Board of Councilors Report

Wilford K. Gibson, MD

Greetings!  One of the goals of the Board of Councilors is to report on the Fall Meeting to our constituents.  Historically, this required waiting until the State Meeting in May.  Thanks to the e-newsletter we can keep you up to date in a much more timely and effective manner.

I arrived in Colorado Springs for the Fall Meeting of the AAOS October 15, 2009 after weather and mechanical delays and avoidance of “balloon boy” to beautiful weather and an efficient meeting.  I started that afternoon with the Economic Committee chaired by John Nordt, which is a new charge for me.  Eric Guidi also attended the meeting.  We are looking for ways to ask the AAOS to demonstrate the financial value of orthopaedic surgeons and help maintain the viability of orthopaedic practices.  This is a difficult topic to gel into a few words, but we want to start by demonstrating the 30-40% loss in revenue over the last 15 years, while experiencing a similar increase in medical and malpractice insurance premiums and overhead costs.  Hopefully, this will shine a light on the fact that we are undervalued and the healthcare dollar is not being used for patient care and payment of physicians, but used for administrative costs and profit for insurance companies and their shareholders.  We are just starting with small steps in this battle!  
           
I briefly slipped in on the State Societies Meeting chaired by Charles Hubbard to discover that we did get one- two thousand dollars grant money for membership development and there is still money available primarily for state societies to improve organization, membership development and special projects. The State Legislative & Regulatory Committee also met and agreed to provide ten thousand to Maryland to protect in-office imaging, eight thousand to South Carolina to defend physician owned physical therapy and two thousand to Georgia to help develop a state wide trauma network, along with other smaller grants. 
           
The following morning, we participated in a Leadership Development Conference moderated by David Teuscher, with speakers from the Air Force and Navy, including Brigadier General Samuel D. Cox the Commandant of Cadets of the US Air Force Academy. We also participated in a Health and Information Technology (HIT) conference later that morning.  I’ll spare you the details.  We also received the PAC report from Stuart Weinstein. Our AAOS PAC has financially surpassed the AMA! As I recall, our first year raised just over $300 thousand dollars. Last year, we were over one million.  This year, we have raised over three million dollars for political action!  Unfortunately, the statistic that remains unchanged is this was accomplished each year by less than 30% of the AAOS membership.  If you have not contributed to the AAOS PAC this year, please visit the AAOS website with your credit card in hand and make a leadership gift of $500. I can assure you there has been no other time where your gift was more needed.  Within the next 60 days, our Congress will weigh in on Healthcare Reform and we need to have their attention.  We also heard from Shep Hurwitz  with the ABOS report.  Re-certification and maintenance of certification (MOC) continues.  One of the most important facts to be aware of concerning MOC is if you intend to take the examination three years prior to the expiration of your certificate, you need to get your application in to ABOS by December a year ahead of the examination.  As an example, if your certificate expires in 2014 and you desire to re-certify in 2012, you will need to have the application submitted by December 2011.  That means you need to start accomplishing those 120 hours of category 1 CME and 20 hours of Scored and Recorded Self-Assessment Examinations now!  Please visit the ABOS website abos.org to determine your specific requirements. 
           
On Saturday, October 17, we participated in the CME portion of the Fall Meeting.  The topics included The Innovator’s Prescription:  A Disruptive Solution to Healthcare and Value-Based Care.  The most exciting component of the weekend was the presentation by Jason Hwang.  Dr. Hwang is an internal medicine physician and co-author of the text, The Innovator’s Prescription:  A Disruptive Solution to Healthcare.  He discussed the decentralization of healthcare and the concept of the disruptive innovator.  In brevity, larger incumbent corporations sustain innovation and bring high profit business opportunities to the market place. Unfortunately, these high cost and profitable products and services may exceed the pace of technology and the customer is over served.  The customer looks for a product that he can use that is less expensive but gets the job done at an acceptable level of performance. The disruptive innovator sees an opportunity to produce a less costly and highly profitable product that meets the customer’s need.  Eventually, the incumbent company collapses as it continues to provide costly, complex services or product, while the disruptive innovator profits.  An example provided included US Steel that was driven out of business by innovative “mini-mills” that produced more profitable products (angle irons, bars and rods) at less cost and left the high overhead, complex products (sheet metal) to US Steel.  The relationship to medicine was provided by the example of cardiovascular and thoracic (CVT) surgery and invasive cardiology.  The CVT surgeons provided complex, expensive and profitable coronary artery bypass grafting (CABG), but they did not use balloon catheters.  As the cardiologists developed angioplasty, they became the disruptive innovators and took the CVT business and profits. It is easy to see parallels in our position as the provider of complex, costly care that is profitable and a target for disruptive innovators coming in the form of neurosurgeons, podiatrists, and general surgeons with a fellowship in hand surgery or trauma.  If we do not become the disruptive innovators, I can see that we will go the way of US Steel!   Overall, these were intriguing concepts and I would refer you to his text for further reading.
           
Later Saturday, we received the OREF report from Terry Canale and William P. Cooney, III.  Since its inception, the OREF has provided over 3,500 grants and 98 million dollars for research and education.  More recently, the emphasis has shifted to education.  Twenty-four million dollars has been provided to orthopaedic specialty societies. Unfortunately, with the collapse of the stock market, there has been a contracture of the endowment and a decrease in individual gifts. The OREF, however, remains strong and viable and is providing Fellowship and Residency Enhancement Grants.  Remember the OREF with your end-of-year gifting.  Some state societies have made memorial contributions for deceased members.  Perhaps, as members retire, it would be appropriate for the practice or the VOS to make a gift in the name of the retiree?  I will bring these ideas to our Board of Directors.  Only 16% of AAOS members contribute to the OREF.
           
On Sunday, October 18, we voted on resolutions before the Board of Councilors.  Most of the issues passed with little discussion.  The two most debated issues were the inclusion of a representative of the Clinical Orthopaedic Society (COS) in the BOC and modifications to the Standards of Professionalism (SOP) concerning expert witness testimony.  A large number supported inclusion of the COS, as the previous year regional orthopaedic societies were included.  A small number expressed concern about lack of criteria concerning addition of future organizations to the BOC or Board of Specialties (BOS). There was also concern about the financial impact on the AAOS and potential dilution of smaller state representation given the current formula. The BOC referred the matter to our Board to investigate these issues and return with a recommendation at our next meeting in New Orleans. The revised standards of the SOP with slight modification were approved and referred to the BOD of the AAOS and the membership.  The only significant change, and the issue that raised debate, was the requirement of retired members providing expert testimony or opinion to maintain a current certificate from the ABOS, ABOOS or certifying body. This would require retired orthopaedic surgeons providing expert testimony or opinions to maintain their certification. This issue still needs to be approved by the AAOS BOD. 
           
Hopefully, this summary of the Fall AAOS BOC meeting is helpful and informative. It continues to be my pleasure and honor to serve this meaningful organization.  I look forward to seeing all of you in Charlottesville in May 2010!                                 

                                 
For  the latest proposal on Health Care Reform                 To view the August 2009 AAOS State Newsletter     
and how to get involved, provided by AAOS

Respectfully,
Wilford K. Gibson, MD
Councilor