As members of Congress return to Washington after the August recess, they are faced with the challenges of finalizing and reconciling healthcare reform measures. Although both the House and Senate failed to meet President Obama’s initial deadline of passing comprehensive healthcare reform before Labor Day, neither the president—nor the American public—are willing to let this opportunity go by.

The president has now stated that healthcare reform will pass by the end of the year. Speaker of the House Nancy Pelosi (D-Calif.) has said, “Congress is closer than ever before in history to passing comprehensive health insurance reform … In September, Congress will pass legislation that puts Americans and their doctors back in charge, holds insurance companies accountable, guarantees stability and peace of mind, lowers costs, and provides more choices for higher quality care.”

Senate Minority Leader Mitch McConnell (R-Ky.) is also committed to reform. “As the debate over health care continues, it’s important that we not lose sight of the fact that the American people expect results,” he has said. “Americans want reform, and that’s exactly what they expect us to deliver.”

But as anyone who has ever worked on legislation knows, “the devil is in the details,” and those details have yet to be finalized.

While the debate continues, the American Association of Orthopaedic Surgeons (AAOS) is maintaining contact with members of Congress and other physician groups. Because both Senate and House proposals are still subject to change, the AAOS has not taken a position either supporting or opposing the entirety of any bill under consideration. The current focus of the AAOS is to make existing proposals as beneficial to orthopaedic surgeons and their patients as possible.

Advocacy works:

The demise of IMAC
The AAOS has taken several positions on proposed provisions of healthcare reform legislation being debated in Congress. For example, the AAOS opposes a proposal put forth by Rep. Henry Waxman (D-Calif.), chair of the House Energy and Commerce Committee, to include an Independent Medicare Advisory Council (IMAC) in HR 3200, the House healthcare reform bill.

“The creation of an IMAC-like entity would severely limit Congressional oversight of the Medicare program and replace the transparency of Congressional hearings and debate with a more opaque process overseen by the executive branch with, at best, minimal accountability for the healthcare decisions it makes,” says AAOS President Joseph D. Zuckerman, MD.

In addition, the AAOS joined 15 other surgical organizations, including the American College of Surgeons, in a letter to Speaker Pelosi. The organizations noted that “Medicare payment policy requires a broad and thorough analysis of providers and beneficiaries, and leaving these decisions…in the hands of an unelected, unaccountable governmental body with minimal Congressional input will negatively impact the availability of quality, efficient health care to Americans. Should provisions to place the authority for Medicare payment policy in an unelected executive agency be included in any legislation at any point, the surgical community would vigorously oppose this legislation, regardless of any other provisions that may be included.”

The AAOS and others also argued that the small size of IMAC would limit its ability to grasp the impact of decisions on the delivery of care, in part because physicians—who currently have three seats on the Medical Payment Advisory Commission (MedPAC)—would not be able to “continue their careers while serving on such a policy-setting body at the executive branch level. As a result, such important perspectives that appreciate the patient-provider relationship would be lost.”

In a “Call to Action” issued on July 19, 2009, the AAOS requested that members contact their congressional representatives and encourage them to oppose including this provision in healthcare reform. After hundreds of AAOS members joined other specialty medicine physicians in voicing their opposition to the proposal, it was not included in the final House bill that passed prior to the August recess.

Advocacy works: Imaging referrals
In addition to voicing strong opposition to the creation of an IMAC, the AAOS has also been effective in opposing the Weiner-Braley Amendment to HR 3200. This proposal, sponsored by Reps. Anthony Weiner (D-N.Y.) and Bruce Braley (D-Iowa) would have eliminated the ability of physicians to provide advanced in-office diagnostic imaging services such as computed tomography, magnetic resonance imaging, and positive electron tomography scans.

The AAOS opposition is based on the fact that patients rely on access to imaging services for prevention, early detection, diagnosis, and treatment of musculoskeletal and other health conditions. In a letter to Rep. Waxman, the AAOS and other surgical specialty societies noted, “Professional medical societies are taking significant steps to ensure that only medically necessary imaging procedures are performed and, as a result, growth rates [in the use of such procedures] are declining. We are developing training guidance, appropriate use criteria, guidelines, and other clinical documents to guide our members in delivering the most appropriate care.”

Although the amendment was not introduced before the House Ways and Means Committee’s vote on HR3200, this threat to patients and physicians remains. As of this writing, the House has scheduled a special session to hear more than 60 proposed amendments to the bill, potentially including this amendment.

Advocacy can work with your help
AAOS actions are being guided by its official “Principles of Health Care Reform and Specialty Care,” which, along with other position statement on topics such as Medicare reform and existing government programs, can be found on the AAOS Web site. (Links can be found in the online version of this article, available at www.aaosnow.org) Readers are encouraged to consider the information presented and reach their own conclusions.

The constantly evolving political climate in Congress requires an informed, active membership. To address the need for information, Dr. Zuckerman has initiated weekly updates specifically addressing the status of healthcare reform and the potential implications for orthopaedic surgeons.

In addition, Peter J. Mandell, MD, chair of the AAOS Council on Advocacy, will issue “Calls to Action” as needed. These e-mails include instructions on how AAOS members can contact their elected representatives and express their concerns about specific legislative proposals.

Many AAOS members used the suggested tools in these letters to set up in-person meetings with their senators and representatives during the August break, as part of the new AAOS initiative, Project 535. The goal of this initiative is to have fellows make contact with every member of the House and Senate—all 535 members of Congress. These meetings and the continued engagement of the AAOS fellowship can have a profound impact on elected representatives and will help move legislation in a direction more favorable to ensuring patient access to quality, affordable specialty care.

To ensure that you receive these alerts and other information, make sure that the AAOS is “whitelisted” in your e-mail program. To submit or update your e-mail address in the AAOS database, contact member services at member@aaos.org

Nick Piatek is communications specialist in the AAOS office of government relations. He can be reached at piatek@aaos.org