Residents' Newsletter Contents

Vol. 7 No. 3 - March 2009
Editors: Hassan R. Mir, MD & Prerana N. Patel, MD

This Issue

News for residents:

• Washington Health Policy Fellows Information Center
• MedPAC makes Medicare payment policy recommendations for 2010
• OREF April Resident Research Symposia
• AAOS Board Preparation and Review Course
• AAOS Monograph Series

Features:

1. Practice Tips: "No Such thing as Minor Adjustments"
2. Internet Resources: New Learning Opportunities on Orthopaedic Knowledge Online (OKO) for February - Check out the exciting new orthopaedic self-study tool.
3. Calendar

This Issue: News for Residents

Washington Health Policy Fellows Information Center
Washington Health Policy Fellows (WHPF) have developed an information center located on the AAOS web site. Here you will find a central hub, a roadmap, from which to find out more about AAOS’ efforts on your behalf in Washington, DC and elsewhere. You can also find out how the Academy works. Furthermore, you will find information regarding what other residents have done to become politically involved at the national and local levels.

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MedPAC makes Medicare payment policy recommendations for 2010
On Friday, February 27, 2009 the Medicare Payment Advisory Commission (MedPAC) released its March 2009 Report to Congress: Medicare Payment Policy. This report follows a January 8, 2009 meeting that AAOS staff attended where MedPAC made recommendations for physician services, hospital inpatient and outpatient services, and ambulatory surgical centers (ASCs). MedPAC is a congressionally established group of 17 members that advise Congress in regard to Medicare issues.

MedPAC recommended that Congress increase payment rates for physicians in 2010 by 1.1 percent. Although not directly stated in the recommendation, 1.1 percent is based on the projected change in input prices (2.4 percent) less the adjustment for increased productivity (1.3 percent). As was done last year, MedPAC recommended that Congress should establish a budget-neutral payment adjustment for primary care services billed under the physician fee schedule and furnished by primary-care-focused practitioners. Primary-care-focused practitioners, for the purpose of this adjustment, would be those whose specialty designation is defined as primary care and/or those whose pattern of claims meets a minimum threshold of furnishing primary care services. The Secretary would use rulemaking to establish criteria for determining a primary-care-focused practitioner. MedPAC was also concerned with the practice expense portion of payments for providing MRI and CT. Therefore, they recommended that Congress increase the equipment utilization rate for expensive imaging machines from 50 percent to 90 percent. This would only apply to expensive imaging modalities, which would be defined as those costing more than $1 million. According to MedPAC staff, this recommendation would redistribute about $900 million from imaging to other physician services.

MedPAC recommended that Congress increase payment rates for the acute inpatient and outpatient prospective payment systems in 2010 by the projected rate of increase in the hospital market basket index, concurrent with implementation of a pay-for-performance quality incentive program. MedPAC also recommended that Congress reduce the indirect medical education (IME) adjustment in 2010 by 1 percent to 4.5 percent per 10 percent increment in the resident-to-bed ratio. The 1 percent reduction to the resident-to-bed ratio will translate to about a 20 percent reduction in total IME payments to teaching hospitals. They also recommended that the funds saved from IME payments should be used to support a hospital pay-for-performance program. 

In December 2008, MedPAC discussed a zero update for ASCs. However, due to the advocacy efforts of AAOS, other specialty groups, and the Ambulatory Surgical Center Association, MedPAC recommended that Congress increase payment rates for ASCs by 0.6 percent in 2010. The 0.6 percent update was based on the Consumer Price Index less an adjustment for productivity. They also recommended that ASCs should be required to submit cost and quality data to the Centers for Medicare and Medicaid Services (CMS).       

MedPAC is an advisory commission, and therefore, it is at the discretion of the Congress and CMS to implement the recommendations. The AAOS will continue to stay engaged, work with the Congress and CMS, and update AAOS members when the 2010 proposed rules are released later this year. 

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OREF April Resident Research Symposia
More residents will have the opportunity to participate in the Orthopaedic Research and Education Foundation's (OREF) 12th annual spring Resident Research Symposia. OREF will be adding additional symposia in spring 2009, for a total of eight, thanks to generous educational grants from Biomet and Synthes.

The first two symposia will take place in April:

The first symposium, hosted by Dennis Weiner, M.D., will be held on April 17, 2009 at Akron Children's Hospital. William J. Landis, Ph.D., professor of biochemistry / molecular pathology and orthopaedic surgery, Northeastern Ohio Universities College of Medicine, will be the guest speaker. 

The second April symposium, hosted by Thomas P. Vail, M.D., will be held on April 24, 2009 at the Mission Bay Conference Center, San Francisco. Farshid Guilak, Ph.D., Laszlo Ormandy Professor, Departments of Surgery, Orthopaedic Surgery, Biomedical Engineering, and Engineering & Materials Science, Duke University, will be the guest speaker. Abstracts for this symposium may be submitted to Nancy Knowles by April 1, 2009.

OREF’s annual Symposia give orthopaedic residents in U.S. training programs an opportunity to present research papers and posters to a panel of experienced investigators and clinicians. Panels critique and rank the work, and top presenters are acknowledged. Past participants, residents, panelists, and mentoring attending physicians have told us these sessions are challenging, rewarding, and fun.

All residents and orthopaedic surgeons are invited to attend. Residents should direct all questions about abstract submissions to their residency coordinators. Other questions and RSVPs may be e-mailed to Mary Marino. When responding, please include your name, program/institution, program year, address, phone number, and e-mail address.

