As specialty physicians, orthopaedists embrace medical progress and effectively incorporate these advances into everyday practice. However, we have been slow to influence and understand the health policy consequences of these advances.

The mission of the AAOS is to properly educate orthopaedic surgeons on medical advancements to ensure that we continue to deliver the highest quality care. This mission also includes increasing understanding and involvement in health policy issues to further improve the practice of orthopaedic surgery.

Today tremendous economic, social and political pressures dictate the physician’s ability to deliver proper health care. Clinical or operative decisions made by a physician must reflect both a combination of evidence-based medicine and patient-centered care, as well as an understanding of proper utilization of resources and the cost-effectiveness of the health care delivered.

In 2003, the AAOS established a resident Health Policy Fellowship (HPF) to encourage the next generation of orthopaedic surgeons to embrace the changes in the delivery of care. Eight individuals have been chosen since its inception, and each of us has developed an interest in a particular socioeconomic, health policy, or regulatory issue. As part of our mission, we have compiled a series of articles touching on different issues related to the everyday practice of orthopaedic surgery. As new issues arise, “Ahead of the Curve” will focus on the importance of these topics to the practicing orthopaedic surgeon. Among the topics we plan to cover are the following:

• Technology, including nanotechnology, direct-to-consumer advertising, and computer-assisted surgery
• Orthobiologics, including tissue engineering, tissue safety, and genomics
• Patient safety issues such as bar coding implants, FDA updates, medical device safety, and on-call coverage
• Physician autonomy issues such as the National Provider Database, gainsharing, stand-alone radiology centers, and ambulatory surgery centers
• Reimbursement and regulatory issues, including pay-for-performance, Medicare reimbursement, and medical liability reforms)

As our specialty applies advances in technology and medical knowledge to improve healthcare delivery and patient quality of life, we must be aware that social, political and economic issues can limit our ability to deliver these new advances. The next phase of advances will begin as orthopaedic surgeons understand and embrace the issues to shape the way care will be delivered in the future.

Did you know…?

• Orthopaedists contributed $1.3 million to our Political Action Coalition (PAC) in 2005; trial lawyers contributed $6.1 million to their PAC.
• A total of 3,939 orthopaedic surgeons contributed to the Orthopaedic PAC through November 2006.
• The FDA has no legal authority for granting approval or licensing of allograft tissue products as it does for biologic pharmaceuticals or medical devices.
• Between 1976 and 1980 there were 88 applications to the FDA for new medical devices; from 1996 to 2000, there were 202 applications.
• One liter of nanospheres provides 530 liters of oxygen; one liter of blood provides just 0.2 liters of oxygen.
• From 2001 to 2005, the number of diagnostic imaging centers in the United States increased by 38 percent to 5,760.
• The number of MRIs (other than brain) performed in the United States increased by 99.9 percent from 1999 to 2003.
• From 2001 to 2003, an average of 24.4 percent of orthopaedic surgeons reported using electronic medical records in their office-based practices.