NOLC participants seek support from legislators to fix flawed Medicare reimbursement formula, developing advocacy strategies at the state level

For more than two decades, the AAOS Board of Councilors (BOC) has convened the National Orthopaedic Leadership Conference (NOLC) each spring in Washington, D.C., bringing together the leadership of orthopaedic societies from around the country. In addition to exchanging views on practice and policy, hundreds of orthopaedic surgeons spent an entire day meeting with their senators and representatives on Capitol Hill to lobby for a solution to the flawed Medicare physician payment formula and to recruit support for legislation establishing a more realistic timeline for quality measure development and reporting by physicians.

Because the annual State Societies Strategy Meeting was held on the first day of the NOLC, many more members of state groups were able to participate in the Capitol Hill meetings. More than 135 individuals registered for the State Societies Strategy Meeting, and NOLC registration topped 325.

States examine scope of practice, direct access
The state societies meeting covered considerable ground, with panels on scope of practice issues associated with podiatry and on direct access to physical therapy. Other presentations were geared toward improving state society services, whether by employing professional association management techniques, taking advantage of the AAOS risk management continuing medical education (CME) program (currently under development), or enabling state and regional societies to offer CME credit for their annual meetings under the AAOS joint sponsorship program.

Beverly J. Lynch, executive director of the New Jersey Orthopaedic Society/Orthopaedic Surgeons of New Jersey, detailed the state’s leadership development program, and David A. Lovett, director of the AAOS office of government relations, summarized a report on the future directions of the state action plan.

The Orthopaedic Political Action Committee (PAC) Executive Committee, the AAOS Leadership Fellows Program (LFP), the BOC Communications Committee, and the BOC Professionalism Committee Meeting also met during NOLC. An evening training session helped prepare participants for the next day’s meetings on Capitol Hill. With 12 hours of meetings behind them, the group enjoyed a buffet dinner and reception that included an address by Senator Orin Hatch (R-Utah).

As a member of both the Senate Finance and the Health, Education, Labor, and Pensions Committees—both of which have jurisdiction over healthcare-related issues—Sen. Hatch expressed his commitment to addressing the concerns of the orthopaedic community with legislative efforts. He also pledged to work within Congress to prevent future Medicare payment cuts.

Raising awareness on the Hill
The following day, state delegations made the trek to Capitol Hill to meet with their elected officials. In some cases, the entire contingent from a state met with their representatives. In other cases, state delegations divided into teams to fit in as many meeting opportunities as possible.

During their sessions with legislators, delegates emphasized the unified messages of “fix the Medicare reimbursement formula” and “support legislation that will establish a more realistic timeline for quality measure development and reporting by physicians.” If time allowed, they provided supporting details and discussed other issues.

When the members of the California delegation met with Rep. Fortney “Pete” Stark (D-Calif.), for example, they described in succinct, frank detail their concerns with ongoing delays to enact meaningful physician payment reforms as well as the potential problems with pay-for-performance measures. They urged him, as chair of the Ways and Means Subcommittee on Health, to set a timetable for his subcommittee to address these issues. In return, Rep. Stark emphasized the value and importance of legislators receiving input from physicians.

“You’ve got to help us out,” he said. “You’ve got to help us separate the wheat from the chaff.” Rep. Stark spent the remainder of what turned out to be a lengthy appointment discussing various aspects of healthcare reform with the California surgeons in his office.

That evening, delegates assembled to discuss the results of their efforts. It quickly became apparent that the orthopaedic surgeons had unprecedented access to their elected officials. Instead of a few minutes of time with a staff member, delegates enjoyed visits of up to an hour with the elected officials themselves.

At the awards ceremony that night, the Texas Orthopaedic Association and the Pennsylvania Orthopaedic Society both were honored with the AAOS State Orthopaedic Society of the Year awards, and the recently retired executive director of the Georgia Orthopaedic Society was recognized as the AAOS Executive Director of the Year. (See related article on page 42.)

Focus on communications
During general sessions the next day, AAOS President James H. Beaty, MD, addressed the group, followed by First Vice-President E. Anthony Rankin, MD, and Second Vice-President Joseph D. Zuckerman, MD. David A. Halsey, MD, chair of the Council on Advocacy, reported on progress being made in assembling a unified advocacy agenda and developing a comprehensive musculoskeletal legislative package, and provided an update on PAC activities and the work group on AAOS involvement in Medicare Part A issues.

