News

The Newsletter of The American Ortho paedic Association

This Issue:

1 President’s Message

3 Critical Issue: Trauma Care: What’s Best for the Patient

3 In Memoriam

5 CORD Corner: Your Voice – Reviewing Results from the Resident Leadership Forum Survey

6 Young Leaders Forum: Taking Action

7 AOA Annual Meeting Recap

9 Bundled Payments for Care Improvement

10 Taking an active role in implementing the Own the Bone initiative

12 Academic Medical Centers: Understanding Affiliation, Consolidation and Acquisition Trends

15 A Journey through the AOA’s Leadership Development Programs

16 The Future of Orthopaedics is in Our Hands

17 American-British-Canadian Traveling Fellowship Recount

18 2014 Financial Review: New Directions for Maintaining Growth and Stability

19 2015 AOA Award Winners

20 Important Dates and Deadlines

Would Einstein Have Matched Into Orthopaedics?By Kevin P. Black, MD

Volume 48, Issue 2

ow that the excitement of the annual meeting has passed, it’s a great opportunity to reflect upon our organization and

strategic priorities. I first want to thank our past president, Larry Marsh, for his leadership to our society during the past year. In working with our executive committee and outstanding AOA staff, Larry and 2015 program chair, Ann Van Heest, developed an absolutely remarkable program in Providence.

The title of my presidential address was “Move Your Own Cheese,” reflecting my personal belief that leaders in the orthopaedic profession should not be passive adapters to change that impacts what we value but, rather, the need to think and act proactively about what we can do differently to advance the mission of the AOA: “engaging the orthopaedic community to develop leaders, strategies, and resources to guide the future of musculoskeletal care.” Our goals and objectives include the identification and development of leadership and confronting the most relevant issues facing orthopaedics. Our recently refined strategic priorities focus upon health care reform, education, and leadership development.

In my address I spoke to our evolution as innovators in education, workforce analysis, and the fact that we must have a heightened awareness of the musculoskeletal needs of society as we think about education. Those comments will be published in the Journal of Bone and Joint Surgery in the upcoming year and it’s unnecessary to repeat what I have said previously. Rather, I would like to challenge you with what I believe are other important issues relative to the future of our profession and that our society will be delving

into during the upcoming year. Although I don’t have the answers, I think it essential to initiate the discussion.

When we think about the orthopaedic workforce, we should first consider the evaluation process for the selection of medical students into orthopaedic residency. What are the criteria by which we rank candidates? We are in the enviable position (from our perspective) of having more applicants than positions available. As a result, students routinely apply to greater than 50 programs hoping to garner enough interviews such that they will ultimately match. The down side for the educator is screening the hundreds of applicants for their limited number of positions. Reality is that no one has the time to read through 700 applications in detail, each of which has supportive letters of recommendation, sometimes with cryptic messages obscurely indicating the strength of the candidate, lengthy personal statements reflecting how the applicant tore their ACL, one or two research projects and countless “high passes” with a smattering of honors, and the ubiquitous honors in the orthopaedic acting internship. As a result, the Step 1 score is for us, the filter and, for the student, the threshold of excellence they must cross in order to be offered the crucial interview.

Our students now begin preparing for Step 1 with review books, flash cards, and web-based preparatory programs early in the first semester of medical school! I don’t blame them, but I have a problem with this. Although a low to moderate correlation with ABOS Part 1 pass rates has been demonstrated1, USMLE Step 1 scores have not been shown to be predictive of

NKevin P. Black, MD

continued on page 2

President’s | Message

Leading the Profession since 1887

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AOA News© 2015 The American Ortho paedic Association

The American Ortho paedic Association

2015 – 2016 Executive Committee

President

Kevin P. Black, MD Penn State Milton S. Hershey Medical Center

First President-Elect

Sanford E. Emery, MD, MBA West Virginia University

Second President-Elect

Regis J. O’Keefe, MD, PhDWashington University

First Past President

J. Lawrence Marsh, MDUniversity of Iowa

Second Past President

Scott D. Boden, MD Emory University

Treasurer

Rick W. Wright, MD Washington University

Secretary

William N. Levine, MD Columbia University

Secretary-Elect

Serena S. Hu, MD Stanford University

Delegates-at-Large

Rex C. Haydon, MD, PhDUniversity of Chicago

Keith Kenter, MD University of Cincinnati

Publications Chair

Khaled J. Saleh, MD, MSc, FRCSC, MHCMSouthern Illinois University

Historian

Terry R. Light, MD Loyola University

Academic Leadership Chair

James E. Carpenter, MD University of Michigan

Critical Issues Chair

Kristy L. Weber, MDUniversity of Pennsylvania

Development Chair

C. McCollister Evarts, MDPenn State College of Medicine

Fellowships Coordinating Committee Chair

Jeffrey C. Wang, MD USC Spine Center

Leadership Development Chair

James R. Ficke, MDJohns Hopkins

Membership Chair

Wayne J. Sebastianelli, MDThe Penn State Orthopaedics & Center for Sports Medicine

Program Chair

April D. Armstrong, MD, FRCSCPenn State Milton S. Hershey Medical Center

Lay Delegate

Brian T. Smith, MHA, BEERush University

Executive Director

Kristin Olds Glavin, Esq.

Executive Director

Kristin Olds Glavin, Esq.Executive Assistants

Lexine D. Cramm Deb OsinskiDeputy Executive Director

Jodene M. BrownDevelopment Manager

Jenny BrandhorstManager, Marketing & Communication Strategies

Kari E. McLeanCoordinator, Communications and Development

Jessica L. ScottSenior Manager, Education & Events

Laura McLaughlanSenior Coordinator, Communications & Leadership Initiatives

Katherine A. Yanney

Education Manager

Myria A. StanleyMeetings & Fellowships Coordinator

Kathy SinnenAssociate Manager, Membership & Operations

Sonia ArmendarizCoordinator, Member Services & Projects

Jacqueline IpemaProgram DirectorOwn the Bone

Sarah MurphyAssociate ManagerOwn the Bone

Ashley KlecknerProgram Coordinator Own the Bone

Jessica Yanik

Editorial Staff

Headquarters Staff

Editor-in-Chief: William N. Levine, MD

Managing Editor: Kari E. McLean

Tel: (847) 318-7330 e-mail: info@aoassn.org web: www.aoassn.org You may also login to www.aoassn.org to update your contact information and profile.

Mission Statement: Engaging the orthopaedic community to develop leaders, strategies, and resources to guide the future of musculoskeletal care.

Vision: AOA will inspire the orthopaedic community to excellence through leadership.

AOA News is published three times each year by The American Ortho paedic Association.

Send address changes to The American Ortho paedic Association.9400 West Higgins Road, Suite 205, Rosemont, IL 60018-4975 USA

resident performance.2 This certainly mirrors my personal experience. I tend to think our students would be better off learning the foundational sciences and their application to patient care. I’ve had too many difficult discussions with outstanding young men and women with “low” (low = 220) Step 1 scores, either discouraging them from applying to orthopaedics or preparing them for the worst. I’m certain most of them would have been outstanding orthopaedists, and I find myself often wondering whom we’ve missed by excessively weighting Step 1. As far as I know, test-taking ability is not a surrogate indicator for character, leadership, and creative intelligence. Would Einstein have matched into orthopaedics? Probably, but not without his Step 1 prep book!

For those that are granted interviews, the process is still somewhat nebulous. What are the goals of the personal interview and is it designed in such a way that the desired attributes can be evaluated? I suspect that we can learn from the business world and their utilization of a more structured approach to the interview process. We also need to be aware of our subconscious personality biases and the fact that we tend to rank candidates more highly if they have personalities similar to ours3. Let me be clear. I want residents in my program that I will enjoy working with and represent me well in interactions with my patients and other health care professionals. But, in a subspecialty that is at the bottom of the medical workforce relative to diversity,4,5 I believe the focus should not be on personality but on other attributes such as character, commitment to excellence, leadership, and creativity. I believe the AAMC is significantly ahead of us with this holistic review process,6 which encourages equal consideration of not only the academic metrics of the medical school applicant, but their attributes and life experiences, as well as in the preliminary screening process.

With so many outstanding applicants to orthopaedic residency, I find it interesting that for both our CORD Conferences and the annual Academy Educator’s Course, a popular and

energetically debated topic is the “problem resident.” I’m certain that there are many reasons for this, but it does suggest to me that we have opportunity for improvement in our screening process.

I’m delighted that in the next year CORD will have symposia at our meetings in March and June dedicated to the residency application process, including discussion of Step 1 scores, the acting internship, and behavioral interviews. However, I encourage you to now review the literature on predictors of resident performance, types of interviews and our biases, and begin to have the discussions within your departments. The application season is upon us and there has never been a better time to try new approaches. There are undoubtedly bad ways to evaluate medical students, but I’m not aware of a single best process. Consider new approaches and bring your thoughts and experiences to our meetings in the upcoming year.

