The AAOS is continually increasing the value of your membership with new programs and initiatives that address your needs. Although these programs have cost roughly $16 million over the past 10 years, as can be seen in the table that accompanies the “Treasurer’s Report—2012” on page 42. We can point with pride to programs such as the following:
- The Professional Compliance Program, which although by far the most significant expenditure, continues to receive overwhelming support from fellows. It was introduced in 2005 to promote appropriate behavior within the orthopaedic profession, and to date, the AAOS has spent more than $4.5 million to implement and defend the program. Earlier this year, a court decision dismissed one set of challenges to the program and reinforced the Association’s authority to govern its own members and its efforts to improve the profession. Although other challenges may be filed in the future, the AAOS remains committed to supporting this program.
- Evidence-based practice initiatives, such as Clinical Practice Guidelines and Appropriate Use Criteria, that help shift the paradigm of care to a patient-centered, evidenced-based focus.
- The American Joint Replacement Registry (AJRR), our best hope for a national joint replacement registry to provide outcomes data and tracking information to enable us to identify poorly performing implants early and to change practice patterns to benefit patients.
- Advocacy efforts—on both the state and federal levels—that give orthopaedics “a seat at the table” and build a foundation for physician involvement in change, whether it be reforming medical liability laws, defending orthopaedic ownership of in-office ancillary services, or establishing clear and reasonable criteria for coverage decisions.
- Quality and value initiatives that help support the case for orthopaedic interventions in an era of increasing scrutiny on the “return” that medical procedures deliver.
Focusing on what’s important
To support such programs without increasing member dues over the past 10 years has required a great deal of fiscal restraint and some hard looks at the programs and services being provided. Back in 2003, AAOS President Vernon T. Tolo, MD, noted that more than 100 programs had annual budgets of more than $75,000.
“Our dilemma,” he wrote, “relates to how to select those programs of most value. … Our emphasis needs to stay on education in the broadest sense. At the same time, funding for non-revenue producing activities—advocacy, public education, research—is necessary for the AAOS to provide the representation and services that fuel your desire to continue to want to be an AAOS Fellow year after year.”
As a result, the Leadership Review Group was established, to rate the performance and effectiveness of all AAOS programs. In the decade since 2003, 27 nonperforming, ineffective, and outdated programs have been reduced or eliminated—saving more than $1.4 million annually. In addition, the AAOS staff has become quite adept at reducing costs, regularly ending the year with operations under budget, as AAOS Treasurer Andrew N. Pollak, MD, notes in his annual report.
But as the world’s current fiscal crisis shows, at some point cutting costs is not enough. Additional income is required to meet the rising costs of everything from supplies and personnel to utilities and repairs. And so, your AAOS Board of Directors has also looked at ways to enhance revenues to keep your Academy fiscally solvent and moving forward to meet the increasing demands of our core missions of education and advocacy.
Where the money comes from
Non-dues revenue accounts for nearly 70 percent of the AAOS budget (Fig. 1). Income comes from a variety of sources, including the Annual Meeting (primarily from exhibitor fees), products and publications, courses, and other revenue such as rental income and management fees. Over the years, charges for these products and services have gradually increased to cover rising costs of production.
Recognizing, however, that you—as AAOS members—face similar economic challenges in running your own practices, the Academy has endeavored to keep increases for courses and publications at a minimum. We have also sought new ways—such as webinars and satellite courses—that enable the Academy to meet its educational mandate while reducing your time away from your practices and lowering registration costs.
Although in many associations member dues account for approximately 40 percent of income, AAOS member dues make up just 30 percent of the AAOS budget. For the past decade, dues for AAOS fellows have held steady at $750—despite the previously cited increases in programming and services—to say nothing of the gradual inflationary trend affecting us all. In fact, if 2003 dues had increased at the same rate as inflation over the past decade, current AAOS dues would be $933 (Fig. 2).
For these reasons, the AAOS Board of Directors approved a $150 dues increase at its September 2012 meeting. The new dues structure will be effective in 2013. It was not an easy step to take, but it was a necessary one.
Facing the challenges of the future
With the re-election of President Obama, we can be sure that the mandates included in the Patient Protection and Affordable Care Act will be implemented. We will face significant changes in how we deliver health care and how we are reimbursed for the care we deliver.
The advocacy activities of your AAOS will be more important than ever as we work with both the administration and the new Congress. We must engage them to address unresolved health system challenges such as finding a value-driven solution to the Sustainable Growth Rate formula, reducing the burden of medical lawsuits, reforming antitrust laws that threaten patient choice, and eliminating the regulatory and administrative barriers that impede the patient-physician relationship.
The AAOS is committed to maintaining and improving those programs and services that are critical for supporting our educational and advocacy missions on behalf of our members and our patients. Weighing fiscal responsibility with innovative approaches, we will continue to invest in those programs and services that will give you “the most bang for the buck” both now and in the future.