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By the time you read this, several bills to reform America’s healthcare system may already be making their way through the legislative process. Already, President Obama has created a White House Office for Health Reform and has met with representative stakeholders from the healthcare industry, insurers, patients, and physicians. No fewer than three House committees and two Senate panels are involved in crafting bills.


Published 6/1/2009
Joseph D. Zuckerman, MD

Working together to bring about change

In March, I was privileged to represent the AAOS at a physician-only meeting at the White House to discuss ways to lower healthcare costs and improve quality of care while preserving patients’ ability to control their healthcare options. Just last month, at the National Orthopaedic Leadership Conference (NOLC), we had the opportunity to hear from many of those involved in crafting healthcare reform legislation, including Sen. Jack Reed (D-R.I.), who serves on the Senate Appropriations and Health, Education, Labor, and Pensions Committees, and Rep. Jim Moran (D-Va.) of the House Appropriations Committee.

We also heard from the two orthopaedic surgeons who serve in Congress, Sen. John A. Barrasso, MD (R-Wyo.), and Rep. Tom Price, MD (R-Ga.). Their remarks underscored the need for us to propose solutions and to be active participants in shaping reform, rather than pointing out problems and complaining about others’ proposals.

Believe me when I say that we MUST have a seat at the table during these negotiations. Surgeons—especially orthopaedic surgeons—need to make the case for patient access to specialty care. We need to make the case for the quality of life improvements that orthopaedic surgery provides patients. And the more AAOS fellows who participate in the process—who donate to the Political Action Committee (PAC) of the American Association of Orthopaedic Surgeons, who are willing to hold a fundraiser in district for a politician, who can call their local congressional representative and discuss the real impact of some of these changes—the better off we will be in the long run.

Participation in the PAC is so important that the presidential line has made it a critical issue for this year. Our goal is to achieve 50 percent member participation in the PAC for the 2009-2010 election cycle.

I hope you heeded my call last month and made a contribution to the PAC. If you have not yet made your pledge, I urge you to do so today. You can make a secure pledge online, or download the contribution forms, at www.aaos.org/pac

With your participation and your contribution, we can do for our specialty what this administration has said it will do for the country—bring about change.

Addressing the “on-call” challenge
One area where many AAOS members would like to see changes made is in the orthopaedic response to the on-call challenge. In January, AAOS leadership met with representatives from the Orthopaedic Trauma Association (OTA). We all recognize that—even though this is a national crisis—the solutions must be found and implemented at a local level. This is one case in which “one size doesn’t fit all.”

To address the multifaceted aspects of emergency care issues, the AAOS has also reached out to the American Hospital Association (AHA). AAOS leadership, along with representatives from the OTA and the AHA, are currently preparing a series of “next steps” that we hope will lead to cooperative working arrangements.

We want to ensure that patients who need emergent care receive it, that physicians who provide emergent care—particularly to the uninsured and the underinsured—are adequately compensated for their services, that hospitals support the provision of emergency care with appropriate resources, and that communities understand the crisis and commit to designing solutions that work.

Once again, this is an area where we must all work together to bring about change.

Joint registry moves forward
Another area where cooperative efforts are making a difference is in the establishment of an American Joint Replacement Registry (AJRR). In February, the AAOS Board of Directors allocated $300,000 in start-up funding and established a project team under the direction of David G. Lewallen, MD. Since then, much has happened to fast track the establishment of the registry.

We are establishing a new 501(c)3 nonprofit corporation to house and support the registry. Three specialty societies—the American Association of Hip and Knee Surgeons, The Hip Society, and The Knee Society—have each committed $50,000 to support the project. We are reaching out to the AHA, to payors, to industry, and to the government. We have selected a vendor to provide project management assistance in the following areas:

  • Legal and organizational (structural) issues
  • Data collection and management
  • Legislative issues and coalition building with potential stakeholders

AAOS fellows should know that participation in the registry is not mandated, nor is the registry being established to measure comparative effectiveness. We see this as a win-win situation for patients, payors, physicians, and industry—and indications are that others agree.

I want to thank the members of the AJRR Oversight Board, who have brought the project this far, and the members of the project team, who are determined to see it through: Dr. Lewallen; John J. Callaghan, MD; Daniel J. Berry, MD; Thomas C. Barber, MD; Leesa Galatz, MD; Henrik Malchau, MD; and William J. Maloney, MD. We will continue to update you on the progress of this effort as it proceeds.

Beyond the challenge
Within the challenges lie the opportunities. Within the challenge of healthcare reform is the opportunity to improve patient care. Within the challenge of emergency call is the opportunity to create systems that work for communities. Within the challenge of a joint registry is the opportunity to increase understanding and improve care.

To move beyond the challenges into the opportunities requires everyone’s participation. I challenge you to step up to the plate, to get involved, and to help your Academy implement changes that will improve your practice life, your surgical outcomes, and your future.