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2012 AAOS F ALL L EADERSHIP C ONFERENCE : October 18-21, 2012 Sheraton Society Hill Hotel Philadelphia, PA Board of Councilors Board of Specialty Societies.

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Presentation on theme: "2012 AAOS F ALL L EADERSHIP C ONFERENCE : October 18-21, 2012 Sheraton Society Hill Hotel Philadelphia, PA Board of Councilors Board of Specialty Societies."— Presentation transcript:

1 2012 AAOS F ALL L EADERSHIP C ONFERENCE : October 18-21, 2012 Sheraton Society Hill Hotel Philadelphia, PA Board of Councilors Board of Specialty Societies AAOS Officers and Presidential Line Leadership Fellows Program Participants

2 SYMPOSIUM 1: F UTURE OF O RTHOPAEDICS : H OSPITAL -E MPLOYED VS. P RIVATE P RACTICE Moderator: Fred Redfern, MD – Henderson, NV; Chair, BOC Moderator: Fred Redfern, MD – Henderson, NV; Chair, BOC Participants: Participants: Alexandra Page, MD– Permanente Med Group, San Diego, CA Alexandra Page, MD– Permanente Med Group, San Diego, CA Diane Thome, MBA – DT Research, Albuquerque, NM Diane Thome, MBA – DT Research, Albuquerque, NM Kevin Plancher, MD – Albert Einstein Med School, New York Kevin Plancher, MD – Albert Einstein Med School, New York Henry Allen, Esq – Senior Attorney, American Medical Association Henry Allen, Esq – Senior Attorney, American Medical Association Key Messages Key Messages Data (2010) indicate transition from private practice to employed physicians Data (2010) indicate transition from private practice to employed physicians Numbers still low (approx 10%); varies by region Numbers still low (approx 10%); varies by region Growing trend / way of future ? (doubtful) vs. passing fad ? (likely) Growing trend / way of future ? (doubtful) vs. passing fad ? (likely) 78% indicate autonomy as major benefit of current practice 78% indicate autonomy as major benefit of current practice

3 SYMPOSIUM 2: S AFETY AND Q UALITY : L ESSONS FROM NASA AND NASCAR Moderator: Peter Waters, MD – Boston Childrens; Boston, MA Moderator: Peter Waters, MD – Boston Childrens; Boston, MA Participants: Participants: Marshall Carlson – Pres/ COO – Henderson Motorsports Marshall Carlson – Pres/ COO – Henderson Motorsports Tom Henricks, MPA – NASA Commander/Shuttle Pilot Tom Henricks, MPA – NASA Commander/Shuttle Pilot Jack Flynn, MD – Childrens Hospital; Philadelphia, PA Jack Flynn, MD – Childrens Hospital; Philadelphia, PA Peter Laussen, MBBS – Chair, Anesthesia Dept; Boston, MA Peter Laussen, MBBS – Chair, Anesthesia Dept; Boston, MA Bill Robb, MD – Univ. Chicago; Chicago, IL Bill Robb, MD – Univ. Chicago; Chicago, IL Key Messages Key Messages Safety is rule #1 in NASCAR champions cars and on NASA missions in space; must develop a level of tolerance of risk – cannot eliminate it Safety is rule #1 in NASCAR champions cars and on NASA missions in space; must develop a level of tolerance of risk – cannot eliminate it Lessons applicable to world of surgery? Lessons applicable to world of surgery? Communication failure often root cause of adverse events Communication failure often root cause of adverse events Surgeons must be leaders in safety models; not impediments Surgeons must be leaders in safety models; not impediments

4 SYMPOSIUM 3: M ANAGING THE D ISRUPTIVE OR I MPAIRED P HYSICIAN Moderator: Frank Kelly, MD – Forsyth Street Orthopaedics, Macon, GA Moderator: Frank Kelly, MD – Forsyth Street Orthopaedics, Macon, GA Participants: Participants: Martha Brown, MD – Psychiatry Dept., Univ. of Florida, Gainesville, FL Martha Brown, MD – Psychiatry Dept., Univ. of Florida, Gainesville, FL Edward Craig, MD, MPH –Hospital for Special Surgery, New York, NY Edward Craig, MD, MPH –Hospital for Special Surgery, New York, NY Gerald Hickson, MD – Pediatrics, Vanderbilt University, Nashville, TN Gerald Hickson, MD – Pediatrics, Vanderbilt University, Nashville, TN William Hopkinson, MD – Vice Chair - Ortho, Loyola Univ., Chicago, IL William Hopkinson, MD – Vice Chair - Ortho, Loyola Univ., Chicago, IL Will Latham, CPA, MBA – Latham Consulting Group, Chattanooga, TN Will Latham, CPA, MBA – Latham Consulting Group, Chattanooga, TN Key Messages Key Messages Promoting professionalism – good for all practices and institutions; vast majority can agree to code of conduct and have no problems Promoting professionalism – good for all practices and institutions; vast majority can agree to code of conduct and have no problems 50% concerns = 9% of all physicians; Professionalism Pyramid 50% concerns = 9% of all physicians; Professionalism Pyramid Minority have incidents - handled informally (cup of coffee discussion) Minority have incidents - handled informally (cup of coffee discussion) Fewer still have persistent behavior patterns – need guided intervention Fewer still have persistent behavior patterns – need guided intervention Focus on group governance – dont allow outliers to persist Focus on group governance – dont allow outliers to persist

