August 3rd, 2009
 

 
AAOS Nominating Committee Ballot
  

By John Early, MD
President, Texas Orthopaedic Association

You have recently received the AAOS Nominations Committee Ballot.  If you haven't already voted, please consider casting your vote for the candidates listed below.

Several years ago, the AAOS Board of Directors found it necessary to

limit the number of terms a fellow could serve on the Nominating Committee.

This was necessary because although there are over 16,000 eligible candidates in the Academy, only a relatively small pool of candidates continued to be elected to this powerful committee. Since each voter is unable to properly vet each candidate, this modification brought about little change in the composition of the Nominating Committee since votes are cast mainly based on name recognition which occurs predominantly through publications and lectures. While we believe that AAOS Fellows who publish and lecture extensively should have a voice, the election process has imposed a significant handicap on those leaders who are well known and recognized in their respective States, but not necessarily on the national stage because their career paths do not bring them national attention.  These state and regional leaders have demonstrated excellent leadership in their societies and would bring an additional dimension to the table.

We believe that the large numbers of AAOS fellows that these state and regional leaders stand for have been under-represented in selecting the future leaders of our Academy.

State leaders have carefully evaluated the candidates for the AAOS 2009-2010 Nominating Committee and have selected the following physicians as worthy of your consideration and your vote:

Dwight Burney, III, M.D. from New Mexico
John T. Gill, M.D. from Texas
Stuart Hirsch, M.D. from New Jersey
Douglas Jackson, M.D. from California
Richard F. Santore, M.D. from California
Edward A.Toriello, M.D. from New York
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AAOS Worth Repeating: Tips From The ABOS About Navigating The MOC Process
     

Maintenance of Certification™ (MOC) is far from being a pointless chore or record-keeping exercise, says Shepard R. Hurwitz, MD, executive director of the American Board of Orthopaedic Surgery (ABOS). Instead, he notes, MOC plays a pivotal role in ensuring that orthopaedists provide excellent care.

Patients today want their physicians—particularly those who obtained their board certification 10 or 20 years ago—to demonstrate that they

are keeping up with treatment trends, techniques, and guidelines. When the American Board of Medical Specialties (ABMS), the parent board of all medical specialties, decided to move toward MOC, the ABOS had no objection to the change.

Although MOC may require a certain amount of additional work on the part of the certificate holder, it's a valuable process that ensures that board-certified orthopaedists are up-to-date on the best strategies for providing care. It also demonstrates to the public that our profession holds itself to the highest standards of safety and accountability.

The MOC process is similar to the former recertification process and it evaluates applicants on the following four components on a continuing basis:

  • evidence of professional standing

  • commitment to life-long learning and self-assessment

  • evidence of cognitive knowledge

  • evidence of performance in practice.

Many elements of the MOC process are quite similar to those in the former recertification process. Both have a 10-year timeline, both require accumulation of a certain number of continuing medical education (CME) credits, and both require the applicant to take an examination.

Under MOC, however, we have added some requirements, including the need to obtain 20 credits of scored and recorded self-assessment examinations (SAEs). MOC also breaks down the process in greater detail.

MOC requires applicants whose board certification expires in 2010 through 2016 to obtain 120 AMA PRA Category 1 CME Credits™ in one 3-year cycle prior to taking the cognitive examination. Diplomates whose certification will expire in 2017 and beyond must obtain 120 CME credits in two consecutive 3-year cycles, totaling 240 credits over 6 years, before taking the secure cognitive examination.

Each applicant must submit proof of having obtained 20 credits from scored and recorded SAEs as part of the total 120 CME credits required for each 3-year cycle. Scored and recorded SAEs are available from the Academy and several specialty societies. These exams differ from "self-scored" exams because the answers must be submitted to the exam provider for scoring.

In most states, licensure and relicensure require a certain number of CME credits. Because our requirements for CME credits dovetail very nicely with state requirements, orthopaedists who obtain and/or maintain their board certification through MOC can renew their licensure without taking a state medical exam. Successful participation in MOC also helps board-certified orthopaedists who move out of state obtain licensure in their new state of residence without taking a state medical exam.

