A spirited discussion centering on pay-for-performance (P4P), utilization review physicians, and reimbursement took place during the Town Hall session at the 2007 AAOS Annual Meeting.
On hand to respond to members’ questions and concerns were AAOS President James H. Beaty, MD; Anthony Rankin, MD, first vice-president; Richard F. Kyle, MD, immediate past president; as well as council chairs and senior AAOS staff members. Robert H. Haralson III, MD, MBA, executive director of medical affairs, served as moderator.
“In a very challenging health care environment, a variety of interrelated issues have an impact upon access to our care,” said Gary Friedlaender, MD, of New Haven, Conn., who then asked the panel to comment on the Academy’s position on pay-for-performance.
Dr. Kyle, who had recently visited the Centers for Medicare and Medicaid Services (CMS), said that the development of P4P guidelines was one of the major topics discussed. The Academy’s Guidelines Oversight Committee is prioritizing guidelines to review, and the Academy is interested in synchronizing efforts with CMS. He noted that the Academy is involved in shaping the guidelines, rather than leaving this important function to the government.
Joshua J. Jacobs, MD, chair of the Council on Research, Quality Assessment and Technology, which oversees the Guidelines Oversight Committee, said that the Academy’s approach to P4P hasn’t changed. If orthopaedic surgeons have performance measures, he said, “they have to be evidence-based performance measures developed from evidence-based guidelines.” Dr. Jacobs added that “the Board of Directors has invested a lot of money in building up the evidence-based portion of the research department.”
Brian S. Parsley, MD, of Houston, Texas noted that many members don’t have a good understanding of P4P and that an analysis of the incentives versus the costs involved in the shift to P4P is warranted.
Communicating through local media outlets
The need to create a Web resource for members to use when responding to local media reports about orthopaedic issues was also raised. Relevant articles could be posted online so that members could reference them and provide “meaningful, evidence-based responses” to articles written by malpractice attorneys or others who do not share the Academy’s perspective on issues.
In response, Dr. Kyle noted that someone in the presidential line usually responds to such reports but some opportunities to offer the Academy’s perspective can be missed. He also said that the Academy is revamping some communication efforts and considering new Web site upgrades, adding that an online resource for members could be beneficial.
Craig Alan Zeman, MD, of Oxnard, Calif., questioned the Academy’s stance on utilization review physicians. Dr. Zeman stated that issues related to review physicians may require development of standards of professionalism (SOPs) similar to those developed for expert witness testimony. Dr. Kyle responded that the Council on Advocacy, which established the SOPs for expert witness testimony, would be responsible for evaluating the situation and determining whether such professional standards are needed.
Other issues brought up were funding for advocacy issues and educating patients about the need to advocate on behalf of their physicians, as well as the need for support of non-operative orthopaedic surgeons.