AAOS CEO Karen L. Hackett, FACHE, CAE, jots down her thoughts as Academy President Joseph D. Zuckerman, MD, makes a point on the value of practice management services for AAOS members.

AAOS Now

Published 7/1/2009
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Steven E. Fisher, MBA; Howard Mevis

AAOS aims to improve quality of practice life

Board workshop focuses on practice management issues

Continuing his pledge to “improve the quality of practice life” for AAOS members, Joseph D. Zuckerman, MD, led a workshop on practice management issues for the AAOS Board of Directors in May. The workshop focused on the current environment for orthopaedic practices and the steps AAOS could take to support members in practice management.

How are you doing?
An important first step in improving the quality of practice life is benchmarking your practice against others. According to Stephen P. Makk, MD, MBA, chair of the AAOS Practice Management Committee, benchmarking is a process.

“It starts with knowing how your office operates, understanding how other offices operate, and determining what works best and why. Then you can make decisions on implementing changes to do things better. Finally, you need to document how this was done. That leads back to the beginning,” he explained. “Because you make changes, you have to take new measurements to see their impact.”

According to Michael McCaslin, CPA, two key aspects of benchmarking are collecting consistent data and sharing key aspects of the data and how practices use them to improve practice effectiveness and efficiencies.

“The exchange of benchmark data is an advantage,” agreed James H. Beaty, MD, “but the free exchange of ideas is even more important.” Dr. Beaty, a member of the Campbell Clinic, shared how Campbell was able to use data from and discussion with other members of the Asheville Forum, a group of about 20 large orthopaedic practices that collect and share data, to establish an after-hours clinic.

The Board concurred that benchmarking data generated by a third party would be valuable to AAOS members and authorized market research on the value and benefits of benchmarking programs for solo and small group practices. As an example, the Academy may seek to work cooperatively with the American Association of Orthopaedic Executives, which already has a benchmarking program.

The shift to hospital-based practices
Recent articles in AAOS Now and other publications have explored the shift from private and group practices to hospital-based practices. According to Ian J. Alexander, MD—an orthopaedic surgeon from Mansfield, Ohio, who has been a hospital-employed physician since 2004—this practice setting presents several challenges.

Although being a hospital-employed physician has advantages—including funds for continuing medical education and the opportunity for bonus payments based on relative value unit (RVU) production, it also has disadvantages. Dr. Alexander cited the lack of administrative support, inadequate office space, restrictions on ancillaries (including radiology), lack of operating room time, and potential competition from other hospital-employed orthopaedic surgeons.

“Opportunities exist for physician-hospital collaboration in gainsharing, service line agreements, joint ventures, information technology, and facilities,” agreed Mr. McCaslin. “A key consideration for many physicians who give up private practice for hospital employment is the lack of ancillary services provided by the practice.”

This model, however, requires skill in negotiation, teamwork, leadership, and working within an organizational structure. To help members develop these skills, the Board recommended that the Practice Management Committee consider producing a primer on hospital-employed physicians with a section on contract negotiations and that the Academy consider adding information on negotiating employment agreements in courses.

Increasing numbers of hospital-employed orthopaedic surgeons may also have an impact on the AAOS. Although many members, including academic and military orthopaedic surgeons, may be considered employed physicians, these individuals continue to look to AAOS for education, research, and other services. State and local orthopaedic societies, however, may experience greater difficulty in attracting members. (See “Is the private practice orthopaedist disappearing?”)

Potential new services
Among the potential new services that the Board discussed were an insurance affinity program, a technology education program, and a claims clearinghouse. The Board felt that an insurance affinity program might appeal to solo practitioners, members of small groups, and candidate members, and voted to investigate this option.

The technology education program would include presentations by various companies in different areas, such as electronic medical records (EMR), picture archiving and communication systems (PACS), and billing systems. It will be available in 2010.

A claims clearinghouse could offer the following services: Eligibility verification, patient statement generation, charge and payment posting, claims scrubbing and submission, and appeals/claims adjudication.

Educating orthopaedic residents
The Board expressed strong support for practice management education for orthopaedic residents. In response, a series of online lectures is being developed to help orthopaedic residency programs meet requirements for the System-based Practice Competency as defined by the Accreditation Council for Graduate Medical Education. The program is anticipated to have high value for residents and candidate members.

Implementing EMR
Dr. Makk closed the workshop with a presentation on the emerging issues surrounding EMR implementation in medical practices. The Economic Stimulus Act of 2009 includes funding to support physician acquisition of EMR technology. Although EMRs offer several advantages (such as facilitating patient interaction, improving workflow, and decreasing long-term costs), the disadvantages are significant and include difficulty in implementation, changes to office procedures, and high start-up costs.

Few EMR systems have orthopaedic-specific modules, nor do defined sets of requirements exist for orthopaedic practices or service to ensure successful implementation. The stimulus legislation requires physicians to begin using EMRs by 2011 and imposes Medicare payment reductions starting in 2015 for physicians who fail to implement the technology.

In response, the Board agreed to establish an EMR project team with the following charges:

  • Develop a list of certification criteria for medical/surgical practice and ambulatory care EMRs. In this effort, review the work of the Certification Commission for Health Information Technology (CCHIT) and other organizations working on EMRs.
  • Develop a list of EMR hardware and software standards required for orthopaedic practice. Investigate existing and proposed standards for EMRs developed by standards-setting organizations.
  • Track developments in government regulations regarding the Economic Stimulus Act of 2009. Develop and implement an advocacy and communications plan for orthopaedics regarding EMRs. Propose to the Board of Directors position and advisory statements regarding health information technology.
  • Propose educational programs for consideration by the Practice Management Committee and CME Courses Committee.
  • Create materials and articles for AAOS Now to help members learn about costs and implementation issues for an EMR in an orthopaedic practice.

Steven E. Fisher, MBA, is manager of the practice management group at AAOS. He can be reached at sfisher@aaos.org or (847) 384-4331. Howard Mevis is director of the department of electronic media, evaluation programs, course operations, and practice management group. He can be reached at mevis@aaos.org or (847) 384-4100.