In 2007, AAOS advocacy efforts on behalf of physicians and patients will be more focused than ever before. Plans include new, targeted advocacy initiatives, an energized and growing Orthopaedic Political Action Committee (PAC) that will build on previous Congressional successes, and ways to generate stronger state participation and increased cooperation.
David A. Halsey, MD
To meet that goal, the Council recently proposed—and the AAOS Board of Directors approved—a United Advocacy Agenda (UAA) that identifies and prioritizes federal legislative and regulatory issues of particular interest to the AAOS.
Specialty care, such as orthopaedics, Dr. Halsey points out, “is in a crisis, and the UAA positions the AAOS to respond.”
A United Advocacy Agenda
Dr. Halsey explains that UAA is broad in scope, but fluid and responsive to member concerns and government priorities. It is designed to help guide the allocation of resources, while ensuring that issues are not overlooked. Among the initial priorities are the following:
- the Emergency Medical Transfer and Active Labor Act (EMTALA)
- U.S. Food and Drug Administration (FDA) issues, such as tissue safety
- medical liability reform
- Medicare, including fraud and abuse investigations and Stark II and other antikickback statutes
- Medicare coverage policies under Part B, particularly as they relate to the Relative Value Update Committee (RUC)
- Medicare reimbursement, including correcting the payment formula and pay-for-performance issues
- patient safety issues
“In these areas, and in other areas as well, the AAOS will develop a clear, concise message, assemble the appropriate team to support that message and take our message directly to the decision makers,” says Dr. Halsey.
Comprehensive legislative package
Another new initiative of the Council on Advocacy is a Comprehensive Musculoskeletal Legislative Package (CMLP), which will “serve as a roadmap for orthopaedic-specific activity in the federal arena,” according to Dr. Halsey.
Nine workgroups have been established to identify musculoskeletal-specific needs and priorities that should become provisions in federal law. Each workgroup corresponds to a specific title, or group of issues, under the CMLP. Among the issues included are the following:
- Trauma and Rehabilitation
- Quality and Safety
- Musculoskeletal Research
- Healthy Seniors—Aging
- Health Disparities
- Women’s Health
- Healthy America
- National Action Plan
Because effecting change on the federal level requires knowledge, skill, experience, and commitment, the Council on Advocacy established the new Advocacy Resources Development Committee. The committee, in turn, created the Advocacy 100 program.
“We need a cadre of motivated AAOS Fellows who have a passion and talent for advocacy,” says Dr. Halsey. “As soon as feasible, we hope to bring together a diverse group of doctors and get them involved in a legislative training program.”
Advocacy 100 participants could include people who have been active in the past but are not currently engaged in volunteer activities, such as former members of Committees, the Board of Directors, or the Board of Councilors. “We need spokespeople who can deliver our messages to their representatives and to others who influence healthcare policy decision-making,” says Dr. Halsey.
The Advocacy Resources Development Committee will also encourage an expanded National Orthopaedic Leadership Conference. And, as advocacy activities grow, particularly in patient outreach, the committee expects Research Capitol Hill days to be expanded.
Although the AAOS will remain proactive at the national level, new fronts are opening on the state level, where medical liability reform, scope of practice legislation and direct access issues often take center stage. Under the State Action Plan, “Our goal is to support and work with the smallest state orthopaedic societies,” says Dr. Halsey, “as well as the big state societies such as New York and Florida.
“We will tailor our response to each state’s needs and be more collaborative and proactive,” he adds. “The state societies have many very effective and talented leaders. We’re committed to helping them address the needs of orthopaedic surgeons and their patients at the state and local level.”
The Orthopaedic PAC has been growing for the past several years, according to current PAC chair Stuart L. Weinstein, MD. It’s a trend he is committed to continuing.
“The Orthopaedic PAC is the largest physician specialty PAC,” says Dr. Weinstein. “It has earned that support by being pragmatic, advocating multiple issues, and supporting candidates who support our issues.”