1 Gregg R. Klein, MD; Matthew S. Austin, MD; Susan Randolph; Peter F. Sharkey, MD; Alan S. Hilibrand, MD: Passing the Boards: Can USMLE and Orthopaedic In-Training Exami-nation Scores Predict Passage of the ABOS Part-I Examination? Journal of Bone and Joint Surgery Am, 2004 May; 86 (5): 1092 -1095.

2 Thordarson DB, Ebramzadeh E, Sangiorgio SN, Schnall SB, Patzakis MJ. Resident Selection: How We are Doing and Why? Clinical Ortho Related Research, 2007 June; 459: 255-259.

3 Quintero, AJ, Segal, LS, King, TS, Black, KP. The Personal Interview, Journal of Bone and Joint Surgery Am, 2011 Sep 21; 93 (18): e107 Assessing the Potential for Personality Similarity to Bias the Selection of Orthopaedic Residents. Academic Medical Journal, 84(10):1396-1372, Oct. 2009.

4 Charles S. Day, MD, MBA; Daniel E. Lage; Christine S. Ahn, BA; Diversity Based on Race, Ethnicity, and Sex Between Academic Orthopaedic Surgery and Other Specialties, A Comparative Study. Journal of Bone and Joint Surgery Am, 2010 Oct 06; 92 (13): 2328 -2335.

5 Kanu Okike, MD, MPH; Mekeme E. Utuk, BA; Augustus A. White, MD, PhD: Racial and Ethnic Diversity in Orthopaedic Surgery Residency Programs. Journal of Bone and Joint Surgery Am, 2011 Sep 21; 93 (18): e107.

6 https://www.aamc.org/admissions/admis-sionslifecycle/409104/prepholisticreview.html. Accessed 7/19/1015.

President’s Message (from page 1)

Volume 48, Issue 22

News

Summer 20153

CRITICAL | Issue

Clifford B. Jones, MD

Andrew H. Schmidt, MD

Please let us know if you learn about the passing of a fellow AOA member or if you have information regarding a former colleague’s accomplishments or a photograph you would like to share: (847) 318-7330 or membership@aoassn.org. The AOA website now features an “In Memoriam” page under the AOA Member Center.

Members of The American Orthopaedic Association are the orthopaedic community’s best and brightest. We were

saddened to recently learn about the passing of the following AOA members. We honor their contributions and legacies

to the profession and to the AOA. To friends and families, we offer sympathies.

In Memoriam | Remembering Our Colleagues

Trauma Care –An Appropriate Strategy for Growing Business, or a Scarce Resource that Demands Regional Oversight. What’s Best for the Patient?

n many areas of the United States, hospitals and hospital systems have drawn a line in the sand, trying to

wrest as much influence over their patients and business as possible. The motive is undoubtedly related to increasing their revenue stream, and seems to be unrelated to a given institution’s status as a for-profit or a non-profit entity. A central theme of these new business models is taking control of physicians and their patients, engaging in new compensation models such as bundled payments, exerting influence on established referral patterns, disrupting relationships that extend outside their own system, and limiting collaboration with “outside” physician groups.

Designation as a state or American College of Surgeons certified trauma center might be considered as a “cash cow” in systems desperate for growth or new revenue streams. Trauma activation fees can vary from several hundred to tens of thousands of dollars per patient, can be associated with favorable payers such as automobile accident insurance or worker’s compensation plans, and brings significant prestige to the institution. However, in

these new business scenarios, hospitals determine referral patterns for patients based upon political power, money, and business contracts, rather than benefitting from established and successful referral relationships.1,2 For example, under some current contracts, if a physician does not feel comfortable, competent, or is otherwise unable to care for a given patient, and refers the patient elsewhere, he/she may be faced with adverse metrics which can threaten his/her employment and salaries/bonuses. Referrals outside the institution are a threat to the initial hospital’s bottom line, and are being limited despite the potential negative consequences to the patient. These adverse effects include causing a delay in care, the need for multiple transfers, redo or revision surgeries, and postsurgical complications.3,4

Strategically, hospital systems have begun to open referral hospitals or build (or buy) trauma centers, so that even if referral to another center is needed, the patient stays “in system” and helps to maintain the system’s bottom line.5,6 However, from a societal perspective, this approach comes at a significant cost to the public, since taxpayers contribute to the funding of

expensive-to-operate trauma centers for acute care needs and after-hours service.7-9

Along with the costs associated with keeping even a single regional trauma center open, having additional trauma centers in the same locale will have further negative impact on trauma care by lessening the number of cases done at each center and by a given surgeon, thereby diluting case concentration, and making it more difficult for a given surgeon or hospital to maintain competency. As Malcolm Gladwell discusses in his book Outliers, it requires 10,000 hours to become an expert at anything, and the training of future surgeons is negatively impacted by case dilution too.

Some hospitals that “add on” a trauma center designation may not provide adequate resources to what in fact are often underfunded patients, so that the fracture care is shifted from daytime to nighttime. There is some evidence that the

By Clifford B. Jones, MD and Andrew H. Schmidt, MD

I

continued on page 4

• William F. Enneking, MD*Class of 1968

• Albert B. Ferguson, MD*Class of 1962

• Victor M. Goldberg, MDClass of 1983

• William J. Kane, MDClass of 1975

*Indicates Past President of the AOA

Volume 48, Issue 24

outcome of such “after-hours” care is associated with certain complications, such as greater need for revision surgery.10 Delays in surgery certainly increase the cost of care, even if the outcome is unchanged. Furthermore, the metamorphosis of an elective surgery or community hospital to a trauma center often demands the hiring of new providers to care for the trauma patients. It is attractive, from the hospital’s perspective, to employ such physicians directly. This may lead to conflict as the newly-employed surgeons compete with an established group. In some cases, the hospital may create a practice environment that has the effect of “forcing out” existing physicians. If an established surgeon group is in jeopardy of losing patient access, control over their practice, their role in the hospital, and/or opportunities for collaboration, they must move out of the community or hospital.

There have been examples of a community losing an entire group of surgeons at once, which generates a loss for the community concerning patient care, costs, and even the viability of the trauma center itself. Likewise, the sudden influx of a new trauma group to an existing community may create abnormal or unwanted competition to an existing physician group. If the established group stays in the same town, then potentially duplicative services are offered in the community. Such overt competition between groups pits practices against each other and generates ill will within the community and organization. Such jobs are often advertised at significantly increased salaries in order to entice surgeons to the situation. This potentially creates a situation of “musical chairs” or “free agents;” physicians who continually search for the best contract without long-term buy-in or patient care continuity.

In conclusion, the business models around trauma centers, which arise from a somewhat perverse set of financial incentives, has created a trauma system in which trauma center location and density has nothing to do with need, and is instead determined by profit and marketing considerations. Surgeons are adversely affected, but the real victims are the patients who suffer from delays in care and not having access in some areas, duplicated services in others, and training systems that don’t have adequate volumes. Without oversight, regulation, and collaboration, trauma care in the United States is destined to regress to years past with higher mortality, morbidity, and cost.

1 Liberman M, Mulder DS, Lavoie A, Sampalis JS. Implementation of a trauma care system: evolution through evaluation. The Journal of Trauma, 2004;56:1330-5.

2 Cho S, Jung K, Yeom S, Park S, Kim H, Hwang S, Change of inter-facility transfer pattern in a regional trauma system after designation of trauma centers. Journal of the Korean Surgical Society, 2012;82:8-12.

3 Sampalis JS, Denis R, Frechette P, Brown R, Fleiszer D, Mulder D. Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. The Journal of Trauma, 1997;43:288-95; discussion 95-6.

4 Sampalis JS, Denis R, Lavoie A, et al. Trauma care regionalization: a process-outcome evaluation. The Journal of Trauma, 1999;46:565-79; discussion 79-81.

5 Veenema KR, Rodewald LE. Stabilization of rural multiple-trauma patients at level III emergency departments before transfer to a level I regional trauma center. Annals of Emergency Medicine, 1995;25:175-81.

6 Weinberg JA, McKinley K, Petersen SR, Demarest GB, Timberlake GA, Gardner RS. Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives? The Journal of Trauma, 2003;54:823-6; discussion 6-8.

7 Onzuka J, Worster A, McCreadie B. Is computerized tomography of trauma patients associated with a transfer delay to a regional trauma centre? Cjem, 2008;10:205-8.

8 Flanagan PT, Relyea-Chew A, Gross JA, Gunn ML. Using the Internet for image transfer in a regional trauma network: effect on CT repeat rate, cost, and radiation exposure. Journal of the American College of Radiology: JACR, 2012;9:648-56.

