Welcome to BOC Now!  This newsletter is a way to share information from our recent meeting and communicate with our constituents: practicing orthopaedic surgeons, colleagues, new candidates/fellows, residents and fellows, state societies, our leadership line and the BOS and LFP.  Take what you’d like out of this newsletter and SHARE it with your key stakeholders! An available editable word document is available within the General Resources of the BOC Community.

Fall Meeting 2017:

The Fall Meeting takes place October 19-21, 2017 in Dallas, Texas. Registration will be online for Councilors in July. Symposia topics are under review.

BOC Group within the AAOS Community:

The BOC Community will serve as a vehicle to help improve effectiveness of the BOC by enhancing Councilor dialogue between meetings. Ultimately, the site will serve as a data resource warehouse for our SLRI, SOS, and Economic Issues toolkits, among other advocacy tools and information. Each Councilor was auto-subscribed at the NOLC, so be sure to set up your profile and preferences to determine how frequently you’ll want to receive information.

NOLC slides and presentation material are available online here.

Key BOC Committee Meeting Takeaways
Economics Issues Committee (Submitted by Dave Cannon, MD):

The Economic Issues Committee met at the AAOS NOLC with discussions about regulatory burdens, the letter from the AAOS to Tom Price, and update on payment models, and a review of the individual state issues.

Administrative burdens are the #1 cause of dissatisfaction in physicians in general and especially with orthopaedic surgeons. This includes, but is certainly not limited to, electronic records/EMRs/EHRs, precertification processes, claim denials, PQRS/quality measures, work letters and excuses. A Health Affairs article sourced the administrative burden in the USA is upwards of $50,000 per physician. Now with the opioid epidemic at the forefront, a new administrative burden is being added in almost all of the states with prescription drug monitoring.

Two actions for this issue:

1. The letter from the AAOS to the Secretary of Health and Human Services, Tom Price, for regulatory relief from these administrative burdens, as well as others within the purview of the HSS Secretary, was reviewed.
2. The Economics Issues Committee passed a motion to work with the AAOS leadership and the AAOS Council on Research and Quality to consider measuring, through polls or other means, the exact time and financial burdens from the multitude of administrative burdens facing the fellowship members with the intended goal of having more concrete information to be used as education for policymakers.

Payment Model Update

The newer alphabet soup acronyms and what they represent were discussed. Alternative Payment Models (APM) is a more well-known part of MACRA. The Physician Focused Payment Models (PFPM) is one that is submitted for evaluation as part of the alternative model area. The physician focused payment model technical advisory committee (PTAC) is tasked with review of the PFPMs for approval. The PTAC was reviewed and is noted to be composed of mostly non-practicing physicians.

Individual State Issues

Many of the legislative activities throughout the states have economic impact on the practice of orthopaedic surgery. Legislation regarding scope of practice, narrow networks, certificates of need, and insurance consolidations are ongoing in many states. The importance of participation was discussed and if possible being a representative on boards to achieve or maintain leverage also was discussed. Legislation exists in Connecticut that levies additional taxes on physicians and hospitals because of budgetary woes. While no legislation currently exists, there have been rumors of states considering employed physicians being allowed to unionize.

Contact Catherine Boudreaux or Jeffrey Angel, MD for more information.

State, Legislative and Regulatory Issues Committee (SLRI) (Submitted by Todd Schmidt, MD):

1. Scope of practice issues are constant
   1. Define/control your relationship with your state medical society
   2. Use opposition words against them
   3. Develop Coalitions with other physician and patient groups
   4. Use AAOS state government staff, or AAOS/BOC resources/toolkit. Email bhatt@aaos.org
2. Ambulatory Surgical Centers, Certificate of Need and Physician Owned Hospitals (POH)
   1. ASC CON laws are being challenged by state orthopaedic societies with success.
   2. Use cost and quality and volume capability as tools to persuade
   3. POH discussions as part of ACA replacement
   4. Out of Network access and billing/compensation issues in many states
3. National Association of Insurance Commissioners model sets out of network payment to a percentage of Medicare in legislation. Undesirable as that becomes the floor and a base for all reimbursement. Preferred is the Fair Health Approach. Change the narrative from physicians vs. insurance company to physician-led, patient centered access. New York state has fixed surprise billing by being pro-physician and pro access to care.

