I remember the first time I attended the AAOS National Orthopaedic Leadership Conference in Washington, D.C., nearly 15 years ago. I participated in Capitol Hill visits and recall the excitement I felt walking the halls of the Hart and Rayburn buildings, seeing the names of the members of Congress I had read about in newspapers and watched on television.
Since then, I have been back many times to educate lawmakers about details of our AAOS Unified Advocacy Agenda (UAA) and the need to increase National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases research funding for our patients. In fact, Andy Pollak, MD, introduced me to Maryland Representative Dutch Ruppersberger (D-Md.) when I lobbied with Maryland orthopaedic surgeons years ago. I was able to see firsthand what a personal relationship can lead to for our members and patients. Representative Ruppersberger was instrumental in getting Congress to fund the Peer Reviewed Orthopaedic Research Program in 2009, and we have since received nearly $400 million to support research grants that provide warriors affected by military orthopaedic injuries the opportunity for restoration and recovery of function.
Advocacy is a key enabler in our new five-year Strategic Plan, which means that it is an essential part of our fabric and not an initiative that fades over time. I cannot overstate the importance of the Academy’s influence on all government policymaking levels. It helps to fulfill our mission: “Serving our profession to provide the highest-quality musculoskeletal care.” It is an organizational responsibility to advocate for our members to be able to provide the best possible care for patients. It is also necessary to achieve our new vision as “the trusted leaders in advancing musculoskeletal health.” As a matter of fact, this purposeful shift in our vision toward musculoskeletal (not orthopaedic) health (not disease) will likely require an upgrade in our current UAA to broaden our view of the musculoskeletal care team and to also consider preventative care.
Our Council on Advocacy, led by Wilford K. Gibson, MD, along with our top-notch Office of Government Relations (OGR) team, keeps abreast of all current legislative and regulatory issues that may impact our patients, anticipates new rules, and suggests new possibilities for access to care or payment reform.
Integrating with quality
In the new Strategic Plan, advocacy is most closely aligned with quality (goal 2): “Equip members to thrive in value-based environments and advance the quality of orthopaedic care.” To achieve this and ultimately achieve our vision, we will integrate AAOS advocacy and quality efforts to a greater degree, along with our registries work. The move to value—which involves both quality and cost—is not going away in our current healthcare system, and it makes sense that we would provide patients high-value care. This means understanding what works, recognizing what doesn’t work, and starting to fator cost in the equation. Payers, employers, and regulators are doing this already, and we will need to collaborate with them to be successful in the long term.
Our work with evidence and quality over the past 10 years has achieved credibility in Washington, D.C., and allows our views to be heard by the Centers for Medicare & Medicaid Services (CMS), the Center for Medicaid and Medicare Innovation, the Food and Drug Administration, and private payers. Leaders in Congress, at the Department of Health and Human Services, and at the Office of Management and Budget of the White House regularly reach out to our OGR team and AAOS members to get our opinions on proposed rules.
We also influence legislation and regulatory rules related to patient access to specialty care and episode-of-care models, respectively. A great example of this is the Sports Medicine Licensure Clarity Act (an AAOS-authored bill), which passed in 2018 after five years of advocacy. It was a successful collaborative effort between AAOS and the American Orthopaedic Society for Sports Medicine that achieved a significant win for practicing sports medicine physicians and all orthopaedic surgeons who travel across state lines to care for athletic teams.
Currently, AAOS is partnering with the American Society of Anesthesiologists (ASA) and the American Academy of Physical Medicine and Rehabilitation (AAPM&R) to develop the perioperative surgical home (PSH) targeted to small and rural musculoskeletal practices. AAOS, ASA, and AAPM&R will recommend the PSH to CMS for improving the quality of post-acute care and will advocate for team-based episodes of care that emphasize value.
In my current role, I have the opportunity to frequently travel and listen to members. I recently heard a member suggest that all practicing orthopaedic surgeons go on strike until the government changes things back to a prior era when doctors were the only decision makers, there were no authorization requirements for tests or procedures, and all payments were fee-for-service. No administration is going to allow that to happen.
The newest generation of AAOS members (residents and those with less than 10 years in practice) was trained differently than members who have 10 years or less remaining in practice. This generation is steeped in the philosophy of evidence-based thinking and value-based practice management. These surgeons will be in practice for the next two to three decades, and they have a greater interest in using data and evidence to supplement their experience and ability to help patients make decisions about their care.
Likewise, the Academy has an opportunity to implement published, evidence-based science to optimize musculoskeletal care. There are so many beneficial treatments and procedures that provide value to our growing and aging patient population that we should no longer focus on less effective care. Our family of registries can help us demonstrate the benefits of such treatments and procedures.
The following areas will be critical as we move forward:
Understand the current legislative and regulatory environment and anticipate future directions of health care in the United States.
Speak up when new rules or regulations will inhibit our patients from receiving the highest-quality care.
Collaborate with other like-minded groups in the healthcare space.
Lead our members to survive this uncertain time until they can thrive by helping them understand what is necessary to be reimbursed appropriately for providing value-based care to patients, as well as providing mechanisms like registries for reporting quality.
The Orthopaedic Political Action Committee (OrthoPAC)—the largest healthcare PAC in the nation—is critically important as a means to allow our members and OGR staff unprecedented access to key decision makers related to orthopaedic issues. Such access allows AAOS to shape the legislation and regulation that frame your practice.
Using personal contributions from our members, OrthoPAC supports candidates for federal office who champion these critical issues and, in turn, serve as a vehicle for advancing the legislative agenda of AAOS. By collecting corporate contributions from orthopaedic business accounts, we amplify our reach and invest in state party committees and independent expenditures, as well as financially support all activities related to running a multimillion-dollar political operation.
When it comes to lobbying or donating to the PAC, remember that we should align around issues such as access to specialty care for patients, opioid legislation that allows for safe and effective pain relief, and demonstrations of the value of musculoskeletal care. This is the lens through which our PAC supports candidates. We are not assessing the positions of candidates on social issues unrelated to health care. It is rare to find a lawmaker who supports every issue you personally care about. If particular nonhealthcare issues are important to you, consider identifying a candidate you can support from either party and determine whether he or she aligns with AAOS on our advocacy positions.
Join OrthoPAC and consider hosting a fundraiser for your candidate. Get involved in advocacy one way or another—call a member of Congress, lobby on the Hill, or become an expert on our issues and educate your orthopaedic colleagues.
Kristy L. Weber, MD, is president of AAOS, as well as a professor and vice chair of faculty affairs in the Department of Orthopaedic Surgery at the University of Pennsylvania.