Those who choose the computer examination pathway must submit a 3-month list of surgical cases, with a maximum of 75 cases. Those who choose the oral examination pathway must submit a case list from 6 consecutive months.

Case Lists Requirements. When fellows compile and review their case lists, they can note whether they signed the site before surgery and gave preoperative antibiotics, both of which are in line with pay-for-performance (P4P) protocols. They may have good reasons for not administering preoperative antibiotics in certain cases, and that can be reaffirmed by looking at their results. If, however, they're seeing a few infections that most orthopaedists in practice wouldn't see, the case list review can prompt them to comply with this P4P measure.

The peer review component. After the ABOS receives an application for the cognitive examination, we send evaluation forms to the people named as being able to evaluate the applicant's performance. Peer reviewers may include orthopaedic surgeons; the chiefs of the anesthesia, radiology, or emergency departments; operating room nurses; administrators; and others.

The evaluations measure whether the applicants are fulfilling all their obligations. For instance, if they are supposed to be on-call, do they come in and take call? Do they communicate well with their patients and other physicians? So, we're really asking whether applicants are good citizens as well as good surgeons.

After ABOS receives the case lists and peer review information. The ABOS Credentials Committee meets in the fall the year before an examination to review the information and determine whether the applicant meets the professional and ethical standards for being a board-certified orthopaedist. Committee members also determine whether the applicant is performing enough operative procedures to be considered an active orthopaedic surgeon. They look for any recurring problems that may indicate the need for performance improvements, such as a high number of returns to the operating room or many infections.

Each year MOC is updated. New examiners are invited and new questions are written. Younger people are becoming involved and giving input regarding the skills and knowledge diplomates should be able to demonstrate.

Time Factor. Some orthopaedists are not entirely comfortable with MOC. It does take time to enter a case list, and it takes additional time and a little bit more money to complete scored and recorded self-assessment examinations. We believe, however, that these are extremely worthwhile endeavors and resources are available to provide assistance. Practically every activity related to the MOC process is in line with the trend in American medicine to be more reflective about how we practice and what our outcomes are. Some of our colleagues, in fact, find it a stimulating process that improves their skills. Not everyone feels that way, but the ABOS sees MOC as a quality improvement process rather than a set of hurdles to jump over.

Finding MOC Resources. Sharpen your skills by obtaining educational products from the Texas Orthopaedic Association and Texas Orthopaedic Foundation (coming soon), AAOS and specialty societies, as well as by attending appropriate CME courses.

The Texas Orthopaedic Foundation will offer online credits beginning November of 2009 on a subscriber basis. TOA now offers approximately 25 CME hours to its membership in live programming each year. A CME tracking system will enable online subscribers the ability to access their TOA/TOF CME hours for reporting purposes.  Texas Orthopaedic Foundation subscribers will be able to print a CME certificate after online course evaluation and testing has been successfully completed.

The AAOS has a free transcript service (www.aaos.org/transcript) for all members. It automatically logs CME credits earned through Academy-sponsored courses, multimedia programs, and exams, as well as programs offered by many of the specialty societies. It also allows orthopaedists to add information about any CME earned from other sources. Fellows should be sure to retain all documentation from any organization that has sponsored their CME activities.

Any and all questions about MOC and specific deadlines should be directed to the ABOS, either online at ww.abos.org or by phone at (919) 929-7103. Also, be sure to read all communications sent by the ABOS and maintain current e-mail and address information by alerting the ABOS office in Chapel Hill, N.C., of any address changes.

Maintenance of Certification for Diplomates of the American Board of Orthopaedic Surgery with certificates expiring in 2011 who want to take the 2011 examination (PDF)

More information can be found in the July 2009 issue of AAOS Now.