For all state legislative issues:

• Define/control relationship with state medical society.
• Use opposition’s words against them.
• Push the “team” approach to care.
• Hospitals and employers are powerful.
• Use ideological organizations.
• Testify and create public comments.
• Speak with your Governor’s staff.
• Language is important, control the narrative.
• Target lawmakers that have jurisdiction of the issues. Who are the members of your state house and senate health and human services committees?
• Look for friends in medicine.
• Support physicians that run for state office.
• Use grassroots to build relationships.
• Don’t give up.
• Create a message for the public.
• Patients are on your side against insurers.

Contact Manthan Bhatt and Chris Kontogianis, MD for more information.

State Societies Committee (Submitted by Jeff Nakano, MD):

1. The purpose of the of the State Orthopaedic Societies Committee (SOS) of the BOC is to pursue strategies to strengthen and foster development of the individual state orthopaedic societies’ infrastructure to allow them to effectively address their own state health policy issues. Having a strong state society is paramount for responding to potential threats to orthopaedic practices from all arenas.
2. The SOS has grants available from the AAOS to give to state societies to achieve these goals. These grants are awarded after careful consideration of the SOS to a request from the state society.  Grants for pilot programs requests that will become self-sustaining are favored.  Grants were given to 4 states at the recent NOLC meeting:
   1. Georgia Orthopaedic Society: Received a $3000 grant to help defer the costs of a senior resident’s program that is organized by the Georgia and South Carolina Orthopaedic Societies covering topics such as malpractice, practice management, contract negotiations, state and federal health care policy, and lifestyle balance.  The program has been successful in the past and is getting larger.  The grant will be replaced in future years by greater industry sponsorship.
   2. Missouri State Orthopaedic Association: Received a $1650 grant to help provide funding for a resident paper competition at the annual meeting of the state society.
   3. Tennessee Orthopaedic Society: Received $2500 to help defer expenses for officers of the Tennessee Orthopaedic Society to visit practices throughout the state to promote membership
   4. Virginia Orthopaedic Society: Received $2000 to help develop a patient education tool for opioid drug disposal or return.
3. Future grant requests will be considered at the Fall Meeting of the BOC in Dallas later this year. Contact SOS staff liaison:  Erin Volland to obtain information on grant requests.

Contact Greg Gallant, MD, or Erin Volland for more information.

Advocacy Resource Committee (ARC) (Submitted by Andy Ryan, MD):

As I left the BOC Communications meeting we were talking, vociferously I believe is the word, about resident involvement. They are the future. I walked upstairs to the ARC and the conversation seamlessly resumed. Is it coincidence?

     I think it not a strange coincidence for we have placed the Resident Assembly in an increasing representation to the Academy and the NOLC. With increased representation comes the opportunity for more responsibility. Is this not the same “graduated responsibility” we encourage in other aspects of their professional development? We the leaders in the AAOS have a vision for mature professional life: the surgeon should be skilled at delivering care and engaged with political process. There is self-defense intrinsic to defending the group. To develop involvement in advocacy issues in all our members, the easiest path to success is to instill a sense of responsibility in the youngest of our group. Over the long years of their full careers, we thus gain the greatest return on our efforts. Plant an apple tree now and grow apples for several generations. I see a co-evolution in progress. For all our efforts as senior members in the community to include the residents, they seem equally interested in altering the field upon they will practice which only increases our senior enthusiasm to hear their junior voices.

     The residents in the Resident Assembly (RA) are enthusiastic and want to be active in Advocacy. Is this a self-selected process? Are these just the only residents out of 600 some who are interested? A quick look at the data finds that residents across the board are contributing to the PAC in large numbers. We at ARC asked Nicholas Bonazza the rep from the RA and from his viewpoint this is a real grassroots movement among the residents. They are interested and want to be engaged.

     Are we getting help from the Program Directors – or hindrance? The same questions were brought up at both the Communications and ARC meeting. This needs to be addressed and we need confirmation of the positive feedback and input from the residency program leaders. A few BOC/BOS at the next day symposium expressed the same concern. My personal guess is if the AAOS makes it a point of emphasis to encourage resident participation in the RA, the Program Directors will fall in line.