AAOS members are becoming more aware of the importance of the PAC’s initiatives and are showing their support with donations. “During the 2003-2004 election cycle, the Orthopaedic PAC raised $900,000 from 13.5 percent of AAOS members,” notes Dr. Weinstein, “but during the 2005-2006 election cycle, the PAC raised $2.5 million from 25 percent of AAOS membership.
“We worked very hard,” Dr. Weinstein says, “to make members aware of the issues that impede their ability to improve patient care, and to show them how their contributions to the PAC could have an impact.”
A Democratic Congress will not change the basic operations of the PAC, points out Dr. Weinstein. “We have supported both Democrats and Republicans,” he says. “With new leadership in Congress, we will continue to determine where legislators stand on AAOS issues and develop new relationships.”
AAOS participation in both Doctors for Medical Liability Reform (DMLR) and the Alliance of Specialty Medicine has enhanced its reputation among legislators. “Since 2003, DMLR has been very effective in educating congressmen on both sides. Its Web site, www.protectpatientsnow.org, encourages public feedback and keeps the issues before the public,” Dr. Weinstein explains.
Dr. Weinstein says DMLR has become the authoritative source “in the Beltway” on medical liability reform. DMLR’s success has also made members more aware of the value and effectiveness of advocacy donations. Orthopaedic PAC activities this year will include a greater effort to mobilize AAOS grassroots support and encourage more in-district events to support candidates.
In addition, Dr. Weinstein hopes that the new initiatives sponsored by the Council on Advocacy—such as increased attention to state advocacy and training and resources to support member involvement—will encourage members to apply their expertise and skills to the PAC’s efforts.
“Ours is a robust PAC,” Dr. Weinstein says. “However, we need more members to become energized about the importance of advocacy and the value of their PAC contribution. We also want to increase personal participation in PAC activities. Although about 25 percent of the AAOS membership participate in the PAC—the highest among medical specialty societies—such participation is low compared to other professions. More than 90 percent of trial lawyers, for example, contribute to their PAC.”
David Lovett, JD, director of the AAOS Washington, D.C., office, can attest to the growth and potential of AAOS’ advocacy efforts. Established in 1980, the AAOS government relations office once had fewer than three full-time employees. Today, 15 employees work in Washington, D.C., and in Rosemont, Ill., on federal and state advocacy issues.
Such growth reflects an increasing sophistication and a growing engagement with political processes by physicians. “It’s not as easy for the federal government to simply impose an unworkable system on today’s physicians,” says Lovett.
“For example, physicians understand that a federally mandated pay-for-performance system will not necessarily improve quality or reduce costs, unless physicians themselves (through their medical societies) are part of the process and active in defining the quality measures and in determining the quality data to be reported.
“The AAOS has been a leader in working with the AMA physician consortium, as well as the AQA (formerly the Ambulatory Care Quality Alliance) and the National Quality Forum,” he continues. “It is important for Congress and for the Centers for Medicare and Medicaid Services to ensure that physicians play a lead role in the development of quality measures for which they will be held accountable.”
The AAOS has a history of coalition-building, which will be important in dealing with the new Congress. The AAOS was one of the founding societies of the Alliance of Specialty Medicine, which, says Lovett, has been very successful and “is branded on the Hill.”
The Alliance’s priorities include reforming the Medicare program to ensure the greatest access to care for seniors; reforming the medical liability system; and, ensuring patient access to the highest quality health care, in part, by ensuring effective patient safety measures are in place.
In considering the new Congress, Lovett says “health care is a nonpartisan issue that demands bipartisan solutions. Healthcare costs represent more than 15 percent of the U.S. gross national product. We welcome new opportunities to address what are universal concerns.”
Among those concerns is the need to pursue a permanent solution to the Medicare physician payment formula. “A Democratic-controlled Congress may bring new opportunities,” says Lovett. “Key members on the House side have already been outspoken in their dislike and suspicions of a quality reporting program. On the Senate side, we have been working in a bipartisan manner with members of the Senate Finance Committee, and that is not going to change.”