On Thursday, May 1, 2014, more than 300 orthopaedic surgeons from around the country converged on Capitol Hill to meet with their representatives in Congress as part of the 2014 American Association of Orthopaedic Surgeons (AAOS) National Orthopaedic Leadership Conference (NOLC).

During the sessions with their Congressional representatives, NOLC participants focused on a variety of key orthopaedic issues. They urged their senators and representatives to take the following actions:

• permanently repeal and replace the sustainable growth rate (SGR) formula
• adopt antitrust reforms that would correct the imbalance between healthcare professionals and health plans during payment negotiations
• enact medical liability protections for sports medicine professionals who provide medical services in a secondary state

Fix the SGR—permanently
NOLC participants reminded members of Congress that permanent repeal and replacement of the sustainable growth rate (SGR) formula remains a top priority of the AAOS. They urged legislators to work together to find ways to pay for the legislation that would have bipartisan support so that permanent SGR reform could be enacted this year.

“The cumulative cost of enacting temporary patches now exceeds the cost of a permanent SGR fix,” stated Thomas C. Barber, MD, chair of the AAOS Council on Advocacy. “Continuing the reckless system of simply passing one patch after another is harmful to the economy and to Medicare patients seeking access to specialties they desperately need. The AAOS has worked diligently with all committees of jurisdiction to put into place real reform and we look forward to final passage of H.R. 4015/S. 2000 by the end of this year.”

H.R. 4015/S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, would replace the SGR formula with a new system of legislated updates. Physician payments under the current fee-for-service program would increase 0.5 percent each year for the next 5 years, while the Medicare payment program transitioned to a value-based payment formula. The legislation would also implement a process to improve payment accuracy for individual provider services and introduce physician-developed clinical care guidelines to reduce inappropriate care.

Antitrust reform
NOLC participants also raised awareness about the importance of protecting healthcare professionals engaged in contractual negotiations with a health plan for the delivery of health care services from federal antitrust prosecution. H.R. 4077, introduced by Reps. John Conyers Jr. (D-Mich.) and Dan Benishek, MD (R-Mich.), is a key piece of legislation on this issue. NOLC participants sought cosponsors for the bill.

The legislation would exempt healthcare professionals, including individuals and entities, from federal and state antitrust laws in connection with negotiations with a health plan regarding contract terms under which the professionals provide healthcare items or services for which plan benefits are provided.

Liability protections
In their meetings with their congressional representatives and their staff, NOLC participants also asked for support of H.R. 3722/S. 2220, a measure that would provide protections for certain sports medicine professionals who provide certain medical services in a secondary State. Introduced in the House by Reps. Tom Latham (R-Iowa) and Cedric Richmond (D-La) and in the Senate by Sens. John Thune (R-S.D.) and Amy Klobuchar (D-Minn.), this legislation protects sports medicine professionals from civil and criminal malpractice liability when they provide care to athletes at sporting events in another state.

As a direct result of NOLC efforts, an additional 20 members of Congress agreed to sign-on as co-sponsors. After spending one day “on the Hill,” NOLC attendees convened in general sessions for several educational symposia on regulatory and legislative issues.

Anticipating the future
One of the symposia, “The Future of the Practice of Orthopaedic Surgery,” moderated by David D. Teuscher, MD, AAOS first vice president, educated NOLC attendees on various issues regarding physician supply and graduate medical education (GME).

According to Leonard J. Marquez, director, government relations for the American Association of Medical Colleges, Medicare covers about 20 percent of direct teaching costs for GME. However, the number of residency slots that hospitals may count for GME payments is limited to 1996 levels, which may not be sufficient for the future.

Margie Almanza, senior legislative assistant for Rep. Aaron Schock (R-Ill.), noted that efforts are being made to increase the number of GME training positions. According to Ms. Almanza, a few bills have been introduced to address this issue, including H.R. 1180/S. 577, the “Resident Physician Shortage Reduction Act of 2013.” If enacted, this legislation would create an additional 3,000 slots and would link payment to hospital participation in certain quality reporting programs. However, she admitted that the size of the physician workforce is a low priority, especially given the additional cost.

The value of orthopaedics
Changing the discussion from how much orthopaedic surgery costs to how much value it provides was the focus of a second symposium. According to AAOS Past President John R. Tongue, MD, “What has been missing from the narrative about our profession is the indirect cost savings that result with appropriate orthopaedic care, so that patients can continue to work, maintain their mobility, live independently, and contribute to society.”

Orthopaedic surgeons, said Michael F. Schafer, MD, past chair of the AAOS Communications Cabinet, can stand out to policymakers and the media as experts in bone and joint health by demonstrating the results of our care. He introduced a follow-up effort to the Academy’s popular and successful A Nation in Motion® campaign, which focuses on orthopaedic surgery as an investment in society, rather than a cost to society.

The new campaign—Second Firsts—highlights the return to activities and occupations by patients who have had orthopaedic procedures. “It can be something very basic like opening a jar without pain,” said Dr. Schafer, “or something monumental like running another marathon after recovering from a knee replacement.”

Networks and exchanges
Past Board of Councilors (BOC) Chair Wilford K. Gibson, MD, moderated a symposium on the federal and state health exchanges. According to presenter Michael Kolber, of Manatt, Phelps & Phillips, LLP, most plans offered in health exchanges have narrow provider networks, high levels of cost sharing, and a reliance on accountable care organizations. However, pushback against narrow networks at the state level appears to be increasing. William A. Hazel Jr, MD, Virginia’s secretary of health and human resources, also discussed the exchanges, in particular Virginia’s path to a health insurance exchange.

Other symposia covered performance measures in orthopaedic surgery, antitrust and health care monopoly issues, and an explanation of the Congressional Budget Office scoring system. A more in-depth look at these programs will be provided in next month’s issue of AAOS Now.

Elizabeth Fassbender is the communications specialist in the AAOS office of government relations. She can be reached at fassbender@aaos.org

What is the NOLC?
The National Orthopaedic Leadership Conference (NOLC) is an annual gathering of leaders from state orthopaedic and specialty societies. Attendees include members of the AAOS Board of Directors, Board of Specialty Societies (BOS), Board of Councilors (BOC), the Orthopaedic Political Action Committee (PAC) Executive Committee, the Leadership Fellows Program, the Washington Health Policy Fellows Program, and the Council on Advocacy.

Held each year in Washington, D.C., the NOLC raises awareness of critical orthopaedic issues through Hill visits, symposia on current advocacy topics, and discussions surrounding various legislative and regulatory issues.