Published 8/1/2012

Readers Suggest Next Steps in Healthcare Reform

Push forward faster
It is not enough to oppose a law designed to help provide more Americans with health care. I have lived, worked, and traveled throughout Western Europe. I think the United States has a second-rate system compared to most European countries.

We have areas of outstanding care in multiple specialties including orthopaedics. On an almost daily basis, however, I see poorly conceived procedures on patients with vague diagnoses and perhaps a marginal MRI. Then, when the patient has a poor result, the surgeon sends him or her off to “Pain Management.”

The AAOS needs to be a better leader and stop helping to justify marginal doctors doing marginal procedures. As an organization, the AAOS needs to actively push members to be involved in “outcomes.” As an organization, the AAOS needs to take a stand on all of the unnecessary back operations and excessive shoulder/knee/hip/ankle arthroscopies. Is there any evidence for surgery for planter fasciitis or for the use of extracorporeal shockwave procedures?

It is no wonder that medical care in this country costs so much. Let’s push forward faster before the system is bankrupt.
David L. Chittenden, MD

Mill Valley, Calif.

Don’t lose sight of our duty
As a longstanding member of the AAOS, I have agreed with much of what this organization has done with patient and member advocacy. As a pediatric orthopaedist and spine specialist who has a significant patient population with Medicaid as the paayer, I want my organization to consider that it should also advocate for me and my patient population.

The AAOS wisely has publicly supported some of the provisions of the Patient Protection and Affordable Care Act. Now, rather than have our members of Congress dig their heels in and obstruct the funding of this bill, I want my organization to move on. The status quo is over.

Let us not lose sight of our duty to look after all Americans. It’s a tough message to deliver, but the irony of this situation is that if all providers did their share and fewer patients fell through the cracks, we might not have gotten to the point where a president believed that he had to overhaul the delivery of health care. I believe that all Americans should have access to good health care.

With so much of the emphasis on Medicare-related issues, are we even trying to raise the payments for all Medicaid providers? This is a shrinking pool of doctors. Many of my colleagues who focus on adults are insisting on less trauma call and on sustaining their reimbursements through optimizing payer mix. In my opinion, this contributes to access issues for patients.

Shouldn’t I be paid for my services as much as the adult specialists? AAOS has not promoted this kind of parity. I would, however, be content if the AAOS promoted that all orthopaedists do their fair share of the undercompensated, trauma, and Medicaid work rather than leave it to trauma centers and teaching centers.
Nigel J. Price, MD

Kansas City, Mo.

Setting Now Straight
If you want to set AAOS Now straight, send your letters to the Editor, AAOS Now, 6300 N. River Rd., Rosemont, Ill. 60018; fax them to 847-823-8033; or email them to