2017 was a good year
Although 2017 was a tumultuous year for the politics of health care, the Board of Specialty Societies (BOS), with the help of the AAOS Office of Government Relations (OGR), demonstrated how to break through the noise and make a lasting impact in healthcare policy. The BOS played a role in nearly every major legislative and regulatory action taken by AAOS last year, including providing comments on letters to regulators, participating in grassroots email campaigns to Congress, joining the Advisor's Circle and donating to the Orthopaedic PAC, and traveling to Washington, D.C. to directly lobby legislators.

In this article, we highlight some of the advocacy successes the BOS helped achieve.

AOFAS stands strong for "physician" designation
In February, Congressman Brad Wenstrup (R-Ohio), a podiatrist, introduced the VA Provider Equity Act. The proposed bill would have labeled podiatrists physicians, granted pay raises, and given them unrestricted access to clinical leadership positions at the U.S. Department of Veterans Affairs (VA).

Although AAOS and the American Orthopaedic Foot and Ankle Society (AOFAS) didn't oppose raising salaries to help the VA recruit and retain the best qualified podiatrists, they maintained that any equivalency between podiatry and orthopaedic surgery must be achieved through equal training and accreditation, not legislation. Working with the OGR, AOFAS formed a small task force to travel to Washington, D.C., and engage proactively on the topic with Rep. Wenstrup, the other members of the House VA Committee, and the American Podiatric Medical Association (APMA).

In May, James Ficke, MD, representing both AOFAS and AAOS, provided testimony to the House VA Committee Health Subcommittee on the groups' opposition to the proposed legislation. Many meetings, emails, and months later, the AOFAS team was successful in negotiating a new version of the bill, passed by the U.S. House of Representatives in July, that met all their qualifications and which gave podiatrists a raise but no physician title and no clinical supervision of MDs or DOs.

As a follow-up, the OGR is developing a structure that would facilitate regular conversations between AAOS, AOFAS, and APMA so that the organizations can work together to mitigate any differences they may have on future legislative or regulatory issues.

OTA battles poorly constructed regulation
In 2016, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the Surgical Hip and Femur Fracture Treatment (SHFFT) bundled payment model. Orthopaedic Trauma Association (OTA) members were concerned that the mandatory model, owned and run by the hospital and lacking validated quality measures, could compromise patient care. In response, the OTA began developing a plan to convince CMS to change its course.

With consultation from regulatory experts at OGR, the OTA Health Policy Committee wrote a white paper discussing in detail the problems with this significant proposed change to payment policy. OTA argued that placing the treatment of proximal femoral factures in the elderly in alternative payment models (APMs) could be inappropriate due to the advanced comorbidities of the population and the lack of preoperative workup, education, and preparation afforded to elective arthroplasty patients. The paper also covered the difficulties in assessing quality in patients with proximal femoral fractures as well as the need for effective hip fracture registries.

In response to OTA's comments, an AAOS comment letter expanding on these concerns, and letters from many other stakeholders across the country, CMS finalized the cancellation of SHFFT on Nov. 30, 2017. The OTA Health Policy Committee's work was influential in securing the significant victory.

AOSSM advances crucial sports bills
Orthopaedic team physicians face unique policy hurdles due to the necessity of travel, which often takes them across state lines. The American Orthopaedic Society for Sports Medicine (AOSSM), along with AAOS, has developed two parallel federal policy efforts to address the gaps that make it more difficult for team physicians to care for their athletes.

The Medical Controlled Substances Transportation Act, introduced by Rep. Pete Sessions (R-Texas) allows mobile physicians to transport and dispense controlled substances for 72 hours. This addresses the common problem of a team doctor having to go to the home team or other local physician to get his/her athlete the proper care. It also provides increased transparency and security for these substances.

The Sports Medicine Licensure Clarity Act was introduced by a bipartisan team of Reps. Brett Guthrie (R-Ky.) and Cedric Richmond (D-La.) in the House, and Sens. John Thune (R-S.D.) and Amy Klobuchar (D-Minn.) in the Senate. The legislation targets both licensure and liability coverage for team doctors who travel across state lines. This federal effort continues alongside a state-by-state campaign to acknowledge the licensure of visiting team physicians.

