BOARD OF COUNCILORS REPORT American Association of Orthopaedic Surgeons The Illinois representatives to the American Association of Orthopaedic Surgeons Board of Councilors met in Washington, D.C., at the annual National Orthopaedic Leadership Conference from April 28th through May 1st. Rod Rieger, Joe Schrodt and I were accompanied by Daniel Nagle, Chairman, American Society for Surgery of the Hand, and chairperson of the ASSH Governmental Affairs Committee, and Tom Wiedrich, member of the ASSH Government Affairs Committee. On Thursday we met with Senator Richard J. Durbin, Senator Peter G. Fitzgerald, Representative Rod R. Blagojevich (D-5th), Janice D. Schakowsky (D-9th), John Edward Porter (R-10th), House Speaker J. Dennis Hastert (R-14th), Minority Leader Richard A. Gephardt (D-3rd), and Secretary of Commerce William M. Daley. Prior to the trip to Washington, the AAOS had been in continued communication with your Board of Councilors representatives regarding issues of major concern to the orthopaedic surgeons of Illinois. On arrival in Washington several hours were directed to further updating and expansion, and this initiative was continued for half a day Thursday prior to our visit with the members of government. Our talking points included: I. Collective Bargaining--Physicians Unions H.R. 1304, The Quality Health Care Coalition Act, a bill introduced by Representatives Campbell (R-CA) and Conyers (D-MI) to allow physicians and other health care professionals to collectively negotiate with health care plans without violating the antitrust laws or having to join a labor union. Our senators were asked to support legislation in the Senate similar to the Campbell-Conyers bill in the House. We are currently looking for a "champion" in the Senate to introduce this legislation. II. Patient Protections For the last six years, we have advocated that six patient protection provisions be included in any health care legislation considered by the Congress. Provisions are: (1) a ban on "gag clauses," (2) a prohibition on financial incentives that result in the withholding of care or denial of referral, (3) a timely external independent appeals mechanism, (4) access to specialists in-network, (5) comprehensive information to evaluate health plans, and (6) a point-of-service option allowing patients to seek out-of-network treatment. As there are several major patient protection bills pending in the 106th Congress, our particular emphasis was placed on the H.R. 358 Patients Bill of Rights Act of 1999 introduced by Representative John Dingell (D-MI). This is the house democrats leadership bill. In the U.S. Senate, S.240 Patients Bill of Rights Act of 1999 introduced by Senator Tom Daschle (D-MD) is the Senate Democrats leadership bill which does contain the six patient protection principles supported by the AAOS. III. Centers of Excellence--Joint Replacement Representatives and Senators were asked to oppose any legislative initiative which will create "centers of excellence," bundle Medicare Part A and Part B payments, regionalize or otherwise restrict or limit Medicare enrollees to receive hip and knee replacements from only certain designated sites. IV. Private Contracting There is no action currently pending in Congress. V. Medical Savings Accounts (MSAs) Federal legislation to encourage the use of MSAs did not achieve the anticipated increase in usage. To compound this matter, the insurance industry has been reluctant to offer MSAs since more money can be made through the sale of other products. As a result, MSAs have not achieved widespread use as a health insurance alternative. In a position statement, the AAOS strongly supports MSAs but it is not likely that the 106th Congress will approve additional legislation on this subject. VI. Medical Liability Reform The passage of medical liability reform including a cap on noneconomic damages continues to be a top priority for the AAOS and the entire physician community. The Academy has joined medical liability reform coalitions and has a strong position statement on this subject. The patient protection bill approved by the full house of representatives in 1998 contained liability reform provisions. However, the Senate did not consider these provisions. The Senate continues to be a stumbling block for approving medical liability reform in the new congress. It is unclear at this point whether congress will address medical liability reform this year. Once again, President Clinton in his budget for fiscal 2000 has proposed a provider tax for physicians who receive payment for services provided under the Medicare program. In the past Congress has not included these user fees in any budget it considered and the AAOS has consistently opposed user fees. VII. ERISA Reform Most employer-funded health care plans in this country are constituted under a federal law, the Employee Retirement Income and Security Act (ERISA). To a large extent state law does not apply to these plans because most federal courts have concluded that ERISA preempts states from enforcing their own tort and patient protection laws. As a consequence, patients are unable to sue these ERISA health care plans and they have escaped liability for decision making, coverage policy and negligent conduct. The AAOS has a very general position statement which recognizes the ERISA problem. The AAOS Committee on Professional Liability is currently drafting a statement, however, which calls for a more immediate solution -- that all ERISA plans must have a timely, external, independent appeals mechanism to resolve coverage disputes and other grievances with the health care plan. VIII. Miscellaneous Issues Patient privacy and confidentiality, telemedicine, and coverage of bone mass measurement were just a few of the additional issues which were discussed on the Hill with members of government. On Friday, the National Orthopaedic Leadership Conference turned its attention to position statements, resolutions, philosophical differences within organized medicine, the AAOS public relations initiative and alternative health care payment systems. We were addressed by U.S. Surgeon General David Satcher, M.D., Ph.D., and learned about the AMA's health policy agenda from E. Ratcliff Anderson, Jr., M.D., executive vice president, American Medical Association, we received Alan Morris' AAOS Council on Health Policy and Practice Report regarding HCFA policy on E&M documentation and guidelines. You will be happy to know that the anticipated change from our current method of documentation and E&M methodology will not be until the year 2001. The agenda of the National Orthopaedic Leadership Conference was quite extensive, as you see; believe me, I am sparing you from much more in this report. You will receive an expanded report directly from the Academy in the more extensive Board of Councilors report of the American Association of Orthopaedic Surgeons. You should be aware, however, of one more initiative which I learned in my capacity as a member of the State Orthopaedic Society committee. The Pennsylvania Orthopaedic Society using the Gary Siegel practice expense study categories undertook a practice cost difference study between treating a workers compensation patient and a nonworkers compensation patient. The purpose of the study was to determine whether it was reasonable to offer discounts to the payers of workers compensation covered lives in exchange for a large volume of patients. Conclusions drawn from the study were: 1. The expense of treating a workers' compensation patient is equal to approximately 125% of the expense for treating a nonworkers' compensation patient. 2. While average revenue per comp patient exceeds that of a noncomp patient, greater expense for the comp patient drives down any potential profit to a break-even position. If a discount to the fee schedule were accepted, losses would occur. If you have been exhausted by attempting to digest the above materials, let me share with you contents from the Washington Post business pages of April 29, 1999, wherein Aetna-U.S. Health Care posted its first quarter operating earnings with a profit of 33% accounting for an increase in the stock of 12-1/8 on April 28, 1999. Analysis of the increased profitability of this managed health care company was due to a premium increase ranging from 9 to 13%, success in restricting prescription costs through controlling the formulary, decrease in compensation for physicians performing work and elective withdrawal from Medicare/HMO offerings. It is our profession versus the insurance industry. If you do not take a part in the Illinois Association of Orthopaedic Surgeons, you will be taken apart. Respectfully submitted, Mitchell B. Sheinkop, M.D. MBS:MTS/k Return to the IOS Newsletter Educational Meetings and Program | Board of Directors | Residency | Find a Surgeon | Membership | Allied Association Links | Newsletter | Governmental Affairs | IAOS Main Page All material Copyright from the Illinois Association of Orthopaedic Surgeons, all rights reserved.