Gerald R. Williams Jr, MD,

AAOS Now

Published 2/1/2016
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David D. Teuscher, MD

Your AAOS—Leading the Way in Improving Orthopaedic Quality

What an exciting, eventful year this has been! Since I assumed the presidency at the 2015 AAOS Annual Meeting in Las Vegas, there's been a whirlwind of activity on multiple fronts. Fortunately, I have had two capable wingmen— first vice-president; and William J. Maloney, MD, second vice-president—at my side.

The AAOS is now well-settled in its new headquarters building in Rosemont, Ill. The phenomenal Orthopaedic Learning Center (OLC) Education and Conference Center, with its digital and modular state-of-the-art Bio-Skills Training Lab, earns praise from faculty and students alike. With its video production studio, multipurpose lecture and meeting spaces, and large-format, high-definition displays, it's been called "the most comprehensive surgical and skills education center in the country." I heartily encourage all AAOS members to take advantage of the fantastic learning opportunities offered at the OLC.

The new look and feel of the AAOS website, www.aaos.org, which debuted this year, is designed to better serve your needs. It has a responsive design that recognizes the type of device you are using and reconfigures itself for better viewing. The Academy's emphasis on this and other forms of technology is sure to generate a tremendous return on investment that will benefit current and future members, as well as our patients.

In national news, Congress finally put an end to the annual "doc fix" due to the sustainable growth rate (SGR) formula by passing MACRA—the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act. Now comes another heavy lift as we monitor and comment on the proposed regulations that will implement MACRA. We have observed quality and value opportunities for improvement in the voluntary Bundled Payment for Care Improvement (BPCI), but now the Centers for Medicare & Medicaid Services has recently released final regulations on the Comprehensive Care for Joint Replacement (CJR) payment model—shifting payments from individual services to episodes of care. Just as the SGR originally sounded like a good idea, we must work to ensure that the next "good idea" like CJR doesn't become equally onerous upon implementation.

In the last decade, the AAOS has made impressive strides in fostering and promoting quality and value in orthopaedics, cementing our reputation as a major player in the national healthcare quality movement. After beginning with clinical practice guidelines (CPGs) and appropriate use criteria (AUC), the AAOS is now moving into the crucial area of developing orthopaedic-specific performance measures (PMs). These and other patient safety efforts are critical to providing our patients with safe, high-quality care, and to ensuring that orthopaedic practitioners will define quality in musculoskeletal care. Member input and leadership has been key in these efforts.

Developing CPGs
The AAOS boarded the "quality train" early, with the Guidelines and Technology Oversight Committee (GTOC)—the forerunner of the Committee on Evidence-based Quality and Value (EBQV). The GTOC was tasked with improving the quality of orthopaedic care by developing evidence-based CPGs and technology overviews. Today, the AAOS has 18 CPGs on a wide range of subject areas, from Achilles Tendon Rupture to Distal Radius Fracture—and, most recently, Surgical Management of Osteoarthritis of the Knee (SMOAK). All are available to you and the public at www.orthoguidelines.org

CPGs are based on a systematic literature review of available published literature, serve as educational tools, and outline accepted approaches to treatment. Clinician work groups, peer reviewers, and public commentary at various stages of CPG development limit the risk of bias and ensure that many experts help shape the final product. The Academy also makes sure each rigorously meets all of the Institute of Medicine's standards for developing trustworthy CPGs.

Although CPGs include meaningful recommendations based on all the available literature, highest levels of evidence are sometimes limited or lacking, but the effort is having a positive impact on clinical research. An example is the SMOAK CPG having more strong recommendations than any previous CPG. (See "Evidence Bolsters Recommendations in New CPG," AAOS Now, January 2016.)

The value of AUC
The Academy has made a point of working with specialty societies to ensure that experts' input is included in both CPGs and AUC. An AUC specifies when it is appropriate to use a particular treatment or procedure. AUC are based on CPGs, adding expert opinion to create a functional tool for clinical practice. As EBQV Chair David Jevsevar, MD, MBA, explains, "AUC fill in the gray areas."