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This Week In Texas: Mignon McGarry Memos

By Mignon McGarry
TOA Legislative Advocate
TOA Online Version: All Memos

 

Wednesday, July 29, 2009

There will be 11 proposed constitutional amendments on the ballot in Texas on November 3rd this year.  Since it was enacted in 1876, the

Texas State Constitution has been amended more than 400 times.  In order for an amendment to appear on the ballot, the proposal must pass by a two-thirds vote in both the Texas House and Senate.  The proposals must receive a majority vote to be amended to the constitution.  The last day to register to vote in November's election is October 5.  Prior to each election that has proposed constitutional amendments on the ballot, the Texas Legislative Council publishes Analyses of Proposed Constitutional Amendments. The publication, available in September, includes the text of each joint resolution, ballot language, background and analysis of the proposal, and arguments for and against passage of the measure.  Once it is available, we will send you the link for your review.

Texas Secretary of State Hope Andrade held a drawing Tuesday to determine the ballot order for the propositions and to call attention to the upcoming election. Below is a complete listing of the amendments:

Proposition 1 (HJR 132)

"The constitutional amendment authorizing the financing, including through tax increment financing, of the acquisition by municipalities and counties of buffer areas or open spaces adjacent to a military installation for the prevention of encroachment or for the construction of roadways, utilities, or other infrastructure to protect or promote the mission of the military installation."

 

Proposition 2 (HJR 36-1)

"The constitutional amendment authorizing the legislature to provide for the ad valorem taxation of a residence homestead solely on the basis of the property's value as a residence homestead."

 

Proposition 3 (HRJ 36-3)

"The constitutional amendment providing for uniform standards and procedures for the appraisal of property for ad valorem tax purposes."

 

Proposition 4 (HJR 14-2)

"The constitutional amendment establishing the national research university fund to enable emerging research universities in this state to achieve national prominence as major research universities and transferring the balance of the higher education fund to the national research university fund."

 

Proposition 5 (HJR 36-2)

"The constitutional amendment authorizing the legislature to authorize a single board of equalization for two or more adjoining appraisal entities that elect to provide for consolidated equalizations."

 

Proposition 6 (HJR 116)

"The constitutional amendment authorizing the Veterans' Land Board to issue general obligation bonds in amounts equal to or less than amounts previously authorized."

 

Proposition 7 (HJR 127)

"The constitutional amendment to allow an officer or enlisted member of the Texas State Guard or other state militia or military force to hold other civil offices."

 

Proposition 8 (HJR 7)

"The constitutional amendment authorizing the state to contribute money, property, and other resources for the establishment, maintenance, and operation of veterans hospitals in this state."

 

Proposition 9 (HJR 102)

"The constitutional amendment to protect the right of the public, individually and collectively, to access and use the public beaches bordering the seaward shore of the Gulf of Mexico."

 

Proposition 10 (HJR 85)

"The constitutional amendment to provide that elected members of the governing boards of emergency services districts may serve terms not to exceed four years."

 

Proposition 11 (HJR 14-1)

"The constitutional amendment to prohibit the taking, damaging, or destroying of private property for public use unless the action is for the ownership, use, and enjoyment of the property by the State, a political subdivision of the State, the public at large, or entities granted the power of eminent domain under law or for the elimination of urban blight on a particular parcel of property, but not for certain economic development or enhancement of tax revenue purposes, and to limit the legislature's authority to grant the power of eminent domain to an entity."

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Healthcare Reform Update
    

Healthcare reform continues to take shape in Washington, DC, and the AAOS remains engaged and active.

In a prime time speech on Wednesday, July 22, President Obama

reiterated his desire to have legislation passed in both houses prior to Congress' August recess. As events transpired during the rest of the week, however, it does not seem likely that either the Senate or House will meet that goal.

Recent House Committee Action. In the House of Representatives, the America's Affordable Health Choices Act (HR 3200) remains in the House Energy and Commerce Committee. The AAOS continues to have several major concerns with the House's current efforts.