Frank B. Kelly, MD, chair of the Communications Cabinet, and Alan M. Levine, MD, chair of the Council on Education, provided updates on activities in their respective areas. Delegates also heard from J. Edward Puzas, PhD, on the U.S. Bone & Joint Decade; David G. Lewallen, MD, on the American Joint Replacement Registry Oversight Board; and Robert H. Haralson III, MD, MBA, on the Medicare Physicians Quality Reporting Initiative.

Dr. Halsey, moderator of a panel discussion on healthcare reform, set the stage by labeling the current situation as “a system in crisis.” He then reviewed the major features of health insurance expansion bills and strategies being considered by the federal government. Panelists Cybele Bjorklund, Democratic staff director for the Ways and Means Health Subcommittee, and Stephanie Carlton, healthcare legislative aide to Sen. Tom Coburn (R-Okla.), then argued the benefits of the plans supported by their respective political parties.

A second panel discussion, this one led by Matthew B. Shapiro, MD, looked at the issue of volunteerism. Dr. Shapiro documented the national downward trend in levels of volunteerism, noting the degree to which professional membership organizations like AAOS are so dependant on volunteers. Panelists Alan M. Levine, MD; Susan Sarfati, CAE; and Edward Able, FASAE, offered possible reasons for that downward trend and strategies for attracting and retaining volunteers. The morning culminated with the presentation of the AAOS Media Orthopaedic Reporting Excellence (MORE) Awards, as reported in the May issue of AAOS Now.

Putting a “face” on war injuries
An afternoon symposium on extremity war injuries, led by Andrew N. Pollak, MD, powerfully profiled the efforts of orthopaedic surgeons treating casualties of the Iraq war. Capt. Dana C. Covey, MD; Col. Elisha T. Powell IV, MD; and Lt.Col. Romney Andersen, MD, presented an account of devastating injuries being treated, with extraordinarily high percentages of positive outcomes.

For example, more than 52,000 patients have been treated in Col. Powell’s Echelon III facility (comparable to a U.S. level I trauma center) since 2001, and today’s war casualties have a 90 percent survival rate, compared to only about a 75 percent survival rate for casualties of the Vietnam conflict. And the presentation was not limited to a recitation of statistics graphed on PowerPoint slides. On the dais with the panelists was Kimberly Dozier, a CBS news correspondent, who opened her remarks with the simple statement, “I am living proof that the whole military healthcare system works.”

Dozier was the casualty of a mobile improvised explosive device (a “car bomb” she explained with a wry expression) that killed associates CBS News cameraman Paul Douglas and soundman James Brolan, U.S. Army Capt. James Funkhouser and his Iraqi translator, as well as injuring several military personnel in Baghdad a year ago. Her heart stopped twice before she was stabilized, and she was told initially that the injuries she had sustained would require amputation of her legs.

Through the efforts of military orthopaedic surgeons in Iraq, Landstuhl, Germany, and the United States, Dozier was able to avoid amputation. After more than 20 surgeries, she is walking again, is relatively pain free, and plans to return to Iraq as a news correspondent. Her story was the subject of a CBS television special, “Flashpoint: Kimberly Dozier and the Army’s Fourth ID—A Story of Bravery, Recovery and Lives Forever Changed,” which aired in late May. As an advocate for increased funding for the Orthopaedic Extremity Trauma Research Program, Dozier testified before the Senate Defense Appropriations Subcommittee with Dr. Pollak on May 16. (See story on pg. 38)

Combined BOC/BOS meeting
The NOLC ended with a combined BOC/BOS business meeting. After hearing the recommendations on two proposed Standards of Professionalism, on the advisory opinion on state society membership, and on potential changes to the Academy bylaws related to aspects of the AAOS election process, representatives voted; the outcomes are detailed in the article on page 40.

During the business meeting, John G. Kloss, MD, councilor from Idaho, and Troy B. Watkins Jr., MD, president of the Idaho Orthopaedic Society, reported on the movement in their state to unionize orthopaedic surgeons. Michael P. Connair, MD, councilor from Connecticut, reviewed the results of judicial actions taken when orthopaedists in his state engaged in union activities.

During the subsequent separate BOC business meeting, councilors discussed the results of the State Society Strategy Meeting and proposed new plans for AAOS/state society relations.

The BOS business meeting focused on Medicare payment issues, industry representative in the operating room, and policies related to specialty society membership and representation.