2012 AAOS FALL LEADERSHIP CONFERENCE:

October 18-21, 2012October 18-21, 2012

Sheraton Society Hill HotelSheraton Society Hill Hotel

Philadelphia, PAPhiladelphia, PA

Board of CouncilorsBoard of Specialty Societies

AAOS Officers and Presidential LineLeadership Fellows Program Participants

SYMPOSIUM 1:FUTURE OF ORTHOPAEDICS: HOSPITAL-EMPLOYED VS. PRIVATE

PRACTICE

Moderator: Moderator: Fred Redfern, MD Fred Redfern, MD – Henderson, NV; Chair, BOC– Henderson, NV; Chair, BOC Participants: Participants:

Alexandra Page, MDAlexandra Page, MD– Permanente Med Group, San Diego, CA– Permanente Med Group, San Diego, CA Diane Thome, MBA Diane Thome, MBA – DT Research, Albuquerque, NM– DT Research, Albuquerque, NM Kevin Plancher, MD Kevin Plancher, MD – Albert Einstein Med School, New York– Albert Einstein Med School, New York Henry Allen, Esq Henry Allen, Esq – Senior Attorney, American Medical Association– Senior Attorney, American Medical Association

Key MessagesKey Messages Data (2010) indicate transition from private practice to employed Data (2010) indicate transition from private practice to employed

physiciansphysicians Numbers still low (approx 10%); varies by regionNumbers 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 practice78% indicate autonomy as major benefit of current practice

SYMPOSIUM 2:SAFETY AND QUALITY: LESSONS FROM NASA AND NASCAR

Moderator: Moderator: Peter Waters, MD Peter Waters, MD – Boston Children’s; Boston, MA– Boston Children’s; Boston, MA Participants: Participants:

Marshall Carlson Marshall Carlson – Pres/ COO – Henderson Motorsports– Pres/ COO – Henderson Motorsports Tom Henricks, MPA Tom Henricks, MPA – NASA Commander/Shuttle Pilot– NASA Commander/Shuttle Pilot Jack Flynn, MD Jack Flynn, MD – Children’s Hospital; Philadelphia, PA– Children’s Hospital; Philadelphia, PA Peter Laussen, MBBS Peter Laussen, MBBS – Chair, Anesthesia Dept; Boston, MA– Chair, Anesthesia Dept; Boston, MA Bill Robb, MD Bill Robb, MD – Univ. Chicago; Chicago, IL– Univ. Chicago; Chicago, IL

Key MessagesKey Messages Safety is rule #1 in NASCAR champions’ cars and on NASA missions in Safety is rule #1 in NASCAR champions’ cars and on NASA missions in

space; must develop a level of “tolerance” of risk – cannot eliminate itspace; 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 eventsCommunication failure often root cause of adverse events Surgeons must be leaders in safety models; not impedimentsSurgeons must be leaders in safety models; not impediments

SYMPOSIUM 3:MANAGING THE DISRUPTIVE OR IMPAIRED PHYSICIAN

Moderator: Moderator: Frank Kelly, MD Frank Kelly, MD – Forsyth Street Orthopaedics, Macon, GA– Forsyth Street Orthopaedics, Macon, GA Participants: Participants:

Martha Brown, MD Martha Brown, MD – Psychiatry Dept., Univ. of Florida, Gainesville, FL– Psychiatry Dept., Univ. of Florida, Gainesville, FL Edward Craig, MD, MPH Edward Craig, MD, MPH –Hospital for Special Surgery, New York, NY–Hospital for Special Surgery, New York, NY Gerald Hickson, MD Gerald Hickson, MD – Pediatrics, Vanderbilt University, Nashville, TN– Pediatrics, Vanderbilt University, Nashville, TN William Hopkinson, MD William Hopkinson, MD – Vice Chair - Ortho, Loyola Univ., Chicago, IL– Vice Chair - Ortho, Loyola Univ., Chicago, IL Will Latham, CPA, MBA Will Latham, CPA, MBA – Latham Consulting Group, Chattanooga, TN– Latham Consulting Group, Chattanooga, TN

Key MessagesKey Messages Promoting professionalism – good for all practices and institutions; vast Promoting professionalism – good for all practices and institutions; vast

majority can agree to code of conduct and have no problems 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 Focus on groupgroup governance – don’t allow outliers to persist governance – don’t allow outliers to persist