9 Berkseth TJ, Mathiason MA, Jafari ME, Cogbill TH, Patel NY. Consequences of increased use of computed tomography imaging for trauma patients in rural referring hospitals prior to transfer to a regional trauma centre. Injury, 2014;45:835-9.

10 Ricci WM, Gallagher B, Brandt A, Schwappach J, Tucker M, Leighton R. Is after-hours orthopaedic surgery associated with adverse outcomes? A prospective comparative study. The Journal of Bone and Joint Surgery, American volume, 2009;91:2067-72.

Trauma Care... (from page 3)

125 Years Ago“I trust that our meeting this year will add much valuable material to that which has already been collected during the three years of our existence. To make our Association strong and valuable, each member must do his whole part; all minor interests and petty differences must be put aside, and we must work unitedly in order to secure the proper advancement of scientific work. Each year must show an increase in the ability and in the character of our productions.”

- DeForest Willard, MDPresident’s Address, 1890

Summer 2015

he Resident Leadership Forum gathers selected leaders from nearly every residency in the United States and brings them to a development program–especially for residents–at the

AOA Annual Meeting. They have much passion as future leaders, both about the profession and about education. This year, the Young Leaders Committee decided to use this opportunity to see what could be learned from them as well. As part of the Resident Leadership Forum, we included a comprehensive pre-meeting survey and moderated table discussions led by AOA and AOA’s CORD program leaders.

The survey was sent to the residents before the meeting asking what issues most concerned them, and we were careful to structure some of the meeting content around those themes. At the end of the meeting, the participants were divided into three different rooms and then subdivided into smaller working groups. Each group was moderated by volunteers from the CORD program and each table charged with discussion questions around the topics. Each table explored a variety of issues, and then brought the issues to the entire group in presentations when the groups rejoined.

The residents brought forward two themes to demonstrate the value of this project. Residents were extremely concerned about faculty and resident apathy. To combat this, they encouraged alignment of incentives for the faculty to facilitate excellence in teaching. They also recommended enlisting the chiefs to reduce apathy in the junior residents, particularly for those residents who avoid clinic duties in favor of OR or ED responsibilities. Finally, they mentioned that the PGY2 year may be a significant year for apathy and recommended scheduled “team-building” activities outside of work to avoid this.

Another area of discussion was the balance between service and education. The residents recognized that service is a needed part

of education and that service in one setting was not service in another. For example, involvement in a revision total hip replacement may be service for an intern, but excellent education for a chief. To balance this, they recommended placing junior residents with junior faculty so that autonomy can be balanced by faculty experience. A second area was floor service, especially discharge work. Recognizing that there is a need for residents to be able to complete paperwork, the residents suggested creation of a “Discharge Summary” or paperwork milestone. That way, after demonstration of competency in this area, further discharge work could be passed on to Advanced Practice Providers.

Overall, based on the post-forum surveys, the residents enjoyed the experience and most comments were positive or implied that they wished there had been more time for discussion. In the future, the Young Leader’s Committee will enhance and expand this opportunity to help residents guide our understanding of their time in residency.

Your Voice: Reviewing Results from the Resident Leadership Forum SurveyBy Jonathan P. Braman, MD

CORD | CornerNews

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TJonathan P. Braman, MD

100 Years Ago“Our responsibilities are great in this field of surgery and its future will be determined according to the character of our work. The decline of interest which has been manifested at times in the past—due probably to an absence of brilliant operative work—ought not to occur in the present, for the latter methods have been developed and are resorted to as the occasion requires. Therefore, the orthopaedic surgeon can no longer be regarded as a man of mere straps and buckles.”

- George B. Packard, MD President’s Address, 1915

Save the Date: Plan to attend the spring CORD Conference. Friday, March 4, 2016 7:00am-10:00am

Held in conjunction with the AAOS Annual Meeting in Orlando, FL.

66Volume 48, Issue 2

Young Leaders Forums: Taking Action

2015 Resident Leadership ForumIn 2015, 124 orthopaedic residency training programs across the US and Canada sent 173 PGY4 incoming chief administrative residents to the AOA’s Resident Leadership Forum. Nominated by their Program Directors and Department Chairs, these individuals attended sessions which introduced key leadership topics and offered them the opportunity to engage the wisdom of both AOA members and professional educators alike. Key topics included communications, work-life balance, consideration for setting up a practice, decision making, and residents as teachers.

Of note this year were two new endeavors. The first was a section of time devoted to pairing the Resident Leader attendees with Program Director CORD Affiliates for increased collaboration. (For a complete summary and discussion of this activity, please see Your Voice: Reviewing Results from the Resident Leadership Forum Survey, authored by incoming Young Leaders Committee Co-Chair and 2016 Resident Leadership Forum Chair, Jonathan P. Braman, MD.) During this time, the groups addressed challenges often observed in residency programs, and proposed potential solutions. This work resulted in a presentation at the 2015 Summer CORD Conference.

Attendees extolled the value of this activity afterwards. One attendee wrote on the evaluations, “I was able to find a number of simple strategies to take back to my program and use for resident education.” Another wrote, “It was very valuable to sit and get the Program Director perspective and allow us to see how they look at a situation compared to how we as residents do.”

Another interesting feature was a move to a take home educational package. Attendees were charged with making a presentation on two sessions—Residents as Teachers and Motivating Others through Effective Communications—highlighting the key takeaways and applications to his or her residency program. Each resident was given an AOA slide deck, and asked to complete this presentation at her or his institution prior to September 1.

2015 Emerging Leaders ForumThis year, 86 members of the Emerging Leaders Program attended the Emerging Leaders Forum, which had the theme “Leadership: Achieving Balance through Engagement and Delegation.” Sessions included Fostering Engagement and Buy-In and Leading in the Business of Health Care. Of particular interest was a session that recapped work done over the course of the year: Emerging Leaders Forum Innovations Research Project.

Participants of the 2014 Emerging Leaders Forum in Montreal were tasked with proposing project ideas that

could demonstrate the value of attending a leadership forum. Under the guidance of Young Leaders Committee members, Gregory Della Rocca, MD and Jaimo Ahn, MD, a work group comprised of Emerging Leaders Matthew D. Karam, MD, Walter B. McClelland, MD, and Rajiv Rajani, MD developed, administered, and reported on survey results about important educational

opportunities for personal career growth. They presented their findings at the 2015 Emerging Leaders Forum and made recommendations for the AOA to consider.

Emerging Leader respondents expressed interest in leadership skills and team building, conflict resolution, communication skills, and professional networking. Many indicated in-person events were of interest, with an even higher number indicating web-based learning (such as webinars) were something they’d like to see the AOA provide more of. The work group recommended a quarterly webinar series and that the AOA explore CME credit for both participation and enduring content.

In sum, the Emerging Leaders Forum was met with positive reviews, with one evaluator describing the value of the Forum in this way: “It was interesting to meet other physicians at different career stages and engage with them in the small group activities. It was helpful to hear similar issues and concerns across subspecialties and to gather suggestions from others about how to manage specific work situations.”

ALASKA-2

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The AOA’s Young Leaders Committee, chaired in 2015 by M. Daniel Wongworawat, MD and Robert A. Hart, MD, implemented yet another successful iteration of young leaders programming in Providence, Rhode Island.

Summer 2015

embers and guests convened June 22-27 in Providence, Rhode Island, for the 2015 AOA Annual Meeting. Throughout the meeting, several special sessions were

held including the Leadership Institute on Decision-Making with Greg Bunch of the University of Chicago Booth School of Business and the Facilitated Roundtable with Douglas R. Dirschl, MD and Arthur L. Caplan, PhD.

Participants indicated that they enjoyed the collegial and informative aspects of the meeting, with quality of topics and speakers rated highly. Evaluations noted that networking with colleagues and peers remains one of the most valued opportunities that the meeting provides.

Thursday’s Business Meeting opened with the formal introduction of the AOA Class of 2014. Officers provided reports to the attending members. Historian Terry R. Light, MD provided a thoughtful reflection on the passing of those AOA members we learned about in the year. The Business Meeting also included reports from OMeGA Medical Grants, ABOS, and JBJS. (Login to www.aoassn.org and navigate to the AOA Member Center to see the slides).

Chair, Scott D. Boden, MD, presented the slate selected by committee members David C. Ayers, MD; Frank J. Eismont, MD; Robert A. Hart, MD; Brian G. Smith, MD; and Kristy L. Weber, MD.

The slate was approved and voted upon by members as follows:

• Second President-Elect: Regis O’Keefe, MD, PhD Washington University

• Secretary-Elect: Serena S. Hu, MD Stanford University

• Delegate-At-Large: Keith Kenter, MD University of Cincinnati

• Membership Committee Member: April D. Armstrong, MD, FRCSC Penn State Milton S. Hershey Medical Center

AOA Annual Meeting Recap

“Orthopaedic planning in an increasingly difficult future medical environment with the

AOA seeking potential solutions.”

