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Published 11/1/2008
Charlene K. MacDonald, MPP

AAOS ramps up state advocacy activities for 2009

Health Policy Action Fund supports state activities

The saying “all politics are local” has never been more true. Increasingly, healthcare battles are being waged at the state level where legislative action is often more expedient and provides a greater return on investment relative to the cost of Congressional lobbying. When similar issues do arise at the federal level, lawmakers almost always look to the states to determine the support for and effectiveness of similar legislation.

Recognizing these trends, the AAOS Board of Directors recently approved a budget increase to fund state advocacy initiatives designed to advance the policy interests of orthopaedists across the country. The bulk of these funds will be distributed to state orthopaedic societies through the Health Policy Action Fund, a grant program that has achieved great success in addressing issues such as medical liability, scope of practice, and physician ownership.

In 2008, requests submitted by state orthopaedic leaders totaled more than $700,000, but the fund had only $300,000 available for grants. Recognizing the need for additional support, the Board has allocated $400,000 to the fund in 2009.

The role of state societies
State orthopaedic societies play a crucial role in the formation of health policy at the state level. The Health Policy Action Fund provides assistance for those state organizations with resources and expertise to advocate for change.

For example, grants to the California Orthopaedic Association (COA) have supported various initiatives, including its recent fight against legislation that would permit direct access to physical therapy. By mobilizing both its members and physical therapists supportive of their position, the COA was able to stall the proposed scope of practice expansion bill. (See report in September 2008 AAOS Now.)

Smaller societies can take advantage of the Health Policy Action Fund to pursue legislative goals while building up the infrastructure of their government relations programs. As reported in the October 2008 AAOS Now, the Rhode Island Orthopaedic Society (RIOS) received a $5,000 grant to protect physician-owned physical therapy services. By networking with other state societies, RIOS leaders adapted a strategy employed in Alabama in 2007 to preempt efforts by the state’s physical therapy lobby to restrict physical therapists from seeking employment in physician-owned physical therapy clinics.

Advocacy ambassadors
In addition to the Health Policy Action Fund grant program, the AAOS is launching a new “Advocacy Ambassador” program to encourage networking by leaders in orthopaedic advocacy and to facilitate the exchange of knowledge and experience from state to state. Advocacy ambassadors will be reimbursed for attending other state orthopaedic society meetings as speakers or strategic advisors.

Volunteers with issue expertise will be matched with state societies facing these issues. The first ambassador, James York, MD, of Maryland, will address the annual meeting of the Washington State Orthopaedic Association this month on his experience in fighting for the right of physician specialists to provide diagnostic imaging services in-office.

Dr. York’s insights should prove crucial as Washington confronts a legislative attack on imaging services with language virtually identical to that of the existing Maryland statute, which is currently embattled in both the courts and the State House.

Healthcare politics at both the state and federal levels is shifting rapidly, with reimbursement system restructuring and cost-cutting measures at the forefront of the debate. The AAOS considers a multitiered approach to legislative and regulatory advocacy essential for increasing access to and quality of patient care in the United States.

How funds are allocated
Chaired by Dirk H. Alander, MD, the State Legislative and Regulatory Issues Committee, within the AAOS Board of Councilors, administers grant funds and establishes state legislative priorities. For 2009, the committee will consider all applications, but give priority designation to grant proposals related to the following issues:

  • Physician-owned physical therapy
  • In-office diagnostic imaging
  • Direct access to physical therapy
  • Podiatry scope of practice
  • Ambulatory surgical centers
  • Workers Compensation

Grant applications are reviewed four times a year. The deadline for applications for the first round of grant reviews is Nov. 21, 2008; awards will be distributed on Jan. 1, 2009. The AAOS strongly encourages all state orthopaedic societies—particularly those that have not had the opportunity or the resources to participate in previous years—to considering applying. AAOS staff can help develop proposals and implement funded projects and welcomes inquiries from interested societies.

Charlene K. MacDonald, MPP, is manager, state legislative affairs, in the AAOS office of government relations. Contact her at macdonald@aaos.org for more information on any of these programs.