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Published 2/1/2019
Amy L. Ladd, MD; Jordan Vivian

BOS Records Significant Victories in 2018

The final year of the 115th Congress brought success for several long-fought priorities of orthopaedic specialty societies. In partnership with the AAOS Office of Government Relations (OGR), the Board of Specialties (BOS) has worked to ensure that the priorities of each interested society are part of its overall advocacy strategy. This coalition has produced tangible policy victories for orthopaedics and continues to be a cornerstone of advocacy work in Washington, D.C., and in the states.

In 2018, the BOS conducted a survey of societies as part of the BOS Partnership Summit. Societies reported high satisfaction with joint advocacy efforts, with more societies engaging with AAOS in advocacy than any other area of partnership. This year, we’ve continued to build on this collaboration by reforming the Specialty Protocol for Decision and Response process to more easily allow societies to provide feedback and sign onto AAOS letters and statements. We’ve also seen growth in the Orthopaedic Political Action Committee (PAC) Advisor’s Circle, which gives group practices and specialty societies access to exclusive political opportunities. The American Association of Hip and Knee Surgeons (AAHKS), American Shoulder and Elbow Surgeons (ASES), and American Society for Surgery of the Hand (ASSH) are all members of this exclusive group.

We hope that the victories outlined here demonstrate the value of specialty advocacy to orthopaedics and inspire even more societies to reach out and engage with the OGR team.

AOSSM—Sports Medicine Licensure Clarity Act signed into law

Following five years of hard work by the American Orthopaedic Society for Sports Medicine (AOSSM) and others, the Sports Medicine Licensure Clarity Act was signed into law on Oct. 5, 2018. The law now provides licensure and liability protection for traveling team physicians while safeguarding injured athletes’ timely access to care.

Previously, physicians traveling across state lines to care for their teams had no guarantee of licensure reciprocity unless the state involved had passed its own legislation. In addition, liability insurance often did not travel, leaving physicians open to potentially career-ending risks when caring for their athletes in another state.

In tandem with successfully passing individual state measures to increase licensure reciprocity, the OGR worked with a bipartisan team of lawmakers to introduce the national bill. Members include Reps. Brett Guthrie (R-Ky.) and Cedric Richmond (D-La.) and Sens. John Thune (R-S.D.) and Amy Klobuchar (D-Minn.).

“It took more than five years, three sessions of Congress, and the dedication of hundreds of physicians from various specialties advocating for change at both the state and federal levels,” said John J. McGraw, MD, an AAOS Congressional Ambassador. He, along with Russell A. Betcher, MD, personally met with Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-Tenn.). “The sports bill is proof that perseverance always wins, and our voices can be heard loud and clear by Congress,” said Dr. McGraw.

OTA—Trauma priorities included in major pandemic package

In 2018, the AAOS OGR and the Orthopaedic Trauma Association (OTA) worked on two major initiatives to help maintain military surgical readiness and to provide new protections for orthopaedic surgeons and care teams traveling to disaster zones. These priorities were included in pandemic legislation, called the Pandemic and All-hazards Preparedness and Advancing Innovation Act of 2018, which received broad bipartisan support in both the House and Senate.

The first priority was a bill introduced by Rep. Michael Burgess, MD, (R-Texas) and Sen. Johnny Isakson (R-Ga.). MISSION ZERO establishes a grant program to enable military providers and trauma teams to offer trauma care and related acute care at civilian trauma centers.

OTA and AAOS also worked on relief for physicians traveling to volunteer in disaster zones by supporting the inclusion of the Good Samaritan Health Professionals Act in the pandemic bill. This legislation increases liability protection for medical volunteers who are often turned away or limited in scope of practice due to the potential of a lawsuit.

Unfortunately, the pandemic bill was caught up in a dispute between the bill’s Senate sponsors as well as government shutdown negotiations and did not pass before the end of the 115th Congress on Jan. 3. Because the pandemic legislation is still a major priority for Congress, the AAOS OGR will work to ensure that both MISSION ZERO and the Good Samaritan Health Professionals Act remain in the final version.

AOFAS—Physician designation protected at VA

In June 2018, President Trump signed the VA MISSION Act. The bill included language carefully negotiated by the American Orthopaedic Foot and Ankle Society (AOFAS) and the AAOS OGR, which amended a bill that would have classified podiatrists as physicians under the Veterans Health Administration. The final legislation allowed podiatrists a raise but did not give them the physician title or the ability to clinically supervise medical doctors or doctors of osteopathic medicine.

AOFAS and the AAOS OGR have built on this success by engaging directly with the American Podiatric Medical Association to work collaboratively on issues where we agree and to attempt to bridge differences early in the policy-making process.

POSNA—CHIP extended for 10 years

In February 2018, following a grassroots campaign from members of the Pediatric Orthopaedic Society of North America (POSNA), assisted by the AAOS OGR, the Children’s Health Insurance Program (CHIP) was funded for 10 years. CHIP provides health coverage for nearly 9 million children around the country from working families who aren’t eligible for Medicaid and who lack access to affordable private coverage.

When CHIP expired in September 2017 due to partisan funding battles in Congress, POSNA went to work generating support for the program by writing letters and making phone calls. The work paid off when CHIP was temporarily extended in December 2017 and again a few months later when Congress authorized an extraordinary 10 years of funding for this important program.

AAHKS, ASES, and ASSH—Orthopaedic PAC Advisor’s Circle members extend political reach

The Advisor’s Circle is designed to provide AAOS members’ group practices and specialty societies with a leadership role within the Orthopaedic PAC—the only PAC on Capitol Hill representing the interests of orthopaedic surgeons. In 2018, Advisor’s Circle specialty society members AAHKS, ASES, and ASSH took advantage of this program to greatly increase their political impact.

The Advisor’s Circle helped secure Sen. John Barrasso, MD (R-Wyo.), for a speaking engagement at the ASES 2018 Annual Meeting. ASES also held a successful Capitol Hill Day, bringing its leadership to meet with key lawmakers and to advocate for a new accurate shoulder definition by the Centers for Medicare & Medicaid Services. AAHKS members attended a retreat with Rep. Burgess and advocated for changes to the two-midnight rule for total knee arthroplasty. AOFAS also increased its political engagement, sending members to retreats with the Democratic Governors Association and the National Republican Senatorial Committee.

Amy L. Ladd, MD, is chair of the AAOS BOS.

Jordan Vivian is a manager in the AAOS OGR.