“Concentrated on real system and behavior issues.”

75 Years Ago “Changing times bring changing problems, and we of the older generation view with some concern the problems for which you of the younger generations may be called upon to find the solutions. Changing times, however, do not change fundamental truths and fundamental standards. The honorable and unselfish precepts laid down by the founders of the Association for its guidance are just as sound and true today and will be tomorrow as they were yesterday. These precepts must be upheld and defended against all attempts at invasion, if this organization is to continue in the purpose in which it was conceived—namely, that of maintaining the specialty of orthopaedic surgery on a plane of truth, progress, and service.”

- Frank D. Dickson, MD President’s Address, 1940

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8Volume 48, Issue 2

AOA Annual Meeting Recap... (from page 7)

The Business Meeting concluded with the nomination of members from the floor for the 2015-2016 Nominating Committee. Nominating Committee elections are in process as we go to print. Please look for the results to be announced in an upcoming Community of Leaders e-newsletter and on the website.

Friday featured the installation of the AOA’s 2015-2016 President, Kevin P. Black, MD. His address, “Move Your Own Cheese,” addressed concepts having to do with moving beyond ensuring professional competence and considering what additional new knowledge and skills an orthopaedic surgeon must demonstrate in the 21st century. He concluded with a call to action, “…amidst change, strong leaders are most needed, and we have never needed you more…I look forward to addressing the challenges that lie ahead, and invite each of you to join me.”Read his Address at www.aoassn.org.

Thank You Thank you to all who provided input and attended the Annual Meeting. The key to the AOA’s value is its members, the engagement between members, and its focus on leadership confronting critical issues in orthopaedics. Save the date to join us in Seattle, Washington for the 129th Annual Meeting of The American Orthopaedic Association and Leadership Conferences. Visit www.aoassn.org for details.

Mark your calendars to attend the 129th Annual Meeting of

The American Orthopaedic Association and Leadership Conferences.

June 21, 2016Resident Leadership ForumEmerging Leaders Forum

June 22, 2016Leadership Institute

June 23, 2016Own the Bone Symposium

June 24-25, 2016CORD Conference

50 Years Ago “The diversity of the men who have pioneered in orthopaedics and who founded The American Orthopaedic Association in 1887 is significant to us today. We are directed and reinforced and inspired by our Association and the fellowship of its members. The future of our society, however, depends as it did at its inception, on this same diversity and creative vision that made orthopaedics emerge as a special science.”

- Jesse T. Nicholson, MD President’s Address, 1965

News

Summer 2015

Bundled Payments for Care Improvement

undled Payments for Care Improvement is a new initiative from Centers for Medicare and Medicaid Services (CMS) that launched in 2013. The goal of this initiative was to identify

certain organizations that were willing to engage in alternative pay-ment models to try to improve the quality and efficiency of care. In “Model 2,” the organizations will be paid not simply for performing surgery, but for the entire episode of care from admission up to 90 days post-operatively. According to the CMS website, “These models may lead to higher quality, more coordinated care at a lower cost to Medicare.” It is important to recognize that this will mean the organization will assume the cost for all interventions including hos-pitalization costs, post-operative rehabilitation stays, physician work, imaging, and therapy.

In order for this kind of payment system to be successful, orthopae-dic surgeons need to be willing to explore and control not only the variables of surgical care, but the overall experience for patients. It will require improved understanding and control over post-operative rehabilitation, as well as imaging and medical management to reduce hospitalization needs in addition to complications. Patients make their decisions about where and when to have surgery based on their relationships with their surgeon. Consequently, surgeons will be required to lead in this initiative. Furthermore, patient experience is one of the benchmarks, further demonstrating the value of surgeon investment in this process. Surgeons have traditionally been the decision-makers about the types of implants, need for revision, length of hospitalization, and frequency and duration of therapy. In order to be effective about managing these costs, it will require collaborative relationships to develop between administrators who have access to the cost data and the surgeons who understand the opportunities for savings and increased efficiency.

In transplant surgery, such bundled services have been used for some time. Consequently, it will be imperative for surgeons to look at their colleagues in the transplant service lines (solid organ or bone marrow transplant) for ideas. Surgeons who are part of a single group or work at a single institution will be challenged with creating evidence-based standardized protocols for pre-op, operative, and post-op care. Once the referral has been received and the patient is approved for surgery, standard protocols will need to be followed. The protocols will need to include surgical clearance and managing the team in the operating room. Can the surgeons and the OR team be standardized as it relates to supplies, equipment, tray configuration, and various personnel to manage the variation?

In the area of post-operative planning, can the development of evidence-based discharge planning, follow-up procedures, therapies, and consulting services be based on outcomes that are driven by quality, cost, and a maxi-mization of patient outcomes while managing costs within the bundle? This transition to an environment when all services are at risk for quality, outcomes, and cost will demand that the surgeon understand the various compo-nents and team members across the continu-um, since all will be at risk financially. From a reputation standpoint, the outcome will be directed toward the surgeon and the facility at which the procedure was performed. Staffing decisions will require expert help and negotiations with existing staff-ing models to enhance floor, clinic, and OR staffing efficiency. This will force team members to specialize in the types of procedures and services required to minimize cost while maximizing the outcomes within a bundle that shifts the risk to the providers.

This will require courageous conversation around pathways, clinical resource management, and evidenced-based protocols for the various components of the continuum to agree to their respective component across the share of the bundle or all will be subject to financial penal-ties and the potential of being excluded from future arrangements if the required cost and quality outcomes are not met.

The challenge in this health care transformation will be that all members of the team will need to sacrifice some autonomy for the good of the system. Additionally, each individual needs to feel safe asking for help. There will be situations where the surgeon is unsure and needs assistance to deliver the most efficient care. At the end of the day, the ultimate goal is to make sure the surgeon and his facility are a tip of tongue from a local market or brand perspective so that patients see the service as a desired in-network option. Moving from a fee-for-service system to a bundled 90-day payment system will force colleagues of all disciplines to engage in ways they previously never thought necessary.

Questions? Interested in providing your input and insights on this topic? E-mail info@aoassn.org or call (847) 318-7330.

B

0

By Jonathan P. Braman, MD and Brian T. Smith, MHA, BEE

Jonathan P. Braman, MD

Brian T. Smith, MHA, BEE

9

Volume 48, Issue 210

steoporotic fractures represent a major and growing public health threat for approximately 50 percent of American men and women ages 50 and older. The

costs of these fractures are significant for patients, their caregivers, and the public at large: patient disability and reduced quality of life, decreased life expectancy for hip and vertebral fracture patients, and an estimated $19 billion in annual costs to the US health care system.

Community hospitals have taken an active role in implementing The American Orthopaedic Association’s Own the Bone secondary fracture prevention quality improvement initiative in an effort to reduce their patients’ risk of recurrent fractures. With collaboration and support

from its orthopaedic surgeons, a dedicated APP coordinator, and nurse navigators, Holland Hospital used Own the Bone to establish a fracture liaison service (FLS) to ensure that bone health evaluations are incorporated into care pathways for fragility fractures in patients 50 and older.

Visit ownthebone.org for more information about how you can join the over 180 institutions in 48 states that have gotten started with secondary fracture prevention using the AOA’s Own the Bone QI program.

olland Hospital is a 189-bed independent, not-for-profit hospital which serves the greater Holland area and surrounding communities in western Michigan.

In 2011, our orthopaedic surgeons decided to pursue the establishment of a systems-based effort to support coordinated bone health care for older adult fracture patients in the local community, joining the Own the Bone program, and establishing a Bone Health Services unit. As a nurse practitioner specializing in osteoporosis diagnosis and management, I was recruited to coordinate the program.

At Holland, implementing Own the Bone has resulted in a coordinated care model, whereby multiple providers, including myself, work together to ensure the fragility fracture patient is placed under osteoporosis management to help prevent future fractures:

• Orthopaedic surgeons acted as the physician champions

in advocating for the establishment of a Bone Health Services unit for fragility fracture patients and securing hospital administration buy-in and support.

• Upon hospital admission, care coordinators and nurse navigators trigger a bone health consultation as part of the routine fracture order for all osteoporotic fracture patients. Orders are automatically transmitted to the APP and the patient is automatically added to the NP consulting list, where he or she remains until removed.

