Published 9/1/2012
Madeleine Lovette

AAOS Leaders Attend White House Meeting

Physician town hall session focused on healthcare reform

In early June, AAOS First Vice-President Joshua J. Jacobs, MD; Second Vice-President Frederick M. Azar, MD; and Council on Advocacy Chair Peter J. Mandell, MD, attended a physician town hall hosted by the Obama White House. The topic of discussion was the benefits and potential barriers to care improvement presented by the passage and implementation of the Patient Protection and Affordable Care Act (PPACA).

The meeting, which was held in the Eisenhower Executive Office Building, was attended by nearly 150 physicians, representing approximately 50 medical organizations. Representatives from the Center for Medicare and Medicaid Innovation (CMMI) were also in attendance. Created under PPACA, CMMI is charged with identifying and testing care models that provide beneficiaries with the highest quality of care, better health, and lower costs. These models include medical homes, Accountable Care Organizations (ACOs), and other methods for physicians, hospitals, and other providers to form partnerships to deliver coordinated care.

The medical home
The meeting began with a panel discussion by three providers who are participating in payment and delivery reform models being tested by CMMI.

According to David Loxterkamp, MD, a family physician from Maine, participating in a medical home demonstration project enabled him to improve the overall health of his patients. A medical home concentrates on the “whole patient,” considering both medical and personal issues that may affect the individual’s health. Under the medical home model, physicians receive reimbursement comparable to what they would receive in a traditional practice setting. In addition, they also receive a per-member, per-month care management payment that is not based on visits. This allows physicians to spend more time interacting with patients and be adequately reimbursed for the time.

Participating in a medical home, said Dr. Loxterkamp, gave him the opportunity to step away from the “treadmill of visit after visit” and really listen to his patients’ needs. As a result of the enhanced communication, he realized that his patients could benefit from bereavement counseling—something he would have never considered a barrier to recovery.

The other panelists—a geriatrician from the University of Michigan Medical Center and a psychiatrist from Montefiore Medical Center in New York—discussed their participation in the pioneer ACO program established by CMMI. An ACO is a voluntary collaboration of doctors, hospitals, and other healthcare providers focused on improving outcomes, service, and reducing overall costs.

The two panelists discussed how the ACO helped break down silos within their respective organizations to provide better, more coordinated care at reduced costs. They also told participants that their involvement in an ACO helped them obtain a seat at the policy table because they were able to share what works and what doesn’t in an ACO model.

Feedback from AAOS
According to Dr. Azar, a key takeaway lesson from the panel presentation was that, although these delivery models are being advanced by a federal law, CMMI is interested in how they are working at the local level. “CMMI officials made it clear that there will be some flexibility with these models,” he said, reflecting on the meeting.

The diversity of models being implemented by organizations across the country underscores Dr. Azar’s observation. Recognizing that no “one-size-fits-all” approach will work, CMMI appears to be open to variations on the models, as long as the three aims of better health, better care, and lower costs are being met.

During the question and comment period that followed the presentations, audience members raised several issues. A major concern was the lack of resources available to physicians to enable them to achieve many of PPACA’s goals. The need for participation by emergency medical technicians in ACOs to ensure care coordination during emergencies was also mentioned.

Dr. Jacobs inquired about the role of specialists in the new payment and delivery models. “Although primary care providers are the current focus of these models, orthopaedic surgeons often act as the primary musculoskeletal caregivers,” said Dr. Jacobs. “The Centers for Medicare & Medicaid Services and other stakeholders need to recognize the importance of that contribution.”

Recognizing the validity of Dr. Jacobs’ observation, CMMI representatives later asked for additional information on how orthopaedic surgeons can contribute to ACOs and what type of bundled, episodic, or gainsharing payment models would work best. The AAOS has been invited to share data and examples of how different care delivery models can interact with specialists effectively.

AAOS plans to follow up with CMMI staff to present its ideas and recommendations on how orthopaedic surgeons can contribute to and participate in delivery reform.

Madeleine Lovette is the communications specialist in the office of government relations. She can be reached at lovette@aaos.org