SYMPOSIUM 4:HEALTHCARE IN OREGON: COORDINATED CARE ORGANIZATIONS

(CCO) Moderator: Moderator: John McGraw, MD John McGraw, MD – Knoxville, TN; Secretary, BOC– Knoxville, TN; Secretary, BOC Participants: Participants:

John Tongue, MD John Tongue, MD – Portland, OR; Pres, AAOS– Portland, OR; Pres, AAOS David Schlactus, MBA David Schlactus, MBA – Hope Orthopaedics, Salem, OR– Hope Orthopaedics, Salem, OR Tim Keenan, MD Tim Keenan, MD – Spine surgeon, Portland, OR– Spine surgeon, Portland, OR Robert Orfaly, MD Robert Orfaly, MD – OHSU, Portland, OR– OHSU, Portland, OR

Key MessagesKey Messages Options for savings – government view: Options for savings – government view:

payment to doctors; # covered; services coveredpayment to doctors; # covered; services covered CCO “experiment” in Oregon, endorsed and promoted by CCO “experiment” in Oregon, endorsed and promoted by Gov. John Kitzhaber, MD Gov. John Kitzhaber, MD

(former ER doctor; now in second stint as governor)(former ER doctor; now in second stint as governor) Began August 1, 2012. Plan to enroll 60% Medicaid pts by Jan 1, 2013Began 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 ptsForced” participation? If one wants access to up to 25% all other pts New methods required to deliver more care for less moneyNew methods required to deliver more care for less money

SYMPOSIUM 5:UPDATE ON MEDICARE AUDITS

Moderator: Moderator: David Halsey, MD David Halsey, MD – University Vermont; South Burlington, VT– University Vermont; South Burlington, VT Participants: Participants:

Craig Butler, MD, MBA Craig Butler, MD, MBA – – North Florida Sports Medicine; Tallahassee, FLNorth Florida Sports Medicine; Tallahassee, FL Pamela Clarke Pamela Clarke – – VP-Finance/Mng’d Care, Delaware Valley Healthcare CouncilVP-Finance/Mng’d Care, Delaware Valley Healthcare Council Brian Parsley, MD Brian Parsley, MD – Baylor College; Houston, TX– Baylor College; Houston, TX Debra Patterson, MD Debra Patterson, MD – VP-Clinical Affairs, Novitas Solutions =Medicare – VP-Clinical Affairs, Novitas Solutions =Medicare

Admin Contractor, Jurisdiction 12 (4 states, Wash D.C.); Jurisdiction H Admin Contractor, Jurisdiction 12 (4 states, Wash D.C.); Jurisdiction H (7 states)(7 states)

James Cope, MD James Cope, MD Jennifer Dupee, RNJennifer Dupee, RN

SYMPOSIUM 5:UPDATE ON MEDICARE AUDITS

Key Points:Key Points: Medicare Administrative Contractors (Medicare Administrative Contractors (MACMAC) conducting audits of lower ) conducting audits of lower

extremity total joint arthroplasty in Dx -Related Group (extremity total joint arthroplasty in Dx -Related Group (DRG- 470DRG- 470)) Recovery Audit Contractors (Recovery Audit Contractors (RACRAC) also reviewing retroactively) also reviewing retroactively Reviewers making medical decisions based on template metrics; non-surgical Reviewers making medical decisions based on template metrics; non-surgical

Rx documentation varies by MAC jurisdictionRx documentation varies by MAC jurisdiction MAC’s currently auditing in 3 jurisdictions (H, 9, 12)MAC’s currently auditing in 3 jurisdictions (H, 9, 12)

Initial DRG-470 Initial DRG-470 denial rate = 60% denial rate = 60% in Florida (MAC-9)in Florida (MAC-9) AAOS has met, and continues to meet, with CMS officialsAAOS has met, and continues to meet, with CMS officials 45 Members of Congress 45 Members of Congress signed letter to CMS Admin, Marilyn Tavenner, signed letter to CMS Admin, Marilyn Tavenner,

asking for asking for halthalt of audits (specifically in MAC 4, 12) until policy clarified of audits (specifically in MAC 4, 12) until policy clarified Medicare Learning Network Matters report – Sept 17, 2012: documenting Medicare Learning Network Matters report – Sept 17, 2012: documenting

requirements for hip and knee joint replacementrequirements for hip and knee joint replacement

AAOS wants reports of any audit activity ! AAOS wants reports of any audit activity !