• Inpatient fragility fracture counseling occurs during the “teachable moment” post-fracture. The NP routinely counsels patients, and, when unavailable, care coordinators or nurses counsel the patient relying on APP scripts. During counseling, and prior to discharge, patients and any family members or caregivers present receive a packet of Own the

Taking an Active Role in Implementing the Own the Bone InitiativeBy Kyle J. Jeray, MD, Chair, Own the Bone® Steering Committee

A Hospital-Based Fracture Liaison Service (FLS) Model of Care Using Own the BoneBy Anne M. McKay, NP, ANP-BC, CCD Nurse Practitioner, Holland Hospital Bone Health Program

O

H

Kyle J. Jeray, MD

Anne M. McKay NP, ANP-BC, CCD

• Not-for-profit, private hospital is primary implementer

• Care coordinators and nurses at hospital admissions trigger a fracture order set and automatic referral to the APP coordinator

• Patients are counseled in-hospital and are started on vitamin D and calcium before discharge

• Outpatient bone health consults are scheduled with the APP 4 or 8 weeks post-fracture, and include BMD testing, and pharmacotherapy initiation

• Bone Health Services staff cultivate strong relationships with the patients’ PCPs, who are generally notified by phone or via EMR of outpatient bone health visits

Key features of this model

continued on page 11

News

Summer 2015

Bone materials, a questionnaire, and a map to the outpatient office, where they are referred for an offsite outpatient visit, either eight-weeks post-fracture (hip fracture patients) or four-weeks post fracture (for all others).

• Nurses on the orthopaedic floor counsel and routinely start all fragility fracture patients on vitamin D and calcium; patients receive their first doses prior to discharge. Appropriate patients may also be started on teriparatide, synthetic parathyroid hormone (PTH), while in the hospital.

• Medical assistants, nurse navigators, or NP students enter information from the case report forms into the Own the Bone patient registry. They also generate, from the Own the Bone registry, customized patient education letters which are mailed to patients post-discharge to reinforce counseling and referral for a post-acute bone health consultation.

• Medical assistants research the patient’s PCP and the NP either calls, or sends through the EMR system, a personal message with the information collected through Own the Bone registry.

• The FLS coordinator, an NP, holds separate bone health evaluations for fragility facture patients at her office. There, the availability of onsite BMD testing, and her certification by

the International Society for Clinical Densitometry (ISCD) improve patient access. During the outpatient appointments, the NP conducts and interprets BMD testing via DXA scanning, refers appropriate patients for balance issues, and initiates pharmacological treatment. Older patients are routinely started on denosumab. Additional lab testing is ordered based on the patient’s medical and fracture history.

• As a backup, orthopaedic surgeons have “trigger systems” in their private practice EMR templates that identify patients as Own the Bone candidates during their follow up appointments three to four weeks post discharge. Patients who have not already scheduled an outpatient bone health clinic do so at this time.

Since early in 2011 and through mid-2015, the program has received approximately 100 fragility fracture patients a year; patients, who otherwise would statistically have only a one-in-five chance of being evaluated for any underlying bone health problems which resulted in their fracture. Holland Hospital remains committed to ensuring that evaluation, diagnosis, and treatment of all fragility fracture patients becomes a standard of care.

A Hospital-Based Fracture... (from page 10)

Patient Process Flow for the Own the Bone Program - Holland Hospital

Fracture patient admitted to hospital

Does patient meet Own the Bone

patient criteria?

Not included in the program

No

Nurses and CCs trigger a fracture order set and an

automatic referral to Bone Health Services NP

Yes

NPs, Nurses, or CCs Patient counseling; patients

receive Own the Bone materials, questionnaire, and

map to outpatient office

NPs, Nurses, or CCs Encourage scheduling

outpatient bone health consult 4 or 8 weeks post-fracture,

consult includes BMD testing

Nurses Patients started on vitamin D and calcium; patients receive

their first dose before discharge

During outpatient visit, NP performs a BMD test, receives PT evaluation,

and initiates proper treatment

EMR system identifies Own the Bone candidates during 3-4 week orthopaedic surgeon follow up,

schedules outpatient consult if not already made

MA enters information from case report forms into Own the Bone

registry, generates patient education letters with outpatient referral

reminders

MA researches the patient’s PCP and forward his/her contact

information to the NP

NP calls or sends an EMR message to PCP with patient information

from the Own the Bone registry and outpatient consult status

Inpatient Post-Discharge

11

Volume 48, Issue 212 continued on page 13

Academic Medical Centers: Understanding Affiliation, Consolidation, and Acquisition Trends

n response to recent developments and changes in the health care environment, Academic Medical Centers (AMC’s) across the country have been making

headlines as they acquire, consolidate, and affiliate with other physicians and health systems. This flurry of AMC activity is not expected to slow any time soon. In fact, in 2013, merger and acquisition activity increased by 20 percent, a disproportionately large share of which involved AMCs.

AMCs have begun pursuing various partnership relationships in recent years due to many factors affecting the AMC business model, including increasing reimbursement challenges, declining Graduate Medical Education (GME) support and research dollars, the need to create efficiencies, the desire to broaden referral base, unique and burdensome regulatory constraints, high operating costs, and limited access to capital. AMCs are responding to these challenges by partnering with other systems and providers through (i) loose affiliations and contractual arrangements aimed at increasing care coordination and expanding the range of available services; and (ii) formal affiliations including mergers and acquisitions to form integrated systems where the AMC can either be the acquiring or acquired entity. For example:

• In 2013, North Dakota-based Hillsboro Medical Center (a critical access hospital) merged with Sanford Health.

• In 2014, Vanderbilt University Medical Center, Maury Regional Medical Center, Northcrest Medical Center, and Williamson Medical Center formed a partnership through an affiliation agreement with the intent of expanding the scope of offered services while each entity remained independent.

• In 2014, University Health Care, Inc. (the acquisition vehicle for the University of Wisconsin AMC) acquired SwedishAmerican Health System, an independent multi-hospital system.

• In 2015, Meridian Health and Hackensack University Health Network in New Jersey announced plans to merge, creating one of the largest health networks in the state.

AMC Overview. An AMC is an accredited, degree-granting institution of higher education that consists of (i) a medical school; (ii) one or more other health profession schools

or programs; and (iii) an owned or affiliated relationship with a teaching hospital, health system, or other organized health care provider. In other words, an AMC is the entire health enterprise at a university with a three-pronged mission: education, patient care, and research. Often times, physicians employed within an AMC are employed simultaneously by multiple entities including the medical school, physician practice plan, and hospital. There are more than 100 AMCs nationwide that are public or private and are largely university-based.

Current Challenges and Factors Leading to AMC Transaction Activity. Like all health care providers, AMCs face challenges related to regulatory compliance, reimbursement, and cost pressures and operations. These factors, including those described below, drive the desire for AMCs to affiliate and otherwise transact with other health care providers.

• Reimbursement Pressures and Preparation for Alternative Payment Models Due to changes imposed by the Patient Protection and Affordable Care Act (ACA), AMCs’ share of revenues will likely decline. Additionally, AMCs expect the rates paid by commercial insurers and government payors to continue to decline each year. Such factors, combined with the government’s published goal of shifting payment models from focusing on the volume of services provided to the value of services provided, necessitates that health care providers, including AMCs, consider alternate models and affiliation options to effectively respond to such pressures. Often, larger networks are better positioned to develop and implement alternative payment models and coordinate the care of a patient population.

• Declining GME Support and Research Dollars Graduate Medical Education dollars, which are paid to AMCs to offset certain education expenditures, were reduced in 2013. Most AMCs financially support

I

By Andrea Impicciche, Esq.; Katie Miller, Esq.; and Zachary Jacob, Esq. Hall, Render, Killian, Heath & Lyman, P.C.

Andrea Impicciche, Esq.

Katie Miller, Esq.

Zachary Jacob, Esq.

News

Summer 201513continued on page 14

their affiliated medical schools; however, declining GME dollars negatively affects AMC education budgets. Additionally, research funding from the National Institutes of Health has declined 25 percent in constant dollars since 2003. Each trend is expected to continue, and many AMCs have responded by ramping up their medical research efforts and collaborating with other facilities to consolidate where GME and research monies are distributed. Further, the strategic alignment of physicians engaged in medical research with AMCs, including those with access to private research dollars, is increasingly important to both AMCs and physicians that wish to continue their research efforts amid dwindling resources.

• Desire for Consolidation of Authority and Decision Making AMCs have traditionally operated on a consensus basis, desiring all stakeholders to be “on board” before implementing changes. In the post-ACA health care marketplace, however, AMCs are recognizing that this consensus-based decision making proves to be a slow and burdensome process. Many AMCs have responded with efforts to align decision-making processes across the hospital, faculty practice, and medical school to control the unwieldy structure and more nimbly respond to the changing health care landscape. Along with alignment and consolidation, AMCs are increasingly positioning themselves to establish greater control over the medical staff and faculty practice plan, which may serve to decrease physician autonomy. However, the cultural shift that results from these efforts may also allow the AMC and physicians to realize economies of scale and share knowledge across providers.