  • IMAC. Energy and Commerce Chair Henry A. Waxman (D-CA) has been in discussions with Blue Dog Democrats to incorporate the concept of the Independent Medicare Advisory Council (IMAC) into HR 3200. The creation of an IMAC-like entity would severely limit Congressional oversight of the Medicare program and replace the transparency of Congressional hearings and debate with a more opaque process overseen by the executive branch with, at best, minimal accountability for the health care decisions it makes. This change would move these important Medicare policy decisions to a very small number of unelected officials that will be largely unaccountable to the more than 45 million Medicare beneficiaries. While several Members of Congress continue to push for its inclusion in health care reform because of expected large cost savings, the Congressional Budget Office (CBO) has estimated that it would have a minor impact on reducing the costs of the overall package. The AAOS, along with the American College of Surgeons (ACS), issued a letter to Speaker Pelosi in opposition to Chairman Waxman's proposal. In addition, the AAOS issued a membership Call to Action on Friday, July 24, 2009.
  • Weiner-Braley Imaging Amendment. The AAOS has also made it clear to Chairman Waxman, members of the committee, and staff members that we are firmly opposed to the introduction of an amendment by Reps. Anthony Weiner (D-NY) and Bruce Braley (D-IA) that would remove CTs, MRIs, and PET scans from the list of services for which physicians can refer under the Stark in-office ancillary exception. The quality and accuracy of imaging studies and interpretations performed by surgeons trained in diagnostic radiologic methods are consistently high. It is our strong belief that the elimination of advanced imaging from the in-office ancillary exception will result in reduced quality of care. Please continue to contact your Representative to voice your opposition to the Weiner/Braley Amendment which is expected to be addressed when the Energy and Commerce Committee resumes it's mark up which will likely be tomorrow, Tuesday, July 28, 2009.
  • National Medical Device Registry. The AAOS has called for changes to provisions in the National Medical Device Registry (NMDR) in HR 3200. House staffers of Energy and Commerce are currently working with the Food and Drug Administration to ensure that the language is not duplicative of ongoing private or public efforts and is useful for post-market surveillance. As part of AAOS' continued efforts to improve the quality of care for our patients, we announced earlier this month the incorporation of the American Joint Replacement Registry (AJRR) as a not-for-profit entity dedicated to collecting and reporting on hip and knee procedures. The national registry proposed in HR 3200 contains neither a public-private partnership nor active participation of health care professionals. It is our belief that registries provide the most credible and valid information if they are gathered, analyzed, and disseminated in a responsible manner by experts in the field under the supervision of a board consisting of a broad spectrum of stakeholders.

TOA MEMBER GRASSROOTS ACTION REQUIRED

Background:
As health care reform continues to evolve, there has been a recent proposal put forth by the Administration to create an Independent Medicare Advisory Council (IMAC) to initiate broad changes to the Medicare program. Under this proposal, IMAC would be able to propose any Medicare reforms, including changes to physician payment. If the changes are then approved by the President, Congress would have a limited time frame to override the entire package with no opportunity for amendments or to reject individual items. The IMAC would divert Congressional authority to make crucial health care decisions to an unelected body with the sole responsibility for reducing cost.

A similar proposal being considered would significantly expand the authority of the Medicare Payment Advisory Commission (MedPAC). This proposal gives MedPAC's recommendations the force of law, unless overturned by a three-fifths vote in both chambers of Congress.

Given the critical impact that changes to Medicare have on access and quality of our nation's health care, the Alliance of Specialty Medicine (of which the AAOS is a member) strongly opposes allowing an unelected government entity unlimited authority to decide the future of Medicare. These proposals would create a government run system which has the potential to thwart innovation, ration care, and significantly interfere with the doctor-patient relationship.

Action Needed:
Call your Senators and Representatives today using the Alliance of Specialty Medicine's toll-free number encourage them to oppose including this provision in health care reform.

Instructions to Send Communication:
Call the toll free number 1 – 866-899-4088. You will be asked for a four-digit specialty code.

  • For the American Association of Orthopedic Surgeons, please enter 2323 now.
  • You will then be asked to enter your 5-digit zip code, and you will be connected to your two Senators' offices and to your Representative.
  • When you have finished the first call, stay on the line to be connected to your next legislator's office.
  • Once you are connected, tell them that you are a constituent and leave your name, phone number, and address, along with following message:

"Hello, my name is __________.  I am a constituent and an orthopaedic surgeon. It has come to my attention that there are several proposals that would eliminate all Congressional oversight of the Medicare program via the creation of the Independent Medicare Advisory Council (IMAC) or expanding the authority of MedPAC.

