The repeal of the Sustainable Growth Rate (SGR) formula has been a long time coming. During the 12 years since the SGR started to “mandate” reductions in physician Medicare payments, the American Association of Orthopaedic Surgeons (that’s the blue AAOS) has mounted continuous efforts to overturn it. Repealing the SGR took a sustained campaign and a coordinated team of volunteers and professional staff, with tens of thousands of contacts, communications, and visits to members of Congress by thousands of medical professionals like you. The coalition-building among multiple orthopaedic and medical specialty societies yielded a winning multifaceted campaign headed by AAOS volunteers and staff in our Office of Government Relations (OGR). I hope everyone took a victory lap and waved our colors when it finally became the law of the land!
The SGR repeal—including, as it did, a reversal of the decision by the Centers for Medicare & Medicaid Services (CMS) to convert payment for all global procedure codes to 0-day global codes—underscores the importance of both the Association and the OGR. Founded by the Academy Board of Directors in 1997, the Association—a 501(c)6 organization—engages in health policy and advocacy activities on behalf of musculoskeletal patients and the profession of orthopaedic surgery. Its establishment allowed the AAOS to create the Orthopaedic Political Action Committee (Orthopaedic PAC). The PAC can make financial contributions to candidates who support our legislative goals. Through the PAC, we can build relationships and engage in other advocacy activities with elected leaders.
Even though you pay dues to the Association, a significant portion of your dues dollars are then transferred to the Academy (that’s the red AAOS—a 501(c)3 organization) to support its educational, research, quality, and communication efforts. Both organizations have the same board of directors, but the operations are strictly separate. At each meeting, Academy and Association board meetings are conducted during separate times and each considers issues unique to that entity. For example, the AAOS Professional Compliance Program is part of the Association meeting, while the Annual Meeting education program is on the Academy’s agenda.
Office of Government Relations
The (blue) AAOS operates the OGR (317 Massachusetts Ave., NW, Washington, D.C.) under the direction of William Shaffer, MD, medical director, and Graham Newson, OGR director. The OGR includes 13 staff members based in Washington, D.C., and 4 staff members in Rosemont, Ill.
The following staffers represent your interests in Washington:
- Catherine Boudreaux, senior manager, government relations
- Judi Buckalew, senior manager, regulatory and government relations
- Julia Williams, senior manager, government relations
- Kristin Brackemyer, political affairs manager
- Tammy McAthey, manager, government relations
- Eboni Morris, manager, state government affairs
- Marisol Castillo, clinical data registry policy and advocacy coordinator
- Kyle Shah, clinical quality and medical affairs coordinator
- Elizabeth Fassbender, communications specialist
- Bonda Baxter, finance and operations assistant
- Connie Lamberson, executive assistant
- Katrina Wallace, administrative assistant
OGR staff Erin Ransford, manager, research advocacy; Inger Saphire-Bernstein, senior manager, health policy; Joanne Willer, coding and reimbursement specialist; and Diana Scott, administrative assistant, are based in our national headquarters in Rosemont.
Working with the professional staff are a dedicated group of volunteers, including Thomas C. Barber, MD, chair of the Council on Advocacy (CoA); Kevin J. Bozic, MD, MBA, chair of the Council on Research and Quality (CoRQ); John T. Gill, MD, chair of the Orthopaedic PAC; the members of the Board of Councilors and Board of Specialty Societies; the chairs and members of the committees reporting to the CoA and CoRQ; and the leaders of your state and specialty orthopaedic associations and societies.
What’s next after SGR?
Although the SGR has been a major advocacy focus for a long time, its repeal doesn’t mean that our advocacy efforts can take a rest. Instead, we now must focus on a wider range of other proposed CMS rules and regulations and their implementation. As the global payments announcement last October showed, these regulations can have a major impact on our practices.
We will also take this opportunity to expand our legislative efforts on other priority issues. That’s the message that attendees at the National Orthopaedic Leadership Conference (NOLC) heard last month. (See this issue’s cover story, “Orthopaedic Surgeons Get Results at NOLC.”)
