A year ago, I pointed to the implementation of the Affordable Care Act (ACA) as a guarantee of “interesting times.” That’s certainly been true, although the debacle surrounding the introduction of the online federal healthcare exchange and subsequent national confusion during the last quarter of 2013 wasn’t exactly what I had in mind.


Published 2/1/2014
Joshua J. Jacobs, MD

What a Year This Has Been!

Before I assumed the AAOS presidency, I frequently biked from my home to my office. Chicago has a number of wonderful bike paths, but my route also took me down some heavily trafficked streets, which kept me alert and tested my reflexes. In addition to being great exercise, the ride gave me time to think and to plan the day ahead.

Since receiving the President’s medallion, however, I’ve given up biking to work and have had to carve out other times for thought and reflection, such as when I’m on deadline for this column! As I am approaching the end of my term, I recalled the three “curses” I referenced in my presidential address last March: “May you live in interesting times”; “May the government be aware of you”; and “May you find what you are looking for.” At the time, I thought them vague enough to make me seem prescient. I had no idea how real they would become.

Joshua J. Jacobs, MD


Improving the value proposition
As for government awareness, I’m pleased to note a shift. Where once scrutiny on orthopaedics focused solely on the increased numbers and costs of procedures—and not always positively—today we can see an incremental shift. The multiple steps taken by the AAOS and orthopaedic specialty societies to redefine and improve the value proposition for orthopaedics are starting to pay off. Although orthopaedics is still a focal point in discussions of cost and care, regulators and legislators are less likely to “blame” orthopaedic surgeons and more likely to hear what we have been saying.

This is due, in part, to the Academy’s commitment to improving the value equation for orthopaedics. Over the past year, the AAOS has taken multiple steps to improve the quality of orthopaedic care and to enhance the value of orthopaedic procedures. The Quality as Advocacy Project Team, under the direction of First Vice President Frederick M. Azar, MD, has been instrumental in advancing this initiative.

Our participation in the Choosing Wisely campaign—a national effort to identify and eliminate unnecessary medical tests and procedures—is one example. In addition, the ongoing “A Nation in Motion” campaign has helped draw attention to how orthopaedic procedures help people regain their mobility, reduce their pain, and reclaim their freedom to do what they love at every stage of life.

The Value Project Team, under the direction of AAOS Past President John R. Tongue, MD, published a series of papers that not only introduced a new model for measuring the long-term value of orthopaedic surgery, but also showed how appropriate orthopaedic care—including surgery when necessary—resulted in ultimate cost savings to society. Research on the value of total knee arthroplasty, anterior cruciate ligament reconstruction, and rotator cuff tears have shown the cost-effectiveness of orthopaedic surgery and its role in reducing the economic burden to society of musculoskeletal conditions.

As a result, regulators and legislators are starting to pay attention! For example, this year the AAOS was awarded an innovation grant from the Agency for Health Research and Quality (AHRQ) to help fund development of a computer app that will make it easier for members to bring clinical practice guidelines (CPG) into practice.

A year ago, I pointed to the implementation of the Affordable Care Act (ACA) as a guarantee of “interesting times.” That’s certainly been true, although the debacle surrounding the introduction of the online federal healthcare exchange and subsequent national confusion during the last quarter of 2013 wasn’t exactly what I had in mind.
Since the groundbreaking in August 2013, a new orthopaedic headquarters and Orthopaedic Learning Center has taken shape in Rosemont, Ill. (Left) William R. Beach, MD, first vice-president of the Arthroscopy Association of North America; Jo A. Hannafin, MD, PhD, president of the American Orthopaedic Society of Sports Medicine; Joshua J. Jacobs, MD, AAOS president; Mark R. Hutchinson, MD, president of the board of directors for the Orthopaedic Learning Center; and Bob Hall, then executive director of the American Association of Hip and Knee Surgeons, get ready to dig. (Right) The Orthopaedic Learning Center will be located on the first floor with a 24-station skills lab, a 180-seat auditorium, and classrooms; the remaining four floors will house the AAOS, its equity partners, and other orthopaedic organizations.

Additionally, as reported in this issue, for the first time, the Centers for Medicare & Medicaid Services (CMS) actually prevented massive cuts in reimbursement for total joint replacement procedures (hip and knee). Although work relative value units for total hip and total knee procedures were reduced, CMS rejected the 11 percent to 19 percent reduction recommendations of the American Medical Association’s Multi-Specialty Relative Value Update Committee and imposed values closer to those recommended by the AAOS and the American Association of Hip and Knee Surgeons. (See “AAOS, AAHKS Advocacy Efforts Help Mitigate CMS RVU Changes.")

It also appears that the sustainable growth rate (SGR) formula is on its way out. Bills to eliminate the SGR are currently under consideration by both the House and the Senate, although the “pay-for” remains a matter of contention.

Throughout the year, I’ve had the opportunity to work with the volunteers on the Council on Advocacy, the Board of Councilors (BOC) and Board of Specialty Societies (BOS), and the staff of the AAOS office of government relations on advocacy issues of importance to our members. I’ve see how our efforts to education members of Congress, to meet with legislators and regulators, and to present our advocacy message in terms of solutions to the current healthcare crises can pay off.

The orthopaedic community
As for the third curse—“May you find what you are looking for”—I’ve come to realize that this depends on who you are and what you need. AAOS members look to the Academy for many things, including educational opportunities, practice support, and advocacy. Advocacy efforts have already been outlined, and the AAOS also provides a wealth of educational opportunities and practice support to members.

This year, the AAOS expanded the scope of learning opportunities in the following ways:

  • The introduction of “The Best of AAOS,” an interactive learning experience presenting the best of the 2013 Annual Meeting education. This new product will be a boon to members in the United States and abroad, bringing a mini-meeting to the desktop.
  • Approval of a new initiative to incorporate social and professional networking into AAOS educational programs. The Council on Education has developed a great plan to ensure that the Academy’s high standards of quality and accuracy are maintained, while enabling increased sharing of images and ideas.
  • Innovative international programs, including international scholarships and train-the-trainer programs, to maintain the Academy’s position as a global leader in orthopaedic education
  • Patient safety programs such as TeamSTEPPS, designed to improve communication and teamwork skills among operating room teams, to support quality efforts and foster patient-centered care
  • Approval of the development of a learning management system to facilitate access to information from the Academy’s education and publishing efforts
  • Initiation of efforts to develop orthopaedic-specific performance measures. This will help ensure that such measures are not simply process-based, but are appropriate, evidence-based, and meaningful.
  • Beginning construction on a new home for orthopaedics, with several orthopaedic specialty societies as equity partners, and a new state-of-the-art Orthopaedic Learning Center.

AAOS members are also faced with the challenges of new practice and payment options (accountable care organizations, bundled payments, and changing employment opportunities), meeting meaningful use requirements, and making the transition to ICD-10. In each of these areas, the AAOS has provided significant support, through webinars and other learning opportunities, online information, articles in AAOS Now, and staff resources.

All of these activities fall under the AAOS Strategic Plan, which is currently being reviewed and updated by a project team led by Second Vice President David Teuscher, MD. Those efforts will help guide the Academy’s steps into the future.

A united effort
None of these steps would have been possible without the concerted and united efforts of our volunteers. I owe thanks to the members of your Board of Directors, as well as the many volunteers who serve on our Councils, Cabinet, Committees, BOC, and BOS. The AAOS staff, under the direction of CEO Karen L. Hackett, FACHE, CAE, has provided exceptional support in moving these efforts forward.

It’s been a busy, incredibly rewarding, and productive year. Nonetheless, I’m looking forward to returning to the bike paths this summer.