  • This government entity would create a "one size fits all" solution for millions of Americans, essentially thwarting innovation and rationing care based on cost. Most importantly these bodies would significantly erode the foundation of our nation's health care system - the doctor-patient relationship.

These proposals would also:

  • Eliminate Congressional authority to address the nation's current and future physician and other health care provider workforce needs.
  • Ignore geographic and demographic variances that exist in our nation's health care system and patient populations.

These changes to Medicare will have critical impact on patient access and the quality of our nation's health care.

I strongly urge the Senator (and/or) Representative to reject any health care reform measure that contains either proposal.  Thank you.

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PHA News
 

Thanks to each of you who are spending your valuable time making calls and writing letters to Congress, doing press releases and interviews, visiting Capitol Hill, and scheduling time with your Senators and Representatives in August. Keep up the great work! I can already see the impact of your effort on Capitol Hill…

Please continue to focus your current efforts at your interested Democrat Representatives with the message I brought forward in my last email update – we still need additional Democrats to attend the meeting with Chairman Rangel. Unfortunately, I still do not have a time and date for the meeting – nonetheless, Democrats can express their interest in attending now. Once a time and date are sent, your Representatives will be informed as soon as possible.

Timeline:

The Senate officially announced there will be no vote on health care reform until after the August break (see the attached article for additional details). It is also looking more likely that the House will not be able to get a vote before the August break – the Energy and Commerce Committee has put off its markup at least until next week. Although Speaker Pelosi is threatening to hold over into the August break, the likelihood of that is questionable. At this time, it appears most likely that a majority of the work on health reform (especially on the Senate side) will take place during September and October.

Next Steps:

With the bill being delayed in both the Senate and the House, we have a wonderful opportunity to make a difference both regarding physician hospitals and health reform in general during the August Congressional recess. Once again, I want to encourage you to call your Senators and Representatives and schedule an event for them at your hospital during August. The event may be as simple as a tour, or you may choose to do a fundraiser and reception, or even a press conference (with the approval of your member's office).

I have attached a toolkit which provides a few pointers on scheduling and hosting these events. PHA is happy to assist further, should you have any questions. Also, please let us know of your planned events. We would like to keep track of the visits that are taking place, and we may be able to offer some financial assistance from the PHA PAC.

Additional Pieces of Interest:

Dr. Blake Curd, a PHA Board member, participated in a live event addressing healthcare reform in Washington DC this past Wednesday. Many of you may be familiar with the group, "Pajama Media," who were big players in the 2008 elections. You may watch this very informative event by clicking here.

Finally, I have attached a piece that you might find of interest. It is a side by side comparison of each of the existing health reform bills from each committee, which was completed by Kaiser Health for public education.

Again, please contact Molly Sandvig, PHA Executive Director (605) 321-3483 if we can assist in your political efforts. Remember, grassroots is the best tool we have to affect positive political outcomes!

Side By Side Comparison:

To view a side-by-side comparison of major healthcare reform proposals, please click here.
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WC Educational Conferences Set For Fall In Austin And Dallas
 

The Texas Department of Insurance, Division of Workers' Compensation
(TDI-DWC) is hosting two Workers' Compensation Educational Conferences in 2009. The conferences will provide information about the Texas workers' compensation system to health care providers, employers, employee organizations, insurers, third party administers, attorneys, mediators, paralegals, occupational health nurses, medical office staff, medical rehabilitation specialists and vocational

rehabilitation specialists. The Austin conference will be held September 14-16, 2009 at the Crowne Plaza Austin. The Dallas conference will be held October 26-28, 2009 at the Renaissance Dallas-Richardson Hotel. Registration is $275 per person before August 15, 2009 and $350 per person after August 15, 2009.

To download a registration flier and additional conference details, visit the TDI website by clicking here.  Conference hotels rates are available at the Crowne Plaza Austin, $115 for single occupancy and $139 for double occupancy, and at the Renaissance Dallas-Richardson Hotel, $145 for single or double occupancy. Contact the Crowne Plaza at 512-323-5466 or the Renaissance Dallas-Richardson at 972-367-2000 and reference the "Texas Workers' Compensation Educational Conference" to make reservations.
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