During this presidential campaign, there’s been a lot of talk about “change.” Both candidates claim they will be able to bring “change” to Washington, D.C., but neither has actually addressed how that change will come about. Talking about change is much easier than actually implementing it, as we all know.


Published 8/1/2008
Tony Rankin, MD

What does change take?

Tony Rankin, MD

On the one hand, with the stroke of a pen, the president can ensure that sweeping changes will occur. FDR gave the country a “New Deal” and created an alphabet soup of agencies; Lyndon Johnson’s signature on the Civil Rights Act of 1965 had an incredible impact on the lives of African-Americans, just as George H.W. Bush’s signature on the Americans with Disabilities Act opened doors and improved conditions for thousands of individuals.

On the other hand, getting that legislation to the president’s desk took years of effort by thousands of people, hundreds of hours of debate, and millions of words!

Setting the stage for change
Several years ago, healthcare-related organizations realized the need to draw attention to the burden of musculoskeletal diseases and conditions, not only in the United States but around the world. Thus was born the Bone and Joint Decade (2002-2011). The goals of the Decade are to raise awareness, promote wellness and prevent musculoskeletal disease, and advance research.

For more than a year, the AAOS Council on Advocacy and the office of government relations have been working together to craft legislation that addresses those same concerns. The result is the “Access to America’s Orthopaedic Services Act of 2008” (HR 6478), which was introduced in the House last month by Reps. Hilda L. Solis and Michael C. Burgess, MD. The bill seeks to raise awareness of musculoskeletal diseases and conditions among legislators, healthcare professionals, and the public.

Provisions of the measure address issues such as trauma and rehabilitation, musculoskeletal research, quality and safety, health disparities, women’s health, aging and seniors, pediatric ortho­paedics, the orthopaedic workforce and training, vehicular crashes and workplace injuries, and congressional findings. The legislative language addresses only musculoskeletal issues and does not include global health care issues affecting all medical specialties (such as medical liability reform or physician payments under Medicare).

To maximize the number of cosponsors from both the Democratic and Republican parties, the legislation does not contain any new spending or new programs, and does not place any unfunded mandates on the states.

Instead, it aims to raise awareness of musculoskeletal diseases and conditions in the United States and to develop a roadmap of the important orthopaedic issues that need to be addressed. You can read more about this bill on page 1; a summary of its provisions can be found online, as part of the background materials for the National Orthopaedic Leadership Conference (NOLC), on the AAOS Web site, at www.aaos.org/dc

It takes time to make change
As I noted in my last column, advocacy is a marathon, not a sprint. It’s been 6 years since the first negative impact was felt from the flawed Medicare physician payment formula. Issues such as liability reform, patient safety, and research funding consistently recur in one form or another.

AAOS members have testified multiple times before Congres­sional committees, participated in hundreds of policy discussions, submitted pages of policy comments to government agencies, and ensured that the voice of orthopaedics is being heard through personal visits to Congress and their participation in activities such as Research Capitol Hill Days and the NOLC.

Additionally, the AAOS office of government relations, in collaboration with specialty societies, spends countless hours on Capitol Hill each year, meeting with members of Congress and various government officials to advocate on behalf of the orthopaedic community. As you read David Lovett’s article on the Medicare physician payment “fix” and review the analysis of HR 6331, you can see the time, the thought, and the effort that goes into developing and maintaining a position. And this is just one of many issues that must be addressed.

It takes you to make change
Many of the changes that have occurred in recent years—at both the state and federal levels—resulted from active involvement by individual orthopaedic surgeons, orthopaedic societies, and coalitions of healthcare providers and patients.

AAOS members have been particularly active at the state level, advancing the orthopaedic agenda on scope of practice, direct access, and advanced imaging, among other issues. Numerous state societies took a proactive approach to advocacy in 2008, introducing their own legislation to stave off inappropriate scope of practice expansions by nonphysician providers and to protect the rights of physicians to invest in technology and in-office ancillary services.

The AAOS Health Policy Action Fund has been pivotal in this movement, assisting the Rhode Island and Georgia Orthopaedic Societies in achieving legislative victories on the state level. A total of 16 state societies have received more than $230,000 in grant funding for legislative initiatives.

Several state orthopaedic societies are participating in the AAOS E-Advocacy pilot program, which provides state society leaders with an online tool to communicate the latest information on advocacy issues of importance to their membership and facilitates communication between members and their state and federal representatives. The program has been successfully employed to support grassroots action on everything from the Medicare physician payment cuts to medical liability reform at the state level.

Needless to say, it also takes money to make change. Participation in fundraisers is an essential component of the legislative process at both the state and federal levels. Your participation can be the first step in establishing yourself as a key contact for the orthopaedic community with your elected officials.

Thus far, in the 2008 election year, the Orthopaedic Political Action Committee (PAC) has contributed to more than 130 congressional races and delivered more than $100,000 to in-district fundraising events. The Orthopaedic PAC will continue to increase its visibility among elected officials this year at both the Democratic and Republican Presidential conventions.

Change is coming—be a part of it
As you read this issue of AAOS Now, take note of the articles that focus on what it takes to effect changes—whether those changes are in tort reform laws, evidence-based practices, or physician payments under Medicare. You can also find more information on the AAOS advocacy efforts by visiting the Office of Government Relations Web site at

I hope that, in reading these articles, you gain a better appreciation of the efforts the AAOS is expending on your behalf. I also hope that these articles will motivate you to join in our advocacy efforts at whatever level you can—whether it be a check to the Orthopaedic PAC, a letter to your congressional representative, a personal contact, or active involvement in your local or state orthopaedic society to effect changes in state legislation.