Spring 2019 Issue
By Jeff Schulman, MD
President, Virginia Orthopaedic Society
I can’t believe how quickly time flies as I greet you all with my final President’s message. It has been an honor and privilege to serve as President of your Virginia Orthopaedic Society this past year, and before you know it, many of us will be together in early May for this year’s Annual Meeting in Washington, DC.
In my other Presidential messages, I have tried to emphasize the policy activities with which the society has been actively involved. As I consider the initiatives to update you on and those that we have been working on over the last few months, I feel as though the general pitch for the society has never really been broken down to its basics before. Many times I have heard others say “All politics is local” or “If you’re not at the table, then you’re likely on the menu.” Surely there are other political clichés that could apply. Like many of you reading this, as a surgeon, I had no formal education in public policy or political science prior to my introduction to the Virginia Orthopaedic Society. But it doesn’t take many years in practice before some policy initiative or regulation leaves each and every one of us feeling slighted with a strong desire to call for change. Ultimately, we must ask ourselves how we want that change to occur.
|Delegate Karrie Delaney of the 67th District with VOS President Jeff Schulman, MD.|
While the AAOS is our national organization with a broad membership, it is a very large and diverse organization with many widespread initiatives. Many of these initiatives are for the greater good of our profession, but implementation often needs to trickle down by region or into the states. A great example that our state Executive Board has been working on over the last few months has been signing on to multiple letters from AAOS leadership (along with multiple other state societies), addressed to CMS leadership, regarding the removal of total knee arthroplasty from the inpatient only list. In this regard, your voice has been heard more loudly with a strong state society allied with a strong national society. On a monthly basis, our Executive Board receives correspondence from AAOS or other state societies asking if the VOS would like to partner in formal correspondence to government officials or third party payers regarding matters of concern to practicing orthopaedists within Virginia. Going in the reverse direction, many national initiatives, such as tort reform, need to actually be implemented at the state level. To support such initiatives, AAOS is extremely supportive of vibrant and active state societies with ongoing grant money for various initiatives. Within the last two years, VOS received an AAOS grant in support of our Certificate of Public Need (COPN) reform lobbying efforts. Finally, individual members of the VOS can and have brought their concerns, such as payer practices and policy issues, to our Board for consideration. In these cases, we have been able to amplify that member’s voice by putting the VOS name behind their concerns to drive real change.
Putting this all together, when it comes to many of the issues that actually effect your practice on a daily basis, implementation occurs at the state level. Quite simply, reaching out to AAOS with your concerns may not be heard with the volume one would hope. On the other hand, the Virginia Orthopaedic Society, like all state societies, is much more approachable and is your voice. Our membership numbers are in the hundreds, not tens of thousands, and a phone call or an email puts you in touch with a real person at our office in Richmond. For those active society members in the Commonwealth, and even for those who are not active members, the society has always been your voice to the Legislature in Richmond, to the AAOS, to payers and even to Congress. Let me repeat that, member and non-member surgeons alike in Virginia both benefit from our voice because legislators have always looked to us at the society to speak for all orthopaedic surgeons. It should come as no surprise that all of this costs money! All we ask is $300 annual dues for VOS membership, and for those that join as a whole practice, there is a 10% discount. It is a very small price to pay for the access and voice this society gives you, and I promise that the causes fought for on your behalf by VOS over the last few years easily cover that cost. Feel free to visit our VOS website and look at some of the current and past issues. I would call particular attention to the Workers' Comp fee schedule reform and let you imagine what that could have been without our society’s top-notch representation here in Richmond. Please share this message with anyone who will read it, we need their support now and in the future.
As I look down the list of state policy initiatives that were on our radar this past year, one really rose to the top of the list and has the potential to be a prominent issue for several years to come and another took somewhat of a back seat this year, with an eye towards 2020. Beginning almost a year ago, Virginia legislators told all stakeholders that this year’s session would deal with medical balance billing, or as you will likely read across all the press, “Surprise Balance Billing.” This issue would not be where it is without a few bad actors within the medical community. All physicians understand the legislative title alone is a propaganda victory by the payer community, where inappropriately small physician networks, reimbursement rates and routine denials of claims as standard operating procedures are more representative of the widespread, if not uniform, institutional imbalances seen across the medical industry. As I write this message, it seems that this year’s legislative debate will be focused primarily on care delivered specifically in the Emergency Department, and the likelihood of any legislation actually passing is slim. But there is potential for the involved parties to try and expand the scope of these laws in the years to come and touch on the practice of orthopaedics and medicine more broadly as a whole with all sorts of predictable, as well as unintended consequences. Balance Billing legislation will be a high priority for VOS over the next few years.
Moving on, this was the year that we finally thought Certificate of Public Need reform was going to happen. Medical Society of Virginia and VOS worked diligently with Richmond for several years. After much discussion in Richmond, COPN reform was not going to happen until Medicaid expansion went through. When it was voted through last year, our stars were finally aligning. We made our arguments, we bided our time, we waited through changes of office and then we were asked to hold tight again. Medicaid expansion needed to be actually implemented this year. Unfortunately, anyone who has turned on the news recently may be aware that Richmond is getting quite a bit of national attention for reasons for which no one should be proud. The political landscape is somewhat unpredictable at this time, and we will have to hold tight a little longer to see how things play out. As a non-partisan society, VOS and its members can always be confident that our positions are for the good of the practice of orthopaedics and our patients and will appeal across the political spectrum when we are given a venue to share them.
In closing, I wanted to reflect on a few final points that I have learned during my journey with the Virginia Orthopaedic Society. Further, there may be a few points that recent events can highlight for all of us. It no longer seems enough to just be good surgeons. We need to contribute to our communities and institutions as mentors, advocates and leaders. Physicians have often been looked to as somewhat of a moral compass by virtue of our training and dedication, and it is up to us to carry that role forward in these times, where social justice and equity are rightly earning their proper place in public discourse. Such discussions first start with careful reflection upon our local environments, as medical institutions have historically had their share of improper work environments over the years. As we prepare the next generation of orthopedic surgeons, this should be a top priority. Only then can we work together on a grander scale for the good of our patients as we strive to take back the practice of medicine. It has been my absolute honor to serve you all this past year, and I look forward to seeing you all in Washington, DC on May 3-5.
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May 3-5, 2019
at the Wharf