If You’re Not at the Table, You’re the Menu, and Other Themes from Day One at AAOS

The annual meeting of the American Academy of Orthopaedic Surgeons is underway in New Orleans, and already some key themes have emerged.

“If you’re not at the table, you’re on the menu”

Dr. John Tongue, a former president of AAOS, made a forceful argument for how it is critical for orthopedic surgeons to convince the wider world of the true economic value of what they do daily.

That necessarily means engaging representatives of Congress and even senators, who often are not aware of the long-term financial and societal benefits that emerge from orthopedics procedures such as total knee replacements and ACL reconstructions,

This interaction is all the more important now that the Centers for Medicare and Medicaid have cut reimbursement for total knee procedures. Starting Jan. 1 Medicare reimbursement for total knee arthroplasty has been reduced 11%. Tongue contended that CMS and private payors are reducing access to musculoskeletal disorders because the media has fed them a steady diet of how TKA procedures are one of the most expensive procedures and that as baby boomers age, demand for these will skyrocket.

But financial analysis funded by the AAOS and researched by IHS Global Inc. and KNG Health paints a wholly different picture. The series of studies looked at National Health Information Survey data from more than 185,000 people and data from existing clinical research and using that researchers developed a unique method to analyze the data and estimate the overall value, including the impact on indirect costs, of specific orthopedic procedures, such as TKA.

The studies found that the cost savings to society as a result of 600,000 TKA procedures in the U.S. in 2009 to be a staggering $12 billion.

AAOS has been talking with legislators out of concern that patients are not going to get access to procedures that provide long-term economic value, Tongue said.

But he stressed that every orthopedic surgeon needs to get in front of local elected officials.

“Elected officials are like puppy dogs, "Tongue said. “I don’t mean to be condescending but they need attention. They need to get re-elected and they respect doctors,” so talk to them.

He recalled how he invited U.S. Congressman Kurt Schrader (D-Oregon) to his home and how only three orthopedic surgeons showed.

“If you’re not at the table, you’re the menu,” Tongue said quoting someone else.

“You are an orthopedic surgeon and a care manager”

One of the dizzying truths about being an orthopedic surgeon or a doctor of any kind these days is that you can’t be concerned exclusively with the practice of medicine.

Orthopedic surgeons need to understand where they fit in on the value spectrum.

“Do you know the cost and outcomes of everything you do?” challenged Michael McCaslin, a chartered accountant, AAOS attendees. "“You are a surgeon and a care manager,” McCaslin told the audience.

McCaslin declared that value equals outcomes divided by cost, and that the only way orthopedic surgeons will have a handle on the value question is if they begin to look at data that is scattered throughout their practice.

That involves regularly reviewing practice management data, quality/process related data in addition to annual/quarterly financial data.

"Data is awesome in a medical practice," he said. "The challenge is that data is everywhere." 

Later, Craig Mahoney, partner at the Iowa Orthopaedic Center, urged attendees to “look at the financial ramifications” of what we do.

“No Way in Hell”

AAOS attendees appear to be bucking one important national trend in a big way. Or at least the roughly 150 attendees who attended a morning session are.

An article in the New York Times about how more doctors are taking salaried from hospitals quoted the American Medical Association saying that “Today, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists — such as ophthalmologists and ear, nose and throat surgeons — are employees rather than independent,”

But at the morning AAOS session, a spot poll of attendees revealed that 85% were not hospital employed and roughly the same percentage intended to stay that way.

One audience member when asked to explain his response reacted “No way in hell,” clearly showing the antipathy to losing autonomy to a hospital.”

It was a feeling that was widely shared among the audience. When asked to report whether the audience felt that their relationship with the hospital had become “more friendly,” “more hostile” or neutral, 40% of the audience responded that it had grown more hostile.

This will probably become a complicating factor as surgeons, physicians, device makers and hospital administrators battle it out in the uncertain times ahead. Uncertain times wrought by Obamacare/ACA and the move to value-based healthcare.

-- By Arundhati Parmar, Senior Editor, MD+DI
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