• Broaden Referral Base and Specialty Capabilities AMCs are traditionally able to offer highly specialized and cutting-edge care. However, in order to respond to the changing health care environment, AMCs have begun to recognize the benefits of developing a referral network with a broad range of resources across the continuum of care. These referral networks are expected to increase coordination and quality of the services provided by AMCs.

• High Operating Costs and Limited Access to Capital Unlike individual hospitals and hospital systems, AMCs have a three-pronged mission that includes not only patient care but also a focus on education and research. This three-pronged mission contributes to a relatively higher operating cost than private hospitals. AMCs are looking for ways to mitigate these high operating costs through affiliations with, or acquisitions of or by other private hospitals that are able to act as revenue streams and infuse capital into AMCs.

• Compliance with Complex Regulatory Scheme AMCs are subject to a complex regulatory environment. The regulatory environment can be complicated by acquisitions and affiliations with private hospitals, particularly in light of Stark Law considerations related to AMCs. In an effort to more easily comply with such regulations and achieve other benefits, some AMCs push towards employment of physicians rather than mere affiliation.

AMC Trends to Respond to Challenges. In an effort to respond to the challenges, AMCs are increasingly pursuing various types of affiliations with other health care providers. The type and depth of such relationships varies significantly from one AMC to another and is guided by the resources, sophistication, and needs of a particular AMC. Like other health care entities, AMCs pursue strategic initiatives based on a multitude of factors including the general challenges noted above, transaction activity prevalent in the area, whether specific services are lacking for the AMC, status of the physicians and physician groups in the service area, and the payor distribution. In general terms, transaction activity involving AMCs falls into one of two categories: (i) loose affiliations; and (ii) mergers/acquisitions.

Loose Affiliations or Contractual Arrangements

• Contractual Arrangements for Specialty Services. More sophisticated AMCs are able to respond to current challenges through loose affiliations that include contractual arrangements to fill in service gaps (such as particular specialty services that the AMC does not offer) while the AMC remains independent.

• Regional Collaboratives and Clinically Integrated Networks. AMCs that are interested in affiliating more closely with physicians and other providers but are not yet ready for a full acquisition may pursue establishing and participating in regional collaboratives and Clinically Integrated Networks (CINs), the CIN being a more formal and rigorous relationship that can allow, in certain circumstances, joint contracting by participants. In general terms, regional collaboratives and CINs are both characterized by (i) a formal relationship to share resources and capabilities; (ii) a common interest that is advanced through the collaborative/network; (iii) retention of autonomy by each participant; (iv) financial commitment to support the network; and (v) common interest in increasing quality of care.

• ACOs. An Accountable Care Organization (ACO), a formal collaboration of physicians, hospitals, and/or other health care providers, can include an AMC. ACO participants work together to manage and coordinate care for a group of beneficiaries. As with CINs and regional collaboratives, ACO participation can be a vehicle for an AMC to remain independent while engaging other providers.

Merger/Acquisition to Form Integrated Network

• Joint Venture/Joint Operating Agreement. Some AMCs may determine it is in their best interest to enter into a joint venture or joint operating agreement with another provider. These “joint” arrangements are more integrated than the loose affiliations described above and provide for some shared governance between the partners and, in some circumstances, joint payor contracting while still maintaining independence. While such arrangements often appear to significantly

Academic Medical Centers... (from page 12)

14Volume 48, Issue 2

restrain an organization’s independence much like a merger or acquisition, the virtue of this type of arrangement is that it is contractual and, depending on the terms of the contract, the participants may be able to terminate the arrangement at any time.

• Merger/Acquisition. An AMC may choose to respond to the challenges of the current regulatory environment by pursuing a formal, highly integrated model such as a merger or acquisition. In recent years, AMCs have been both on the acquiring and acquired end of these transactions. Whether the AMC is the anchor entity in an integrated system or just another facility in a system not controlled by the AMC depends on the AMC’s strategic vision, needs, resources, access to capital, and availability of suitable partners.

To successfully implement any of the models discussed above, often times AMC leaders believe they must engage physician leaders and obtain physician input. In fact, in some circumstances, an AMC’s Faculty Practice Plan may have a right to vote on certain integration and/or affiliation arrangements. Many of the consolidation efforts will result in a direct impact to physicians (whether or not already affiliated with the AMC) such as a restructuring of the Faculty Practice Plan, emphasis on employment, and, in some cases, loss of autonomy or governance rights. But, these ventures also provide physicians additional benefits including increased access to technology; greater ability to coordinate care, share knowledge, and implement best practices; the ability to continue research efforts; and the creation of a forum for the AMC and physicians to work together to achieve mutually beneficial goals related to quality care and respond to reimbursement pressures.

It is clear that AMCs are increasingly engaging in affiliation and consolidation endeavors to adapt to changes in the health care environment. Physicians affiliated with AMCs should be aware of these trends and seek to understand factors contributing to the increasing trend of AMCs consolidating and affiliating with one another and other providers.

Understanding the particular facts and circumstances of an AMC with which a physician is affiliated will help the physician to provide constructive input into the structure of the affiliation as well as allow the physician to anticipate the impact of a particular affiliation on his or her practice.

This article is educational in nature and is not intended as legal advice. Always consult your legal counsel with specific legal matters. If you have any questions or would like additional information about this topic, please contact Andrea Impicciche at (317) 977-1578 or andreai@hallrender.com, Katie Miller at (317) 977-1404 or kmiller@hallrender.com, or Zachary Jacob at (317) 977-1416 or zjacob@hallrender.com.

Academic Medical Centers... (from page 13)

The Debut of AOALearning: Knowledge at your Fingertips

The AOA now offers convenient, online, self-paced educational offerings, including: courses, recorded webinars, white papers, and other virtual learning formats. These virtual learning products are designed to help you develop leadership skills, enhance resident training, and learn about bone health management/and fracture liaison services.

The content is compatible with a variety of devices: desktop computers, laptops, tablets, and other mobile devices. The learning platform will allow you to track your progress through each offering, enabling you to exit and resume at a later time.

Visit www.aoassn.org/store.aspx and select the “AOALearning” tab to view the education content.

25 Years Ago “When The American Orthopaedic Association decided to limit its membership to enhance the value of its Annual Meeting, it sacrificed the major role in orthopaedics that is now played by the Academy and other organizations However, a precious jewel was preserved—the Annual Meeting of this Association. The Annual Meeting is a unique opportunity for the leaders in North American and international orthopaedics to engage in learned discourse on advances in orthopaedics and in-depth conversation on the problems and challenges of our time. We should not underestimate the value of our Annual Meeting, which, I am certain, has had a major impact on the conduct of national and international affairs in orthopaedics. Our Annual Meeting deserves to be nurtured and strengthened.”

- Michael W. Chapman, MD President’s Address, 1990

15

News

Summer 2015

The AOA: A Journey Through the AOA’s Leadership Development Programs

y residency and fellowship prepared me wonderfully as a surgeon and it provided me with many outstanding examples of educating, practice building, and leadership. As

we all know, expanding our horizons beyond our local environment provides opportunities that can have dramatic benefits to our careers as they move forward.

For me, one of greatest avenues to pursue further knowledge and wisdom has been and continues to be the AOA. A few distinct strengths of the AOA that I have found include the longitudinal and hands-on nature of their offerings. For instance, my participation in the Resident Leadership Forum lead to further engagement in the Emerging Leaders Program during which time I also was selected as a North American Traveling Fellow, became involved in the AOA’s Council of Orthopaedic Residency Directors (CORD) program, and was selected to be an ex-officio member of the Young Leaders Committee.

A critical aspect of all these programs is that they don’t just occupy a “line on my CV;” instead, they have offered me specific hands-on learning that I use in real life and provided me with opportunities to personally interact with leaders in orthopaedics.

The Resident Leadership Forum helps PGY4 residents address critical resident education issues with like-minded colleagues and faculty who truly emphasize teaching—and help attendees create possible solutions to take back to their own institution. The Emerging Leaders Program may have you develop a survey or program to be executed by the AOA and used by hundreds of young faculty all over the world.

As an AOA North American Traveling Fellow, I learned from leaders all over the country (some AOA Traveling Fellowships go to countries across the world)—opening my eyes to possibilities that I didn’t realize and all the while, creating friendships for a lifetime with my fellow Traveling Fellows. I work on JAAOS with Peter S. Rose, MD; multi-center trials and national trauma course with Kelly Lefaivre, MD; emerging/social-media-oriented peer-review with Shane Nho, MD; tissue healing with John Elfar, MD.

Every year, my residency program leadership team learns something of interest at the CORD Conference that we implement in our own program. And serving as an ex-officio member of the Young Leaders Committee has given me the opportunity to help shape the future of the leadership education that the AOA provides to its young leaders.

