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Although many fellows admit that AAOS-generated technology assessment would be beneficial, the reality is that it also could be potentially very expensive—not only in the dollars needed to do it, but also in the risks it raises for the Academy.

AAOS Now

Published 7/1/2007
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James H. Beaty, MD

Do you want tap water or Evian?

The AAOS has studied the topic of technology assessment for more than 20 years. In all that time, you’d think we could come to a conclusion, but deciding what to do about technology assessment is not easy.

James H. Beaty, MD

What is technology assessment? One definition is “the process of systematically reviewing existing evidence and providing an evaluation of the effectiveness, cost-effectiveness, safety, and impact—both on the patient and on the healthcare system—of medical technology and its use.”

This past April, your Board of Directors convened a Board Workshop to specifically discuss the role of technology assessment within the AAOS (see page 35). Our goals were to educate ourselves, understand the methodology behind technology assessment, understand the role of technology assessment from the payor’s perspective, review the legal issues and conflicts of interest related to technology assessment, and evaluate the impact of the Academy’s conducting technology assessment on industry relationships.

The current educational effort on technology assessment is being led by Joshua J. Jacobs, MD, chairman of the Council on Research, Quality Assessment and Technology (CORQAT). We already know, through our member surveys, that 98 percent of our fellows would like the AAOS to participate in and offer some form of technology assessment. And we are flattered that the primary reason members cite for AAOS involvement is that they trust the Academy’s objectivity over other sources.

The next step is to balance your expectations with the reality of what technology assessment by the AAOS means. As Josh noted, “It depends on whether you want tap water or Evian.”

Meeting the demand
The problem is—as Board member Kevin J. Bozic, MD, MBA, pointed out—there is an increasing demand for newer, more extensive (expensive?) technologies and continued public scrutiny of orthopaedic surgeons and procedures. The ultimate questions may be: Is technology part of the problem or part of the solution? Do new technologies improve patient outcomes?

After a full day of discussions, the Board had indeed gained a better understanding of the definition and methodology of technology assessment. We also realized that you—the fellowship—will likewise need information and education about what technology assessment is and what it can and cannot accomplish. We will continue to address that need through articles in AAOS Now and other educational efforts.

Because decisions about technology assessment cannot be made in a vacuum, or limited to just our own perspective, the Board also invited outside guests from the healthcare industry, the Centers for Medicare and Medicaid Services, and other medical associations to share their views and experiences in dealing with technology assessment. They also provided valuable insights on how the AAOS might position itself to contribute in a meaningful manner.

As they pointed out, legal obstacles and risks associated with offering technology assessment to our members and the public are significant issues that must be addressed. In addition, we must determine how to avoid conflicts of interest in the process of assessing new technologies. We need to continue our discussions on the ethical behavior of orthopaedic surgeons and potential conflicts of interest related to participation in technology assessment. How, for example, do we identify individuals who have enough experience with a new technology to make a judgment about it, but do not have a built-in bias or conflict?

What’s the answer?
By the end of the workshop, the Board had come to the following conclusions:

Because the AAOS seeks to be the definitive source for musculoskeletal information and education, we should participate in technology assessment for our members and our patients.

Technology assessment could take the form of a summary document that provides a “quick read.” For more complex topics, however, a more detailed document would be necessary.

The AAOS will likely pursue technology assessment in-house, through the CORQAT. But if specific topics warrant, we will consider going outside for assistance in developing the assessment.

Finally, we will carefully select topics and prioritize areas of technology assessment utilizing our Guidelines Oversight Committee.

In essence, we are recommending that the AAOS no longer remain silent on the issue of technology assessment, but should pursue it in an appropriate and deliberate manner. We have decided to “dip our toe in the water” and to move very slowly and thoughtfully. We must have a defined process for topic selection, as well as education and communication to our members and our patients.

At the Academy, technology assessment will take the form of education and information for you, our Fellows—as well as for patients, payors, and hospitals—about new or existing technology. The AAOS will not make recommendations on the use of a specific product or procedure. We will rely on the expertise provided by the orthopaedic specialty societies, and we will provide the infrastructure and resources to implement an effective process.

New technologies play a central role in the practice of orthopaedic surgery. The AAOS should—and will—serve as a resource for those seeking unbiased information on newly developed surgical procedures, drugs, biologics, and orthopaedic devices. It’s just what you’d expect from your Academy.