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COVID-19 Presidential Update from Joseph A. Bosco III, MD, FAAOS

May 4, 2020

I have not performed surgery in six weeks. I cannot remember not operating for over two weeks (let alone six weeks) since I graduated from medical school in 1986. Many of you are in the same boat. We are all anxious and ready to get back to the rhythm of our pre-pandemic lives. As phase one of the pandemic recedes, several states are relaxing their restrictions on elective surgery. For example, Oklahoma allowed elective surgery to begin on April 27th. Two weeks ago, the AAOS published guidelines for return to elective surgery. Since then, other organizations have either endorsed, or published guidelines similar to the Academy. The basic tenets of these guidelines stress that the decision to perform elective surgery should be based on the local availability of resources and the local prevalence of COVID-19. Furthermore, these decisions should be made by healthcare professionals working together with local authorities. Finally, and most importantly, all decisions must be guided solely by the health and safety of our patients, healthcare workers and general population. This includes the potential decision to curtail elective surgery if, following the resumption of surgery, the COVID-19 prevalence begins to increase. I have supreme faith in the ability of our colleagues to make measured and morally correct decisions. Hopefully, I will get back to the OR before I forget which is the sharp end of the scalpel.

States that have relaxed prior prohibitions on elective surgeries include: Alaska, Arizona, Arkansas, California, Colorado, Illinois, Iowa, Indiana, Kentucky, Louisiana, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Virginia and West Virginia. New York State recently announced that certain counties, without significant risk of COVID-19 surge in the near term, have been approved to resume elective outpatient treatments. Further, additional states that have signaled their intentions to relax limitations - in the coming days or weeks - include: Florida, Minnesota, Nebraska, South Dakota, Vermont and Washington state. However, it is important to note that many states still have various restrictions and defined clinical considerations.

The resumption of elective surgery has engendered many conversations between us and our patients. They have many questions and may forget to ask some important ones during their virtual or in-person visits. In order to augment these conversations, AAOS has reignited the Ortho-pinion blog on OrthoInfo.org to assist patients and curious consumers searching the internet with questions and concerns around future orthopaedic care in the face of this pandemic. Members of the Communications Committee, OrthoInfo Editorial Board and Social Media Ambassadors have stepped up to foster contributions and thoughtful perspectives to inform and promote these resources to patients and the public during what can feel like a very uncertain time.

AAOS Second Vice President, Felix Savoie, III, MD, FAAOS, is also working on a list of potential patient frequently asked questions (FAQ) concerning future orthopaedic surgery. We expect this project to be completed by mid-week and will post to the COVID-19 Member Resource Center for you to access. We are consulting with our specialty societies to broaden the FAQ scope and outreach. We have purposely not consulted our industry partners on this project, but we know that they will view it positively as well.

On the Advocacy side, I have asked First Vice President, Daniel Guy, MD, FAAOS, to assemble a project team to implement a plan for August in-district congressional visits. His team consists of BOC and BOS leaders, PAC representatives and our OGR staff and volunteers. Our vision is to transform member advocacy to a year-round effort. In-district meetings tend to be more relaxed and easier to do than trips to Capitol Hill. Establishing and maintaining personal relationships with your Congressional representatives benefits all of us both personally and professionally and is great for the AAOS as well. Organizing and getting started on these visits can seem daunting for those of us who have never done this. Dr. Guy’s team will guide you through the processes and provide the resources necessary to operationalize these visits.

After last week’s passage of the fourth COVID-19 related package, which included additional SBA loan and paycheck protection funding, not much has happened in our Capitol. On a positive note, the Senate is returning to DC this week to begin debate on the next COVID related package. Senate Majority Leader Mitch McConnell (R-KY) has confirmed in several instances, that he will not pass a bill without liability protections. We are working hard to make sure this includes liability protections for physician offices. We do not yet know when the House is expected to return.

CMS is waiving the video requirement for certain telephone evaluation and management services and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services. In addition, CMS invited AAOS to participate in the publicly accessible "CMS on the Frontlines: Stakeholder Call" on May 1. Dr. Guy and I joined to share our perspectives on opening up and provision of care during this pandemic.

Shortly, all of us will receive our ballots for the Nominating Committee, proposed bylaws amendments and resolutions. This year we have over 100 members who were nominated for the AAOS Nominating Committee and who are eligible and agreed to serve. This is a large number and represents our members' passion and willingness to volunteer. It is a great sign. The ballot also contains the proposed bylaws amendments. Amendments 1 and 2 deal with streamlining the bylaws by moving several items from the bylaws into rules and procedures. This proposed amendment has garnered much attention. The facts are that it was supported by the BOC, BOS and BOD. I support them.

Your vote counts as much as mine. I know that you will vote based on facts and what you feel is best for the Academy. Dr. Guy shared his perspective about the bylaws change on a recent webinar. Listen and review additional details at aaos.org/bylaws. After the vote, regardless of the outcome, I will harness the passion on both sides of this issue and work with all parties involved, to move the Academy forward and execute on our Strategic Plan.

Stay safe and healthy,

Sincerely,
Joseph A. Bosco III, MD, FAAOS
AAOS President