These opportunities are, of course, not in a vacuum. These real-life interactions have meant that I have gotten to know AOA members such as Regis O’Keefe, William Levine, Kevin Black, and Terrance Peabody who continue to mentor me to this day.

As a newly minted AOA member, I reflect on what this organization has provided me and I urge the motivated resident or young leader to explore and engage. Make your contribution to the AOA and take from it all it has to offer. Join the leaders of our field, philosophically and practically, to make our profession even better than it already is.

Encourage your young and developing leaders, whether residents, fellows, or faculty, to engage with AOA programs. Visit www.aoassn.org for details.

M

By Jaimo Ahn, MD AOA Membership Class of 2015

Jaimo Ahn, MD

American-British-Canadian Traveling Fellowship Applications Now OpenThe AOA will be accepting applications for the spring 2017 American-British-Canadian Traveling Fellowship from July 31, 2015 through January 31, 2016. Many of the AOA’s past presidents are alumnus of this prestigious Fellowship, which began in 1948. Visit www.aoassn.org to view the criteria or to download a flyer to share with eligible individuals, post in a break room, or share via your department’s or practice’s newsletter.

In 2015“We are not mice in someone else’s maze. We know what is best for our patients and students and, as leaders in the orthopaedic profession, have the ability and responsibility to create the future reality. That being said, I think we would also agree that in recent years we often feel as if others have provided the direction, and we have adapted to that change. At times, change is, indeed, inevitable, but we should never blindly and happily accept it simply because “that’s the way it is.” When we look at our professional environment, we need to reflect upon why and how others have taken control and identify what we can do to exert greater control over what we value. You need to move your own cheese.”

- Kevin P. Black, MD President’s Address, 2015

Volume 48, Issue 21616

he recent 128th Annual Meeting of the American Orthopaedic Association offered valuable networking opportunities and reaffirmed my enthusiasm about

being an AOA member. As the first orthopaedic association in the world, one that is responsible for major innovations in orthopaedic surgery, the AOA provides thought leadership across a broad range of challenges. Our distinguished past includes a critical role in the founding of associations such as AAOS, ABOS, JBJS, OREF, and OMeGA. Our future holds many opportunities.

As a Past President, I am proud of my AOA membership and the changes and impact it has had upon our specialty. It is a privilege to be a part of the AOA’s tradition of leadership. As the new chair of the Development Committee, I would like to outline some of the plans for increasing individual giving opportunities.

Why We Are Looking For Direct Member SupportDue to changes with the OREF structure, the AOA initiated a direct, individual giving program in 2011 with a newly-formed Development Committee. The more difficult part is in how we find ways to adapt to the changing funding environment to assure that leadership programs and services continue.

Why is Your Contribution Important?Every gift to the AOA is important. As the health care landscape continues evolving, the AOA provides education, leadership skills, and resources that help orthopaedic leaders enhance their talents and nurture future generations. Our dues alone are not enough to take action in all the areas in which the AOA is active. While we continue to seek industry support, companies have significantly reduced funding for many AOA programs of greatest interest to you.

How is Your Contribution Allocated?The AOA continues striving to create programs and activities for the benefit of orthopaedists and improved patient care. By giving directly to the AOA, you decide where your contribution goes: 100% of your gift supports the program(s) you designate:

• Council of Orthopaedic Residency Directors (CORD) Program

• Emerging Leaders Program

• Leadership Initiatives

• Own the Bone Program

• Resident Leadership Activities

• Traveling Fellowships (ABC, NATF, JOA, ASG)

Who Benefits From Your Contribution?The AOA’s path for success resides in our rich history, core values, strategic plan, and most importantly, our members. As we have done since our founding in 1887, the AOA’s prestigious membership ensures the AOA’s ongoing leadership in orthopaedics.

With member support, the future of the AOA will sustain its commitments to innovating, promoting, and advancing major leadership and educational initiatives.

Giving is EasySince 2011, the AOA continues developing various ways to make it easy for people to contribute:

• Annual gifts-can be made via check, credit card, or online.

• Stock gifts-often provide greater tax-benefits than other monetary gifts because appreciated stock is not recognized as a capital gain.

• Beneficiary gifts-name AOA as a beneficiary of cash in your will, retirement plan, financial account, and/or insurance policy.

• Multi-year installments-gifts can be made during a time-frame of one (1) to four (4) years-and can be designated toward a specific AOA program(s).

Looking ForwardWhen we became AOA members, we accepted the challenges and the rewards of being part of this prestigious organization. As members of this unique Community of Leaders, we must continue to support our programs: These will help the musculoskeletal community meet the challenges of today and, most importantly, tomorrow. We can affect the future!

For more information about how you can nurture leaders and ensure leadership, visit www.aoassn.org, e-mail donations@aoassn.org or call (847) 318-7330.

The Future of Orthopaedics is in Our HandsBy C. McCollister Evarts, MD

T

C. McCollister Evarts, MD

Many of you have given to the AOA through OREF

in the past. OREF no longer solicits donations on behalf of the AOA or other societies. By giving directly to the AOA, your donation is acknowledged in several communication pieces, is

specifically allocated to your designated program(s), and

will be used solely to support those AOA activities of greatest interest to you.

Summer 201517

The 2015 ABC fellows embarked on our tour humbled by our selection for such a venerable tradition, unsure of the pending experience. During the subsequent five weeks, we enjoyed an

incredible journey through the United Kingdom, Australia, and New Zealand. Warmly greeted with hospitality and friendship at every stop, we learned about the common struggles facing orthopaedic surgeons across different cultures and health care systems.

United KingdomThe tour started in London, where our hosts were stellar, from the British Orthopaedic Association to the Bone and Joint Journal, to the individual centers we visited. Professor Fares Haddad of The Institute of Sport, Exercise and Health, Professor Tim Briggs of the Royal National Orthopaedic Hospital in Stanmore, and Mr. Pramod Achan at the Royal London and St. Bartholomew’s Hospital, and too many more outstanding individuals to list here, made our time in the heart of England truly memorable.

From London, we made our way to Oxford where Professor Andy Carr set the bar for excellence in research, leadership, and just about everything. Our trip could not have been off to a greater start. We continued heading north, enjoying time in East Anglia with Professor Simon Donnell and Leicester with Professor Angus Wallace among others. The academic discussions and hospitality remained superb and the history ran deep, from Roman ruins to the remains of King Richard III.

A quick flight north then brought us to Glasgow, Scotland. Messrs. Sanjiv Patil and Dominic Meek put on an excellent program, and introduced us to kilts and haggis. We then trained down to Edinburgh where Professor Hamish Simpson and a cadre of former ABC fellows were superb hosts. From St. Andrews to Arthur’s seat, this lovely city was one of the true highlights of the trip.

Turning south, we enjoyed a stop in Newcastle and the Combined Services Orthopaedic Society annual conference. Then, it was back to London for a last night before departing for Australia via Singapore.

AustraliaDown under was truly a special experience. Starting in Perth, which felt like a California beach town, Professor Piers Yates kept us on the go, introducing us to the teamwork, and attire, of surf boat rowing at North Cottesloe Beach, in between academic sessions and clinical exchange. The Jetstar redeye to Sydney was an eye-opener, as was the climb to the top of Sydney Harbour Bridge with Professor David Little the next day. After an excellent session at the Children’s Hospital at Westmead, we were on to Melbourne. Mr. Phong Tran organized a superb academic program, a Footie game at the Melbourne Cricket Ground, and authentic Australian cuisine of kangaroo meat and barramundi fish.

New ZealandThen it was on to New Zealand, landing in beautiful Queenstown. Brendan Coleman and Gordon Beadle met us and took us to the site of a leadership forum. We enjoyed the local activities, from the Kawarau suspension bridge, Shotover jet boats, mountains, and lakes. Christchurch was the next stop, where Professor Gary Hooper arranged an excellent program. We learned about the remarkable recovery since the recent earthquakes and were hosted by consultants and their families in their homes in traditional ABC fashion. On the last stop of the tour in Auckland, our host, Brendan Coleman, arranged a sailing trip through the harbor on an America’s Cup boat. A final black tie dinner and academic session wrapped up an unforgettable fellowship.

_______________________________

Excited to get home to our friends and families after the journey, the true meaning of the ABC was clear: leadership, collaboration, and inspiration. Our hosts, and each other, inspired us to return home with renewed resolve to provide the highest quality and value care to our patients, pursue meaningful research and leadership opportunities, and educate/train our residents and fellows. Thank you to the AOA and our host organizations, institutions, and individuals for this once-in-a-lifetime experience!

The 2015 ABC Traveling Fellows toured orthopaedic centers in the United Kingdom, Australia, and New Zealand in April and May 2015. Applications for the spring 2017 ABC Traveling Fellowship are now open until January 31, 2016.

