Published 12/1/2010

It’s a whole new game

Two days before the national midterm elections, I sat in the audience at the Fall Meeting of the Board of Councilors (BOC) and Board of Specialty Societies (BOS) and listened to members of the AAOS office of government relations, Council on Advocacy, and BOC leadership make some predictions. The session, moderated by BOC Chair-Elect David Teuscher, MD, was titled “AAOS and Healthcare Reform: Hit the Reset Button.”

John J. Callaghan, MD

John T. Gill, MD, chair of the AAOS Advocacy Resource Committee, discussed the potential “tsunami” that would result in a huge freshman class of Representatives, who, as he said, “will need to be educated on the issues.” Council on Advocacy Chair Peter J. Mandell, MD, correctly predicted 60 wins for Republicans in the House. In addition, Republicans picked up 6 seats in the Senate.

This shift in the balance of power will have a significant impact on issues that directly affect AAOS members—such as a permanent fix to the sustainable growth rate (SGR) formula, medical liability reform, and many provisions of the healthcare reform act. Republicans have traditionally been very supportive of some of these issues, such as medical liability reform. Fiscal concerns, however, may make it more difficult to achieve a permanent fix to the SGR. As a result, we are likely to see another short-term patch.

In addition, seven physicians won their bids for congressional seats. The perspective they bring may be significant in effecting change.

Finally, we can be very proud of our Orthopaedic Political Action Committee (PAC) and the role it played in the elections. The Orthopaedic PAC, now the largest medical PAC—surpassing even the American Medical Association’s PAC—was involved in 237 races and had an 89 percent success rate.

An emphasis on quality
One initiative that is unlikely to change is the emphasis on reducing healthcare costs and improving healthcare quality. Americans may not like all aspects of the Patient Protection and Affordable Care Act (PPACA), but repealing it may be difficult.

Among the proposed alternatives to PPACA are efforts to increase individual responsibility for healthcare spending. These include consumer-directed health plans, health savings accounts, and efforts to “manage from the buy side.” That perspective was presented at the Fall Meeting by Cheryl DeMars, president and chief executive officer of The Alliance, a nonprofit, employer-owned healthcare cooperative in Wisconsin.

As Ms. DeMars pointed out, employers are concerned about the costs of orthopaedic care because of the increasing volume of procedures being performed and the lack of quality information. Medicare is no longer the primary payer for total knee replacements, she noted—employers are. And these private payers are going to use every measure they can to differentiate among providers and to identify those who deliver value as well as quality.

Unfortunately, said Ms. DeMars, appropriate measures of quality are not available, leaving employers to focus on cost alone as a differentiator between providers. She appealed to the AAOS and its members. “What can we do on the prevention side?” she asked. “How can we measure quality and efficiency in more meaningful ways? What can be done to ensure appropriate utilization and adherence to evidence-based standards in the delivery of necessary care? How can AAOS be a resource?”

The AAOS Quality Initiative
One way, I believe, is the AAOS Quality Initiative. This multifaceted initiative is based on recommendations from the AAOS Quality Project Team, established in April 2010, and chaired by Frederick M. Azar, MD. In its final report, the Quality Project Team made the following eight recommendations, which were reviewed and approved by the Board.

  • Establish a Medical Directors’ Institute to bring the Academy together with payers, healthcare purchasers, and other stakeholders to address the most challenging concerns confronting patients and their surgeons.
  • Develop appropriate use criteria (AUC) to provide a clear and public demonstration of how the orthopaedic community works for the benefit of patients.
  • Implement organizational changes required for developing AUC, including establishing an oversight committee.
  • Facilitate use of AUC and clinical practice guidelines by developing tools that allow these recommendations to be implemented at common orthopaedic sites of service.
  • Engage in communications efforts that inform members about what AUC and other AAOS quality efforts are, and why the AAOS is developing them.
  • Identify the AAOS members involved in quality efforts, develop educational materials about AAOS positions, develop more formal means to facilitate communications, and formalize processes for positioning AAOS members in national quality organizations.
  • Ask the Guidelines and Technology Oversight Committee to modify the AAOS clinical practice guidelines program.
  • Continue efforts to develop national performance measures with other organizations, and monitor the development of individual performance measures and developments in this field.

The impact of these efforts will be seen in the coming months and years, as the AAOS strives to realize its mission of “serving the profession, championing the interests of patients, and advancing the highest quality musculoskeletal care.”