I complained and was challenged to participate in the county medical society. That started my journey toward advocacy. Along the way I learned many things, the most important of which is that there is hope for the practicing doctor. When we physicians act together as a group, we can be effective. We can get things done, and we can sometimes prevent bad things from happening.


Published 7/1/2013
Lawrence S. Halperin, MD

What Have I Learned?

Not too many years ago, I was one of the apathetic physicians. I tried to take care of my patients, raise my kids, make a decent living, serve on hospital committees, and keep my head down. I thought we were being sliced up by the government, the insurance companies, the hospitals, and the lawyers, with no help in sight.

Lawrence S. Halperin, MD

I learned that the Florida Medical Association (FMA) and the Florida Orthopaedic Society (FOS) had effective advocacy programs in Tallahassee that were making a difference. Florida doctors have achieved much in the legislative arena, including changes in onerous insurance practices and implementation of rules that will punish out-of-state experts who testify falsely. With FMA support, a bill was just passed that could make Florida the toughest state in which to file malpractice suits. Just as important are the bad bills that didn’t become law due to our advocacy efforts.

I learned that being proactive can matter. Medicare Administrative Contractor (MAC) audits went live first in Florida. The original local coverage determination proposed by First Coast Services placed unreasonable requirements on the patient and physician prior to knee arthroplasty. The FOS, the American Association of Hip and Knee Surgeons (AAHKS), and the American Association of Orthopaedic Surgeons (AAOS), working together, were able to effect changes in these unreasonable requirements before they could be implemented.

I learned that the AAOS is more than a group of academics who put on educational events. My interests are well represented in Washington, D.C., by the Orthopaedic Political Action Committee (PAC) and the AAOS office of government relations. I learned that the AAOS Board of Councilors (BOC) does an amazing job making sure the voices and needs of the practicing orthopaedic surgeon are heard. I found myself in the middle of something I didn’t think existed. I was helping to represent my colleagues and make a difference in their practice environment. And I enjoyed it!

The BOC does so much to support practicing physicians. I learned that the seed that led to the establishment of the AAOS Professional Compliance Program was planted in the BOC. The BOC has also spoken to the American Board of Orthopaedic Surgery about the ‘user-unfriendly’ implementation of the Maintenance of Certification process.

I have seen the BOC’s State Legislative and Regulatory Committee provide fiscal support to state orthopaedic societies facing legislative and regulatory challenges—from workers’ compensation in New York and in-office imaging in Maryland to tort reform in Hawaii, MAC audits in Florida, and practice limitations in South Carolina and Maryland. The BOC can make a difference in state capitals across the nation when our patients’ well-being or our ability to practice is challenged.

Serving as chair of the Advocacy Resource Committee, I have learned so much more about the effectiveness of the way the AAOS represents our interests and our patients’ interests. Our Orthopaedic PAC is the largest medical PAC in Washington, D.C. The staff in the AAOS office of government relations are well-respected on Capitol Hill and represent orthopaedic surgeons beautifully as they deal with how to repeal the sustainable growth rate (SGR) formula and to pay for that repeal, how to address repeal of the Independent Payment Advisory Board, how to protect in-office ancillary exceptions, and what to do with the myriad of regulatory questions arising from implementation of the Affordable Care Act (ACA). It is not a coincidence that orthopaedic surgeons made the introductions at the recent Democratic and Republican Freshman Congressional HealthCare briefings.

Some of these victories go almost unnoticed. Bonus payments to primary care and rural general surgeons did not come from payments to specialists. Many small victories center around discouraging or eliminating potentially harmful legislative initiatives from ever coming to the floor.

True, we don’t always win. Our effort to sway some votes away from the ACA didn’t work. A groundswell of Congressional cosponsors for physican anti-trust relief hasn’t yet materialized. I haven’t noticed the SGR going away quite yet (although this is the first year that real repeal is actually on the table).

But we pick up the pieces, regroup, and continue the good fight—which requires adequate funding, with a little bit more from everyone.

I urge everyone I know to join and contribute to the Orthopaedic PAC. If they tell me that they are already contributors, I urge them to give a little more. The ink is drying on my additional $100 check as I type. I think it’s the best way to show appreciation for the representation the AAOS provides.

For more information on the Orthopaedic PAC, visit www.aaos.org/pac

Lawrence S. Halperin, MD, chairs the AAOS Advocacy Resource Committee and practices in Orlando, Fla. He can be reached at lhalperin@cfl.rr.com

© Lawrence S. Halperin, MD