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AAOS Board Preparation and Review Course
April 29 to May 3, 2009 · Chicago, IL

Are you sitting for the Board Exam in July 2009?  The Academy gives you the best preparation available for the most important exam of your career. Dr. Frank J. Frassica and his carefully selected faculty walk you through the testable material you need to study in 5 days of examination-focused review sessions.

This important review course features:

• In-depth lectures focusing on all areas of orthopaedics
• A pre-test to help you pinpoint areas of study
• Daily test questions for you to answer anonymously
• Informal evening Q&A sessions on Anatomy and Pathology give you more time with faculty

Study Materials included pre- & post-course, and on-site!

• Online access to self-assessment examinations
• Eight tutorials with test questions - from genetics to metabolic disease
• Complete course syllabus with lecture details and notes
• Basic Science lectures on CD developed by the Orthopaedic Research Society
• Pathology images CD - to continue your studies

Included with your paid registration - free attendance to a Refresher Webinar before the Board Examination.
This course is filling fast - register soon!
Call 1-800-626-6726 for more details or visit www.aaos.org/BoardPrep
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Enhance your diagnostic and treatment skills!
We are pleased to announce two new additions to the Academy's acclaimed Monograph Series: Surgical Management of Pediatric Long-Bone Fractures and Shoulder Instability: Current Concepts. These concise resources draw on current literature to support diagnosis, initial treatment, and management decision-making in each of these topic areas. World-renowned and widely published experts contribute to these focused titles. Best yet, each monograph is a portable reference that can be used anywhere—no need to leaf through those big textbooks to find what you're looking for! Order your new monographs today. At the special resident price of only $45 each, these titles are a tremendous value. To purchase, simply click on the titles of the products above or call 1-800-626-6726.

Expand your library and subscribe to the series:  For your convenience, four to five new titles throughout the year will be shipped straight to your door, as they are published, so you can be sure you have the latest information at hand! It's simply a pay-as you-go standing order: choose the titles you want to keep and receive a $5 discount per title!  Call 1-800-626-6726 to inquire about this extremely affordable Monograph subscription program so you can start saving today! Or, ask your residency program to subscribe and keep their library updated and topical.

Practice Tips

No Such thing as Minor Adjustments
By Jennifer A. O’Brien, MSOD

Tips to improve your net collections ratio

“We have a net collections ratio of 99 percent!” the physician partner declared confidently during a recent revenue cycle consultation.

“No, you don’t,” I responded sadly. “Your staff has been writing off everything the payors don’t allow to ‘contractual adjustments.’ Your real net collections ratio is much lower; the calculation is flawed by these inaccurate adjustments.” Read the complete article in AAOS Now.

Internet Resources

Did you know that more than 100 in-depth, step-by-step surgical technique videos are available to Residents free of charge on OKO? See the complete list of what’s available.

Exciting New Orthopaedic Self-Study Tool
Create your own self-study multiple choice question exams. Questions are from previous year's AAOS Orthopaedic In-Training Examinations (OITE).

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New Learning Opportunities on Orthopaedic Knowledge Online (OKO)
Volume 7, Number 2, February 2009

NOTE: Access to OKO is FREE to all orthopaedic residents, but it does require you to log in using your last name and password. Forgotten your password? (HINT: Unless you have personalized your password, it is the 8-digit number above your name on your JAAOS mailing label!)

New Search Engine just launched on OKO ... OKO is now fully searchable!

This Month's Clinical Topics
Midfoot and Tarsometatarsal Arthritis (Video) by Steven L. Haddad, MD; Anish R. Kadakia, MD

Posterior Wall Acetabular Fractures: Diagnosis, Treatment, and Results by Berton R. Moed, MD

Recognition and Treatment of Leg Pain in Athletes (Video) by Alexander K. Meininger, MD; William D. Turnipseed, MD; Mark R. Hutchinson, MD

Shoulder MRI/Arthroscopy Correlations - Case 2: Bony Bankart Lesion with Extensive Labral Tear (Video) by Steven D. Levin, MD; Martin L. Lazarus, MD

New OKO-Based CME Courses
Midfoot and Tarsometatarsal Arthritis

Useful Resident Links

AAOS Course Calendar	AAOS Practice Management Website
AAOS Now	JAAOS
AAOS Resident Website	Orthopaedic Knowledge Online (OKO)
OITE & ABOS Preparation	Orthopaedic Trauma Association (OTA) Fellowship Program On-Line Application and Directory
Postgraduate Orthopaedic Fellowships 2007	AOFAS - Sponsored Foot & Ankle Fellowships
OREF	American Board of Orthopaedic Surgery (ABOS)
AMA Fellowship & Residency Interactive Database (FREIDA)	US Bone & Joint Decade
AAOS Job Placement	POSNA Resident Review

Calendar

For a complete listing of AAOS sponsored CME Courses: AAOS CME Course Calendar

March 20, 2009	2009 ABOS Part I Examination Deadline for Candidates to update address information on their profile section
April 15, 2009	2009 ABOS Part I Examination Scheduling Permits will be mailed to Candidates at the address on their profile
July 9, 2009	2009 ABOS Part I Examination EXAMINATION: Location: Prometric Testing Centers
March 26 – 28, 2009	Comprehensive Fracture Course for Residents ** Course scholarships available ** Chicago, IL
April 24 - 25, 2009	Advanced Trauma Techniques Course for Residents ** Course scholarships available ** St. Petersburg, FL
Apr 29 to May 03	AAOS Board Preparation and Review Course Chicago, IL
September, 2009	2009 ABOS Part I Examination Candidates Receive Examination Results (the Board office does not release results by phone)
October 7 - 10, 2009	OTA Residents Comprehensive Fracture San Diego, CA