Since developing its first AUC in 2013, the AAOS has issued nine more AUC on everything from anterior cruciate ligament (ACL) injuries to pediatric supracondylar humerus fractures, always working to provide the best information based on the scientific evidence. Hundreds—if not thousands—of physicians have contributed their judgment and experience to shape these AUC, which represent anything but "one-size fits all" medicine. AUC are available to all at www.orthoguidelines.org

Developed by practicing orthopaedic surgeons and supported by all the available evidence, the Academy's AUC and CPGs have contributed greatly to the quality of the orthopaedic care we provide and helped spur orthopaedic research. As a result, more evidence-based recommendations are supported by strong evidence, leading to increasingly valuable resources for orthopaedic surgeons and their patients.

OrthoGuidelines App
In 2015, the Academy made its CPGs and AUC even more accessible by launching the AAOS OrthoGuidelines App, an online source of information that provides up-to-date treatment guidelines for orthopaedists and other medical professionals. Users can scan through AUC, CPGs, and other evidence-based products. Introduced in March as a web-based app, OrthoGuidelines can now be downloaded on Android and Apple smart phones and tablets.

From conducting key word searches to sorting recommendations by topic, OrthoGuidelines does it all. The app makes it much more efficient to use and implement CPGs, and provides seamless access to AUC, enabling clinicians to check the CPG and then move to a patient scenario to verify that a given treatment is appropriate. All it takes is a couple of clicks. Anyone can access OrthoGuidelines for free, from their desktop or mobile device, at any time.

The recent AUC on ACL treatment and prevention programs were tech-friendly from the very start. Approved in October 2015, the ACL AUC—as well as rehabilitation program and function checklists—come with a suite of online resources for orthopaedic surgeons who manage these injuries and counsel patients about prevention strategies. The two evidence-based checklists help set realistic expectations for rehabilitation and return to play, outlining the various stages in a realistic way. Recently, three new AUC were introduced covering management of hip fractures in the elderly (acute treatment and postoperative rehabilitation of low-energy hip fractures) and treatment of pediatric patients with osteochondritis dissecans of the femoral condyle. All materials, including checklists for two hip fracture AUC, can also be accessed online at (www.orthoguidelines.org). (See "New AUC Cover Hip Fracture in the Elderly and Osteochondritis Dissecans," AAOS Now, January 2016.) Patient safety and performance measures

The Academy's Patient Safety Committee has long made valuable contributions to promoting quality by monitoring patient safety issues and programs related to orthopaedic surgery, care, and practice. From the "Sign Your Site" campaign to the upcoming National Surgical Patient Safety Summit, which the AAOS is cosponsoring with the American College of Surgeons, William J. Robb III, MD, and his colleagues have focused on increasing safety in orthopaedics.

These efforts apply across all orthopaedic specialties. For example, a few months before I took office, the AAOS Board of Directors approved a funding program aimed at supporting patient safety and quality efforts undertaken by member societies of the Board of Specialty Societies (BOS). The BOS Quality and Patient Safety Action Fund can award matching funds of up to $50,000 per project to BOS member organizations that meet the prescribed grant criteria. Providing this funding is an important step in continuing to foster patient safety in orthopaedics. (For more on this fund and the projects it supports, see the "BOS Quality and Patient Safety Action Fund Update.")

No discussion of the Academy's quality efforts would be complete without noting that the AAOS is taking the lead in developing orthopaedic PMs. The AAOS established its Performance Measures Committee, chaired by Warren Dunn, MD, MPH, in recognition of the important role PMs will play in determining physician payments. The committee is working with specialty societies to develop PMs that will confirm the high-quality care you provide, get you credit for payment and scoring of that care, and assist you in fulfilling the requirements of the American Board of Orthopaedic Surgery's (ABOS) Maintenance of Certification (MOC) process—a triple dip!

Final thoughts
It has been an honor to work with the AAOS Board of Directors, Council and Cabinet Chairs, and a staff second to none, all of whom are committed to ensuring the success of your AAOS.

I would also like to express my thanks to all Academy members for giving me the opportunity to serve and lead this fine organization. I feel a deep debt of gratitude to the AAOS membership—here in the United States and around the world—for making me always feel at home in the House of Orthopaedics, where miracles happen every day.

As this is my last opportunity to write to you as president, I want to close by warmly inviting you to attend the 2016 AAOS Annual Meeting, to be held March 1–5, in Orlando, Fla. Come and learn about cutting-edge orthopaedic research and technology to better care for our patients. See you in Orlando!