Due to AOSSM's hard work and persistence, both bills passed the U.S. House of Representatives in 2017 with a unanimous or near-unanimous vote. Work continues toward passage of these valuable policy initiatives in the Senate.

POSNA fights for children's health insurance
Last fall, Congress failed to reauthorize the Children's Health Insurance Program (CHIP) before funding for the program expired on Sept. 30. CHIP provides health coverage for nearly 9 million children from families around the country that aren't eligible for Medicaid and that lack access to affordable private healthcare coverage.

In October, the Pediatric Orthopaedic Society of North America (POSNA) reached out to the OGR for help with getting CHIP funding restored. Using AAOS grassroots alert resources, POSNA and the Scoliosis Research Society (SRS) generated 433 emails to members of Congress from orthopaedic surgeons and patients demanding an extension for CHIP funding. This effort also led to a joint support letter for CHIP from AAOS, POSNA, SRS, and the American Academy of Pediatrics.

Although the long-term extension of the program continues to be tied up in partisan battles over options for cost-savings, the pressure exerted by POSNA helped push Congress to deliver, in December 2017, temporary relief for states running low on CHIP funds. AAOS will continue to collaborate with POSNA and SRS to ensure funding for this valuable program.

OGR and BOS: successful partners
Advocacy is an active process. Each month, the OGR sends an eNewsletter to the BOS members. In addition, members of the OGR attend specialty society meetings to stay on top of and to develop strategies for addressing key issues. Created by the BOS, the Specialty Protocol for Decision & Response (SPDR) helps societies that may need strength in numbers, commentary, and/or support on issues. These activities can range from requesting comments to co-signing documents, which include position statements, legislative and regulatory comments/documents, and specialty society documents, to name a few. SPDR requests are sent to the society's president and executive director and the BOS presidential line representative. In 2017, there were 11 SPDR requests for comments and 17 requests for co-signing documents.

Through teamwork, the BOS and OGR demonstrate how to make a positive impact on advocacy. Let's keep it up for a successful 2018.

For information on how your society can get more involved in advocacy, email Jordan Vivian at vivian@aaos.org. To contact the BOS, email bos@aaos.org.

Lisa K. Cannada, MD, is the BOS chair. Jordan Vivian, is manager, government relations, in the AAOS OGR.

ASES, AAHKS, and ASSH Join the Orthopaedic PAC Advisor's Circle
The Advisor's Circle is designed to provide AAOS members' group practices and specialty societies with a leadership role within the Orthopaedic Political Action Committee (PAC), the only PAC on Capitol Hill representing the interests of orthopaedic surgeons. In 2017, the Advisor's Circle welcomed the American Shoulder and Elbow Society (ASES), the American Association of Hip and Knee Surgeons (AAHKS), and the American Society for Surgery of the Hand (ASSH). The Advisor's Circle was instrumental in enabling ASES to host Sen. Bill Cassidy, MD (R-La.), at their annual meeting in October 2017.

BOS Member Organizations

• American Association for Hand Surgery
• American Association of Hip and Knee Surgeons
• American Orthopaedic Foot and Ankle Society
• American Orthopaedic Society for Sports Medicine
• American Shoulder and Elbow Surgeons
• American Society for Surgery of the Hand
• American Spinal Injury Association
• Arthroscopy Association of North America
• Cervical Spine Research Society
• J. Robert Gladden Orthopaedic Society
• Limb Lengthening and Reconstruction Society
• Musculoskeletal Infection Society
• Musculoskeletal Tumor Society
• North American Spine Society
• Orthopaedic Rehabilitation Association
• Orthopaedic Research Society
• Orthopaedic Trauma Association
• Pediatric Orthopaedic Society of North America
• Ruth Jackson Orthopaedic Society
• Scoliosis Research Society
• Society of Military Orthopaedic Surgeons
• The Hip Society
• The Knee Society