2015 American-British-Canadian Traveling Fellowship

JOA | Traveling Fellows

By Robert H. Brophy, MD (St. Louis, MO); Sanjeev Kakar, MD, MRCS (Rochester, MN); Hue H. Luu, MD (Chicago, IL); Alpesh A. Patel, MD, FACS (Chicago, IL); Suken A. Shah, MD (Wilmington, DE); U. K. Kishore Mulpuri, MBBS, MS, MHSc (Vancouver, BC); and Rajiv Gandhi, MD, MSc (Toronto, ON)

Volume 48, Issue 2

2014 Financial Review: New Directions for Maintaining Growth and Stability By Rick W. Wright, MD, AOA Treasurer

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he AOA maintained financial stability in this period of continuing economic recovery. With $8,778,160 total liabilities and net assets (accrual based), the

AOA ended fiscal year 2014 with a decrease in net assets of $112,904 in revenue over expenditures, primarily due to costs affiliated with the move to the new building and lower 2014 investment revenue and sponsorship.

The AOA’s Smith Barney Investment account continued to rebound from the economic downturn with an increase of 9.7% for a market value of $415,960. The funds from the AOA’s Endowment with OREF grew by 3.4% for a value of $1,980,039.

Despite the many fluctuations in the orthopaedic device industry, the AOA secured 19 grants for $772,053 in 2014, a 6.1% increase from 2013. Funding was received from Amgen, Arthrex, Biomet, DePuy Synthes, JBJS, Lilly, Merck, Smith & Nephew, Zimmer and supported the following programs: Annual Meeting; Council of Orthopaedic Residency Directors (CORD); Emerging Leaders Forum; Leadership Immersion Series; the North American Traveling Fellowship; Own the Bone; and the Resident Leadership Forum.

The Association’s continued stability is due to member participation and support for AOA programs including:

Membership DuesMember dues ($866,813 in 2014) continue to be the foundation for the organization’s operations. Annual Meeting registration fees rolled into dues for Active, Associate, and Affiliate AOA members.

2014 Combined AOA/COA Meeting and Affiliated EventsSponsorship funding for the 2014 AOA/COA Combined Annual Meeting totaled $268,000 and was provided by Arthrex; Biomet; ConMed; DePuy Synthes; Lilly; Microport; Smith & Nephew; Sanofi; Stryker; and, Zimmer. There was also an exhibit hall with 46 companies displaying their products/services.

AOA Leadership Immersion Series at the University of Chicago Booth School of BusinessRegistration fees contributed $165,984 to support expenses associated with this key AOA offering. The “Power, Influence, and Persuasion” was held in February 2014 with 47 members and non-members in attendance. Forty-eight orthopaedists attended the “Lateral Leadership” module in November 2014.

Council of Orthopaedic Residency Directors (CORD) ProgramEstablished in 2009, the CORD program had 150 institutional members in 2014 (including four Canadian programs). Six hundred affiliates at these member institutions participate in CORD activities and events. While CORD membership dues and registration fees generated $140,884, institutional dues do not fully support the increased programming.

Emerging Leaders ProgramIntroduced in 2004, the Emerging Leaders Program provides an essential bridge between the Resident Leadership Forum and eligibility/potential membership in the AOA. As of June 2015, 50 Emerging Leaders have transitioned through the program to become AOA members. This year-round program provides education, resources, and monthly benefits to developing orthopaedic leaders in their fifth year of residency up through their 13th year of clinical practice. With more than 550 members, the Emerging Leaders Program generated $39,760 in paid dues from members in clinical practice. Dues were waived for PGY5 residents, fellows, and active duty military personnel.

Own the Bone Quality Improvement Program In 2014, the Own the Bone program received $247,500 in corporate support. In addition, the program generated more than $230,000 in participation fees for 2014 and 2015 from implementing institutions. Other program products, including patient education materials and educational activities, help to fund a portion of the program costs.

Industry Funding Industry funding guidelines are continually being revised in this era of the Sunshine and Affordable Care Acts. Amidst this regulatory and government scrutiny, pharmaceutical and device companies are facing a consolidated and highly competitive marketplace where mergers and acquisitions are occurring more frequently.

Given these funding circumstances and its limited membership, the Executive Committee is looking beyond traditional revenue streams to support and sustain the AOA’s small but successful programs, while maintaining the highest standards of professionalism.

TRick W. Wright, MD

continued on page 19

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News

Summer 2015

News

Corporate Advisory Roundtable A second series of Corporate Advisory Roundtable panels were held in 2014. In June 2014, Harvard Health Policy Professor Michael Chernew explored ideas about finding the right balance between access and quality of care on an international basis, and appropriate allocation of health care dollars for musculoskeletal care with AOA leadership, Carousel Presidents, and Corporate Advisory Roundtable supporters Amgen, Lilly, and DePuy Synthes. In November 2014, representatives from Lilly joined a group of AOA Executive Committee members and Own the Bone program leadership to discuss issues related to quality and safety in orthopaedics.

Annual Giving CampaignWith OREF’s announcement that it would no longer solicit and support donations/endowments for allied orthopaedic organizations, the AOA began the process of moving the AOA-OREF endowment to the AOA.

The AOA’s Pathways to Leadership annual giving campaign, started in late 2011, encourages members to provide their support directly to the AOA. AOA members and other individuals can allocate their donations to a particular AOA activity, and 100% of the funds are directed to support the designated activities. The AOA began accepting donations of stock in June 2014.

For details on how you can support the AOA and its programs, visit www.aoassn.org or e-mail donations@aoassn.org.

Honoring 2015 Award Winners

Distinguished Contributions to Orthopaedics Marc F. Swiontkowski, MD

Marc F. Swiontkowski, MD developed one of the first Musculoskeletal Functional Assessment (MFA) tools to assess limb function. He has created innovative and integrated health care teams to provide the assessment, treatment, and follow-up for musculoskeletal care and for the outcome of that care.

“All of us in academic orthopaedics are interconnected to one another likely through no fewer than three or four individual connections. We produce the fruits of education and research collectively and together we advance the field for the benefit of our patients. I am so grateful for those that I am closely connected to within the orthopaedic community.”

Distinguished Clinician Educator Joseph D. Zuckerman, MD

Joseph D. Zuckerman, MD has always followed the tenet that the way to elicit the greatest positive exponential effect in health care is to educate medical students, residents, and fellows to provide high quality care to as many patients as possible. He has spent countless hours training over 300 orthopaedic residents and 15 shoulder fellows.

“I have always felt that one of our most important responsibilities, if not our most important, was to educate the next generation of orthopaedic surgeons. The impact on the care of patients with orthopaedic problems, though indirect, is staggering. Consider that each resident we train will probably treat a few hundred thousand patients during his or her career. Multiply that times four or five residents each year, or in our case, 12 residents a year over the course of a career, and the impact becomes clearly recognizable. And that is an impact that each one of us involved in orthopaedic resident education can have.”

2016 Award Nominations will open on November 2 and close on December 7, 2015. Details will be announced in the AOA’s e-newsletter, Community of Leaders, and also on our website, www.aoassn.org. We encourage you to visit the AOA’s online Award Winner Hall of Fame under “About AOA.”

2014 Financial Review... (from page 18)

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Important AOA Dates & Deadlines For details and the most current information, visit www.aoassn.org.

2015 October 9 Own the Bone at the OTA Annual Meeting-Getting Your Fragility Fracture Program Off the Ground:

A Primer for the Orthopaedic Trauma Surgeon

October 13 AOA’s CORD Webinar: Clinical Competency Committees, Part 2 Application & Use: How Are We Using the “Data”?

November 2 Nominations Open for AOA Awards: Distinguished Contributions to Orthopaedics and Distinguished Clinician Educator

November 10 AOA’s CORD Webinar: Remediation, Part 1-Cognitive & Psychomotor Problems

November 17 Emerging Leaders Webinar: Keys to Facilitate Change

December 7 Nominations close for AOA Awards: Distinguished Contributions to Orthopaedics and Distinguished Clinician Educator

December 8 AOA’s CORD Webinar: Remediation, Part 2-Affective Domain Challenges

2016January 31 Applications close for the spring 2017 American-British-Canadian Traveling Fellowship

March 4 Spring 2016 CORD Conference, Orlando, Florida

June 21-22 Resident Leadership Forum for PGY4 residents; Emerging Leaders Forum, for members of the AOA’s Emerging Leaders Program; and the Leadership Institute, open to all

June 22-25 129th Annual Meeting of The American Orthopaedic Association, Seattle, WA-The Westin Seattle

June 23 Own the Bone Symposium on Post-Fracture Management

June 24-25 Summer CORD Conference