President Barack Obama
The White House
1600 Pennsylvania Ave. NW
Washington, DC, 20502

August 13, 2009

Dear Mr. President:
On behalf of the American Academy of Orthopaedic Surgeons (AAOS), I am writing to express our profound disappointment with your recent comments regarding the value of surgery and blurring the realities of physician reimbursements. The AAOS represents more than 17,000 U.S. board-certified orthopaedic surgeons who provide essential services to patients every day. As you yourself have said, “Where we do disagree, let’s disagree over things that are real, not these wild misrepresentations that bear no resemblance to anything that’s actually been proposed.” In that spirit, we would like to bring some clarity to your comments and underscore the value that orthopaedic surgeons bring to Americans every day of every year.

First, surgeons are not reimbursed by Medicare, nor by any provider for that matter, for foot amputations at rates anywhere close to $50,000, $40,000, or even $30,000. Medicare reimbursements to physicians for foot amputations range from approximately $700 to $1,200, which includes the follow-up care the surgeon provides to the patient [for] up to 90 days after the operation. Moreover, orthopaedic surgeons are actively involved in the preventive care you mention. We are a specialty that focuses on limb preservation whenever possible and when it is in the best interests of the patient. Our approach to amputation follows the same careful, thoughtful approach, always with the patient’s best interest as the primary focus.

It is also a mischaracterization to suggest that physicians are reimbursed “immediately.” The AAOS itself, along with numerous other organizations, has testified in Congressional hearings investigating the delays in reimbursement by Medicare and other payers that create additional administrative burdens making it more difficult to provide access to care for patients.

As you continue to pursue your health care reform agenda, we implore you to disengage from hyperbole and acknowledge that health care delivery can only be improved by recognizing that health care is a system in which orthopaedic surgeons play a crucial role. With $849 billion of our national economy impacted by musculoskeletal conditions, orthopaedic surgeons provide care that improves lives and puts people back to work. Pediatric orthopaedic surgeons provide life-altering care to our nation’s children and play an invaluable role in ensuring Medicaid patients have access to needed services. Military and civilian orthopaedic surgeons provide care to our service women and men, which preserves limbs and has improved survival rates over past conflicts. Orthopaedic trauma surgeons perform limb- and life-saving procedures and help to ensure that our communities have the medical services that we all deserve. Total hip and knee replacement surgeries are now two of the most successful operations in medicine through a predictable reduction in pain, restoration of function, and return of patients to both work and activities of daily living. And we are working every day to ensure that medicine provides Americans with disabilities the quality of life to which they are entitled.

The AAOS is committed to improving the American health care delivery system and increasing health care coverage. The most expedient way to accomplish your goal is to ensure that the debate is based in fact and reflects the value of the services that all physicians, including orthopaedic surgeons, provide. We request a meeting with you and your staff at your earliest convenience to discuss these important issues.

Sincerely,

Joseph D. Zuckerman, MD
President, American Academy of Orthopaedic Surgeons

CC: Kathleen Sebelius, Secretary, US Department of Health and Human Services
Nancy-Ann DeParle, Counselor to the President and Director of the White House Office of Health Reform
Melody Barnes, Assistant to the President and Director of the Domestic Policy Council