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Council on Advocacy Chair Peter J. Mandell, MD, one of the members of the California delegation, makes a point in his discussion with Wendell Primus, senior policy advisor on budget and health issues to Speaker Nancy Pelosi.


Published 6/1/2011
Madeleine Lovette

NOLC Participants Report on Outcomes of Hill Visits

Congressional representatives open to IPAB repeal, medical liability reform

As part of the 2011 National Orthopaedic Leadership Conference (NOLC), approximately 400 orthopaedists visited their legislators on Capitol Hill on April 7, 2011. NOLC participants scheduled more than 200 meetings to lobby their senators and representatives on key orthopaedic issues, including repealing the Independent Payment Advisory Board (IPAB), preserving patient access to in-office ancillary services, achieving meaningful medical liability reform, and increasing Congressional awareness of the large and growing prevalence of musculoskeletal diseases.

NOLC participants included leaders from state and specialty societies, as well as members of the American Association of Orthopaedic Surgeons (AAOS) Board of Directors, Board of Specialty Societies, Board of Councilors, the Orthopaedic Political Action Committee Executive Committee, the Leadership Fellows Program, the Washington Health Policy Fellows Program, and the Council on Advocacy. Many participants saw this year’s NOLC as the most successful to date. State delegations were able to meet directly with more members of Congress than in previous years. Recalling his meetings, John T. Gill, MD, chair of the Advocacy Resource Committee, said, “I was impressed that we had more direct meetings with members this year, both Republican and Democrat, than I can ever remember.

“The AAOS office of government relations has done a great job during the past year to get our name out on the Hill. Senators and representatives know who we are; they know we are players,” he said.

Peter J. Mandell, MD, chair of the AAOS Council on Advocacy, also found increased access during his Hill visits. “The California delegation was able to bring the AAOS messages directly to key Congressional leaders such as Majority Whip Kevin McCarthy (R), and House Ways and Means Health Subcommittee Chairman Wally Herger (R) and Ranking Member Pete Stark (D),” he reported.

According to participant feedback forms received by the AAOS, members of Congress and their staff agreed with the AAOS on many issues. Participants report that representatives and senators were most supportive of repealing the IPAB, which was created under the Patient Protection and Affordable Care Act (PPACA).

Following a meeting with Texas delegates Brian S. Parsley, MD, and Howard R. Epps, MD, Rep. John Culberson (R-Texas) became a cosponsor of the Medicare Decisions Accountability Act, a bill to repeal the IPAB. In addition, during the week following the NOLC, Rep. Allyson Schwartz (D-Pa.) lent her name to the bill, making her the fourth Democratic cosponsor.

Medical liability reform
NOLC participants also found that members of Congress were more open to medical liability reform. Although some Congressional representatives expressed concern that the $250,000 noneconomic damages cap proposed in the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, which NOLC participants were supporting, does not reflect a true cost of living, they indicated that they might be willing to discuss a higher limit. In this area, as in several others, Congressional representatives are looking for ways to support reform while retaining their seats.

Both representatives and senators expressed a great deal of interest in the Access to America’s Orthopaedic Services (AAOS) Act, which will be reintroduced later this year. The bill seeks to improve research, diagnosis, and treatment of musculoskeletal diseases and conditions, which are responsible for the greatest number of lost work days in the United States.

“Last Congress we achieved a goal of getting the AAOS Act introduced in both the House and Senate,” said Dr. Mandell. “This year, we hope that our advocacy efforts illustrated the real need for this legislation not only medically, but economically as well.”

In-office ancillary services
Feedback from participants was mixed, however, on the issue of integration of clinical services. Several state delegations reported that both Republican and Democratic representatives supported the idea of integrated care even though they expressed concern about overutilization and unnecessary scans when a doctor owns an imaging machine. (
See “Rules, reforms, and regulations—Part 2” for more on this issue.)

Nevertheless, NOLC participants were successful in convincing a few representatives, including Rep. Culberson, to support HR 1159, a bill to repeal certain PPACA provisions that restrict the establishment and growth of specialty hospitals.

For more information on the NOLC, see the May issue of AAOS Now, available online at or visit the AAOS office of government relations Web site at

Madeleine Lovette is the communications specialist in the AAOS office of government relations. She can be reached at