Joshua J. Jacobs, MD


Published 10/1/2013
Joshua J. Jacobs, MD

Message Management: AAOS Style

Getting the orthopaedic message out—to the media, to our members, to patients and the public, and to Congressional and regulatory representatives—is just as important as—and often more difficult than—clearly defining those messages.

Although the specifics may change, depending on the issue, the AAOS continually reinforces the following key points:

  • When it comes to the burden of disease, few disorders in medicine can match the impact of musculoskeletal conditions.
  • Orthopaedic surgeons have a duty to their patients to deliver high-quality, evidence-based care that helps get them back to work and live independent lives.
  • Appropriate, evidence-based orthopaedic care—whether surgical or nonsurgical—not only benefits patients, but can also provide net economic benefits to society.

The Academy’s public relations department, in conjunction with the members of the Communications Cabinet, monitors the way orthopaedic surgeons are portrayed in the mainstream media and online or in social media conversations. As issues arise, a quick-response protocol is implemented to enable the AAOS to respond in a timely fashion. Because much of this happens behind-the-scenes, I wanted to take some time to let you know what exactly occurs when a newspaper article, radio report, or television story presents inaccurate or misleading information about our specialty.

For example, a recent article that appeared in The New York Times included a graphic that left the impression that orthopaedic surgeons receive as much as $17,500 for a hip replacement—an outrageous and totally inaccurate figure. Your Academy’s response was strong and immediate.

Staff in the AAOS public relations department mobilized their colleagues in the office of government relations and the research department to assemble the appropriate reports and cost figures. Because this was a news article, the response was a letter to the editor, which was quickly drafted and vetted by leadership in both the AAOS and the American Association of Hip and Knee Surgeons (AAHKS). Thomas K. Fehring, MD, AAHKS president, and I signed the letter, which was published just a few days after the article appeared.

But some things are out of our control. The original article and graphic received front-page treatment; the letter to the editor appeared several pages in. The reporter took thousands of words to make her case; our letter was limited to 150 words.

Similarly, when National Public Radio’s Shots blog featured the Academy’s five “Choosing Wisely” recommendations, it originally listed the recommendation against routine ultrasound after total joint replacements without the context of a patient population. The AAOS quickly contacted the reporter and the correction was made.

A variety of tactics are used in issues management, ranging from letters to the editor to press events. The AAOS public relations department helps create opportunities for members to connect with the media throughout the year—from hosting media round tables during the Annual Meeting to creating talking points and key messages for AAOS spokespersons to use in interviews. Statements from orthopaedic leaders, social media tweets and posts, and expert spokespersons who can provide the orthopaedic perspective to an ongoing story are other ways that your Academy ensures that the voice of orthopaedics is heard.

The message in Washington
When it comes to delivering the orthopaedic message to legislators and regulators, whether at the state or federal level, the American Association of Orthopaedic Surgeons (AAOS) also uses a variety of techniques. Our key messages remain the same, but they are augmented by a focus on advocacy issues.

Recently, for example, the AAOS launched a series of informative ads in Politico, Roll Call, and The Hill to educate members of Congress and their staffs about the important role orthopaedic surgery plays in keeping Americans at work and living independently. (See “AAOS Kicks Off Advocacy Ad Campaign”) In addition, the AAOS ran an opinion piece in The Hill’s electronic newsletter, which is delivered daily to members of Congress and their staffs.

The goals of these outreach efforts are not only to deliver a positive message about the value of orthopaedic surgery but also to help frame the discussions and decisions being made about health care and the way it is delivered. Staff in the AAOS office of government relations have built effective working relationships with key personnel in agencies such as the U.S. Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services (CMS)—so much so that these agencies are now turning to the AAOS when they need expert opinion on topics.

When appropriate, the AAOS delivers the message personally, through meetings with officials and their staff. The individual, personal stories they convey can have great impact. We are grateful to our members who provide testimony during hearings, who have built relationships with legislators, and who are willing to participate in advocacy efforts such as Hill Day during the National Orthopaedic Leadership Conference, Research Capitol Hill Days, and various fly-ins during the year.

At every opportunity, the AAOS weighs in on rules and policies that affect our members. Staff review proposed regulations, discuss the implications with members, and prepare detailed responses. Since I assumed the presidency of the AAOS, I have signed numerous letters on topics such as the following:

  • Proposed reforms to the Medicare Physician Fee Schedule and the current fee-for-service system
  • Proposals that would phase in new payment systems under which reimbursement would be based partly on quality and value
  • Reclassification of devices and drugs such as the pedicle screw system and hydrocodone
  • The implementation of the International Classification of Diseases–10th Edition (ICD-10) and its impact on orthopaedic practices
  • Payment schedules for services provided in ambulatory surgical centers
  • The threats to the in-office ancillary service exception under the Stark rules
  • A proposal that would exempt the FDA user fees from additional sequestration cuts
  • A CMS survey of physician time-use patterns under the Medicare fee schedule
  • Advancing interoperability and health information exchange
  • The Medicare Audit Improvement Act

What’s your role?
While all this activity emanates from your Academy, you also can deliver important messages to the media, to your patients, and to your legislators. I encourage you to visit the AAOS newsroom to download the catalog of free public and media resources and take advantage of them.

If you have not yet visited the A Nation in Motion® website (, I urge you to do so to share your story. You can also encourage your patients to visit the site and share their stories.

The AAOS office of government relations website ( also has a wide range of materials available to you. You can read the comment letters, download advocacy tip sheets, learn how to set up a meeting with your legislator, and get in touch with your senator or representative. You can find out more about the Orthopaedic Political Action Committee (PAC) and how it helps us deliver the orthopaedic message to members of Congress.

We, as orthopaedists, may practice in vastly different settings, but we share the same concerns for our patients and for the future of our profession. Your participation in managing the message will be key to achieving our goals.

Additional Resources