Halting the implementation of ICD-10 is a priority for our advocacy efforts. We are moving forward on two fronts. Because ICD-10, if adopted as scheduled, could result in major problems for orthopaedic practices, we want CMS to agree to accept claims submitted with either ICD-9 or ICD-10 coding until CMS, commercial payers, and electronic health record vendors can demonstrate the ability to efficiently process payments. If that fails, we will work on passing legislation to block or delay unilateral action by CMS until these concerns are addressed.
The AAOS is also continuing to reach out to our patients as advocates, with the first NOLC Advocacy Forum for Patient Advocates (see “Advocacy Reaches Patients”). Our patients can be a powerful voice on issues such as access to care, funding for musculoskeletal research, and the value of orthopaedic services. If you haven’t talked to your patients about advocacy as it relates to your practice—whether it be the costly and onerous shift to ICD-10 coding or the encroaching threat of practitioners who do not share our extensive musculoskeletal training—I urge you to do so.
One easy way to deliver the advocacy message to patients is to use AAOS TV, a patient-focused DVD that you can use in your reception area. With a runtime of 1 hour 20 minutes, AAOS TV provides both education and entertainment. The 30 segments on bone and joint health also include information on injury prevention, orthopaedic advocacy calls-to-action, and A Nation in Motion®, the Academy’s public awareness campaign.
The role of the PAC
The best and easiest way to support AAOS advocacy efforts is to annually contribute to the Orthopaedic PAC—the only national political action committee in Washington, D.C., exclusively representing orthopaedic surgeons. It’s our voice, our strength, and our access in Congress. The larger our PAC is, the better your patients’ voice can be heard.
Although the Orthopaedic PAC ranks among the largest medical specialty PACs in America, participation remains an issue. Currently, 31 percent of U.S. AAOS members contribute to the PAC—and the remaining 69 percent of you now have an opportunity to celebrate our success and invest in our future by joining the PAC. We can represent your practice and patients better, but only if you help us. (See “Easy Steps for Advocacy Involvement”.)
Whether through a single donation or an automatic contribution on a monthly, quarterly, or annual basis, participation in the Orthopaedic PAC matters. I want to encourage current PAC supporters to consider asking a colleague to match their next contribution. Better yet, ask him or her to contribute the proceeds of a single surgical case.
I also want to congratulate the winners of the 2014 Stuart L. Weinstein, MD PAC Participation Awards—the Puerto Rican Orthopaedic Society and the Vermont Orthopaedic Society. These awards were established in 2013 to honor the states with the highest PAC participation rate as well as the individual state that has demonstrated the greatest improvement in PAC participation from one year to the next. Puerto Rico achieved the highest participation rate—an impressive 69 percent—while Vermont saw the greatest improvement in PAC participation, from 16 percent in 2013 to 58 percent in 2014.
Watch for some new initiatives from the Orthopaedic PAC during the coming year. The 2016 election cycle will be critical in terms of its impact on health care. Building relationships and getting to know candidates and lawmakers at all levels will be more important than ever before.
On the state level
Having an impact on state legislation and regulations in your state capital is as important as being heard in D.C. Many issues—including scope of practice, tort reform, insurance regulation and licensure—are dealt with at the state level. For this reason, AAOS would like you to prioritize participation in state-level advocacy efforts.
In my home state of Texas, a coalition of medical societies (including orthopaedics) was able to effect comprehensive and successful tort reform in 2003. Actions taken by state orthopaedic and medical associations have been instrumental in improving the medical climate in several states. So remember that change begins at home, and be sure to support your state orthopaedic and medical associations. The OGR has dedicated staff, volunteers and resources to help you in your state capital and the AAOS website has a number of resources available, from advocacy and organizational tools to background on topics ranging from the business of medicine to professional liability reform. You’ll find links to them at www.aaos.org/dc.