5 SYMPOSIUM 4: H EALTHCARE IN O REGON : C OORDINATED C ARE O RGANIZATIONS (CCO) Moderator: John McGraw, MD – Knoxville, TN; Secretary, BOC Moderator: John McGraw, MD – Knoxville, TN; Secretary, BOC Participants: Participants: John Tongue, MD – Portland, OR; Pres, AAOS John Tongue, MD – Portland, OR; Pres, AAOS David Schlactus, MBA – Hope Orthopaedics, Salem, OR David Schlactus, MBA – Hope Orthopaedics, Salem, OR Tim Keenan, MD – Spine surgeon, Portland, OR Tim Keenan, MD – Spine surgeon, Portland, OR Robert Orfaly, MD – OHSU, Portland, OR Robert Orfaly, MD – OHSU, Portland, OR Key Messages Key Messages Options for savings – government view: Options for savings – government view: payment to doctors; # covered; services covered payment to doctors; # covered; services covered CCO experiment in Oregon, endorsed and promoted by Gov. John Kitzhaber, MD (former ER doctor; now in second stint as governor) CCO experiment in Oregon, endorsed and promoted by Gov. John Kitzhaber, MD (former ER doctor; now in second stint as governor) Began August 1, 2012. Plan to enroll 60% Medicaid pts by Jan 1, 2013 Began August 1, 2012. Plan to enroll 60% Medicaid pts by Jan 1, 2013 Forced participation? If one wants access to up to 25% all other pts Forced participation? If one wants access to up to 25% all other pts New methods required to deliver more care for less money New methods required to deliver more care for less money

6 SYMPOSIUM 5: U PDATE ON M EDICARE A UDITS Moderator: David Halsey, MD – University Vermont; South Burlington, VT Moderator: David Halsey, MD – University Vermont; South Burlington, VT Participants: Participants: Craig Butler, MD, MBA – North Florida Sports Medicine; Tallahassee, FL Craig Butler, MD, MBA – North Florida Sports Medicine; Tallahassee, FL Pamela Clarke – VP-Finance/Mngd Care, Delaware Valley Healthcare Council Pamela Clarke – VP-Finance/Mngd Care, Delaware Valley Healthcare Council Brian Parsley, MD – Baylor College; Houston, TX Brian Parsley, MD – Baylor College; Houston, TX Debra Patterson, MD – VP-Clinical Affairs, Novitas Solutions =Medicare Admin Contractor, Jurisdiction 12 (4 states, Wash D.C.); Jurisdiction H (7 states) Debra Patterson, MD – VP-Clinical Affairs, Novitas Solutions =Medicare Admin Contractor, Jurisdiction 12 (4 states, Wash D.C.); Jurisdiction H (7 states) James Cope, MD James Cope, MD Jennifer Dupee, RN Jennifer Dupee, RN

7 SYMPOSIUM 5: U PDATE ON M EDICARE A UDITS Key Points: Key Points: Medicare Administrative Contractors (MAC) conducting audits of lower extremity total joint arthroplasty in Dx -Related Group (DRG- 470) Medicare Administrative Contractors (MAC) conducting audits of lower extremity total joint arthroplasty in Dx -Related Group (DRG- 470) Recovery Audit Contractors (RAC) also reviewing retroactively Recovery Audit Contractors (RAC) also reviewing retroactively Reviewers making medical decisions based on template metrics; non- surgical Rx documentation varies by MAC jurisdiction Reviewers making medical decisions based on template metrics; non- surgical Rx documentation varies by MAC jurisdiction MACs currently auditing in 3 jurisdictions (H, 9, 12) MACs currently auditing in 3 jurisdictions (H, 9, 12) Initial DRG-470 denial rate = 60% in Florida (MAC-9) Initial DRG-470 denial rate = 60% in Florida (MAC-9) AAOS has met, and continues to meet, with CMS officials AAOS has met, and continues to meet, with CMS officials 45 Members of Congress signed letter to CMS Admin, Marilyn Tavenner, asking for halt of audits (specifically in MAC 4, 12) until policy clarified 45 Members of Congress signed letter to CMS Admin, Marilyn Tavenner, asking for halt of audits (specifically in MAC 4, 12) until policy clarified Medicare Learning Network Matters report – Sept 17, 2012: documenting requirements for hip and knee joint replacement Medicare Learning Network Matters report – Sept 17, 2012: documenting requirements for hip and knee joint replacement AAOS wants reports of any audit activity ! AAOS wants reports of any audit activity !


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