     The Milestone Program is sponsoring a resident as guest of the Office of Government Relations. This is yet another demonstration of the Academy’s commitment to resident involvement in advocacy.

     And in the Everyone Gets Involved Dept., independent of the ivory towers, state societies can be reaching out to the residents – as we are doing now in Kentucky. BOC representation to the residency programs I have found to be readily accepted.

     The topic was brought up “Should ARC give awards or recognition?” Since we don’t have a budget for now the best we can do is to give shouts out. A possible solution could be an article on Ambassadors in AAOS Now.

     For those who feel unsure about the process there is an upcoming Webinar on “breaking down the barriers of entry”. Advocacy can be done in your off time including old and new media such as Twitter or local letters to editors or local television spots. It doesn’t matter who; it does matter how; and it mostly matters that we are involved.

     Recruitment is key. We can’t do this alone. As with most of our lives, teamwork is critical. ARC is doing what it can with limited funding and is recruiting new members and more involvement but, like with athletics, much of recruiting is merely scouting. And even more of it is just showing up.

     Key Contact is the old word. Ambassador is a better description. We should all be Ambassadors for the profession. As Councilors we are accustomed to being ambassadors and advocates. Yet every fellow in the AAOS has that potential. And if we happen to have a special relationship to a Member of Congress, we should be active ambassadors. There is no exclusive arrangement between Ambassadors and Members of Congress or Senators. The more involvement the better. The ABC’s remain unchanged: Alert your Representative; Bond – it’s all about relationships; Consistency – and/or persistence – keep doing what you’re doing. Whether it’s the residents and youthful enthusiasm or someone like me with a serendipitous relationship or two, if you find yourself in the position, make it happen and become the Ambassador of Orthopaedics to the Office your Congressman.

Contact Dean Schueller, MD or Julia Williams for more information.

Communications Committee (Submitted by Tom Muzzonigro, MD):

National public service campaigns on prescription safety and the importance of exercise for healthy bones and joints are running across the country to positon AAOS and orthopaedic surgeons as a solution to the opioid and obesity epidemics.

Prescription safety posters are available for member offices, meetings and events to help further public awareness. To request materials, please email media@aaos.org.

A new pilot program, Communities in Motion, was held on Tuesday, March 14, 2017 in San Diego at the Spring Valley East Community Center, the location of the Academy’s 2011 Family Fitness and Fun Park playground build. More than 100 people came out to participate in the event which featured orthopaedic surgeons leading interactive exercise stations to encourage families to be active together to help build strong bones for life.  Photos are available at ANationInMotion.org/communities and the AAOS Communications Cabinet will evaluate success and determine next steps for a 2018 event. Thank you to all our sponsors and volunteers.  To sponsor the 2018 event, click here.

Contact Thomas Muzzonigro, MD or Lauren Pearson Riley for more information.

BOC Booth at Annual Meeting 2017:

The BOC had a kiosk within the AAOS Resource Center (Booth #1423) which was directly adjacent to the PAC booth (Booth #1625). The proximity of these two kiosks likely had a positive impact on the increase of funds raised by the PAC during exhibit hours. The goals of this booth were to increase awareness of the BOC, educate the membership about the BOC’s role within the Academy, and to promote PAC participation. Thank you to those that volunteered your time! The space served the Fellows of AAOS by familiarizing them with and connecting them to their state or regional Councilors. Booth traffic and return on investment is currently being analyzed and discussion about future space will be discussed by the BOC Executive Committee.

BOC Awareness Video: Councilors are encouraged to share the BOC video at any state or regional society meeting.  The video can be downloaded and is posted online at http://www.aaos.org/About/Board_of_Councilors/.

Thank you to our BOC volunteers who helped assemble this BOC Now content.

Please feel free to reach out directly to me at Muzzy@tririversortho.com, 412-780-9961, or Lauren Pearson Riley at pearson@aaos.org, 847-384-4031 with comments, suggestions and ideas for improving the BOC Now.  See y’all in Dallas at the Fall Meeting.

Muzzy
Tom Muzzonigro, MD
BOC Communications Committee Chair