Current conditions demand that the AAOS take an active role in advocacy, and we intend to do so on many fronts. Let me review just a few of the steps we are taking.

AAOS Now

Published 9/1/2007
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James H. Beaty, MD

AAOS advocacy…for our patients and our members

The Council on Advocacy, the Orthopaedic Political Action Committee (PAC), and the AAOS Office of Government Relations in Washington, D.C., are three of the forces for advocacy within the American Association of Orthopaedic Surgeons. Through their activities, AAOS fellows have the opportunity to influence policies—not only at the AAOS, but also in state legislatures and even in Congress.

In fact, finally both the House and the Senate each have an orthopaedic surgeon member (Sen. John A. Barrasso, MD, R-Wyo., and Rep. Tom Price, MD, R-Ga.).

The increased focus on advocacy can readily be seen in the pages of AAOS Now. This issue, for example, features testimony by Frank B. Kelly, MD, on the need for prompt-payment legislation (page 24), news of an increasing orthopaedic presence at the American Medical Association (page 1), and a report from Stuart L. Weinstein, MD, on the Orthopaedic PAC (page 21). My thanks and congratulations to Dr. Weinstein and all our colleagues involved with growing our Orthopaedic PAC and making it a vibrant contributor to the political dialogue.

James H. Beaty, MD

Medicare: Payment issues remain problematic
News from the Centers for Medicare and Medicaid Services (CMS) isn’t good. The current proposal for physician payments in 2008 would result in an approximate 11 percent cut in orthopaedic services overall.

The AAOS is currently preparing a response to the CMS proposal. We are making every effort to ensure that Medicare patients will continue to have access to orthopaedic procedures that enable them to live full, independent lives. We realize that major cuts in reimbursement may mean that Medicare patients will have a harder time getting access to orthopaedic surgeons and orthopaedic procedures.

In addition, the AAOS and other groups within the physician community are working with members of Congress to prevent the proposed cuts in physician payments and fix the flawed Sustainable Growth Rate Formula for determining physician payments under Medicare, by replacing it with a system that recognizes the rising costs of medical practice.

We should know the results of our efforts by the end of the year.

Medical liability reform: Progress at state level
Much of the action in the area of medical liability reform has shifted to the state level, where AAOS grants—totalling nearly $200,000 over the past three years—are helping state orthopaedic societies achieve reforms that are reducing both premiums and the number of lawsuits.

Recent victories include passage of a bill in North Carolina that limits the amount of medical liability awards when both sides agree to binding arbitration, and the announcement of an 11 percent rate reduction in Pennsylvania. AAOS Now has already reported on the progress in Texas and Mississippi, two other states where AAOS grants helped make a difference.

But we haven’t given up hope for federal action. In June, Rep. Phil Gingery, R-Ga., re-introduced the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, comprehensive medical liability reform legislation designed to stem the growing crisis in patient access to medical care.

Doctors for Medical Liability Reform (www.protectpatientsnow.org), a nationwide grassroots campaign of concerned citizens and doctors, is also continuing its efforts for national medical liability reform.

SCHIP: Health care for America’s children
As policymakers and legislators continue to debate healthcare reform in preparation for the 2008 presidential election, the State Children’s Health Insurance Program (SCHIP) has moved front and center. Authorization for SCHIP is set to expire on Sept. 30, 2007, and without Congressional action, the health insurance program for children in low-income families will lapse.

Both the House and the Senate have passed reauthorization legislation, but the two bills must be reconciled, and key differences between both versions remain. The reconciliation process likely will focus on the amount of spending, eligibility expansions, and the size of the increased tobacco tax that will pay for the cost of the bill. In addition, the conference committee that will combine the two bills must decide whether to keep Medicare provisions included in the House version that would prevent the slated physician payment cuts in 2008 and 2009.

The AAOS has been actively engaged with members of Congress and will continue to work to ensure that children have access to the coverage that they need and that Medicare payments to physicians are accurate and appropriate given the continued rising costs of delivering care. In addition, the AAOS Council on Advocacy has embarked on a healthcare reform initiative to ensure that patient access to specialty care continues to be a part of the ongoing debate. We will continue to provide you with updates.

On-call coverage: Making slow progress
According to a recent survey by the American Hospital Association, nearly half of all emergency departments are at or over capacity, frequently resulting in diverting ambulances to other sites and delaying care to patients. One in 13 hospitals cited “lack of specialty physician coverage” as the primary reason for ambulance diversion.

But we are making slow progress in this arena. More than one third of hospitals are now paying for some physician specialty on-call coverage. In 2006, the AAOS Board of Directors adopted a position statement on “On-Call Coverage and Emergency Care Services in Orthopaedics.” This statement recognizes that physicians alone cannot bear the responsibility for a solution to the continuing crisis in emergency care.

The AAOS recognizes that call service remains an ongoing issue for our members. As the best qualified physicians to provide care for patients with musculoskeletal injuries, orthopaedic surgeons should, I believe, be leaders in the effort to solve this crisis. At this month’s Board of Directors meeting, we will be holding a strategic discussion on the issue, and we have invited the leadership of the Orthopaedic Trauma Association to join us.

We need your support
There is power in numbers, particularly in election years. The AAOS can be an effective advocate for orthopaedists, but our voice is hollow unless we can point to the support of our members. I urge you to get involved—at whatever level you feel comfortable. Then, I urge you to think about stretching your comfort level, and taking one more step—whether it be to contribute or increase your contribution to the PAC, or to sign up for the Advocacy 100 legislative training program, or to reach out to your state or congressional representative.

We will continue to report on our progress and our achievements through AAOS Now and the biweekly AAOS Legislative Update e-newsletter. If you have not yet subscribed to the AAOS Legislative Updates, I urge you to do so. These reports from our Washington Office have recently been redesigned to indicate the AAOS position and legislative activity on major issues, making it easier for you to follow our advocacy efforts.