhaps the most significant single decision of 2012 was the board’s vote to construct a new headquarters for AAOS, which will incorporate a new, updated Orthopaedic Learning Center.

“I view the new building as a long-term strategic benefit to the unity of our profession,” he explained. “It’s a structural stewardship that will help hold orthopaedics together for decades into the future. A lot of the credit has to go to Joshua J. Jacobs, MD, who conducted the shuttle diplomacy necessary to recruit our equity partners in the building and the OLC and to ensure that the new building meets their needs as well.”

Echoing his Presidential Address in San Francisco, Dr. Tongue reflects his basic optimism about the future of the orthopaedic profession.

“We have the best job in medicine,” he said. “I know that many of my colleagues are very apprehensive about healthcare reform, but if we all participate in our messy, representative democracy, we will get through the reform period and be stronger than ever. Orthopaedic surgeons tend to be critical thinkers, problem solvers, and passionate about what we do. As long as we communicate the value of the care we provide and the results of the work we do, society will treat us well.

“The best thing about being president of AAOS is being able to see the teamwork of so many people donating their time and talent. There is no association in medicine that I think is comparable. We truly have an outstanding professional
organization.”

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS3_3_19.asp