The Oregon Association of Orthopaedists exists to influence the socioeconomic
and political issues that affect or control the ability of Oregon orthopedic
surgeons to provide high-quality medical care to our patients.
Buy A Ticket
Bill was desperate. Every week he had gone
to church, kneeled in the pew, and prayed to win the lottery. Now for the 10th week, he knelt
alone in the church, again praying to win. A bright light shown
through the stained glass, and a voice came through from above: "Bill Égo
half way with me. Buy a ticket."
As orthopedists, we have our own games of
political forces that impact our practice. We have the games of insurance reimbursement, malpractice,
and call coverage to name a few. We likewise need to be proactive, and Ôbuy
a ticket' if we expect results. Unlike Powerball, our chances of winning
are much higher.
Consider the Prompt Payment Bill. This law had its origins as
a complaint from the lips of physicians standing in their office and
doctors lounge at the hospital. The OAO and OMA supported the bill
through the legislative process. Orthopedists are now being paid
on time as a result of this proactive effort.
Further proactive efforts by the OAO now in process include the MVA
PIP bill that increases the amount to $25,000, and a trauma bill that
improves payment to physicians in hospital trauma management. The week
of March 10, 2003 begins discussions of possible medical malpractice
We have conversations with peers and read
about the problems with practicing medicine. We complain. We get upset. Yet, how many
of us have bought a ticket? Sending in your dues for the OAO and
Orthopedic PAC is buying a ticket. It is also calling, writing,
and contributing to your Oregon and US representative. It is convincing
your local colleagues to do the same. It is participating in
the OAO Web site questionnaires when they come on line.
This year as President I am committed to the following
- 220 OAO members (past membership
- OAO website by April 15, 2003
- OAO database of orthopedists email
- OAO website data base for insurance
- OAO website forum for call coverage
The website will have a secure member section,
where we can hear suggestions, and collect data in questionnaires. The web site will allow us
to track on a statewide basis the rebundling practices by insurance companies,
and collaborate efforts regarding call strategies. Email and
the website will allow us a statewide communication so that we can
those in Salem working for our interests as orthopedists.
Be proactive. Buy a ticket
Timothy L. Keenen, M.D.
Physician for a Day
Want to spend a day in the thick of activity
at the State Capitol? Volunteer
to be Physician for a Day, a program initiated by the OMA.
During your day at the Capitol, you provide
first aid services to legislators and their staffs, if needed. We
will arrange for you to meet your legislators, giving you an opportunity
to discuss health care, liability
reform and other issues of concern to you.
If you are interested, call Nan Heim/ Associates at 503-224-0007
and we will coordinate with OMA.
Report from the State Capitol
Budget Woes....Liability Reform...Trauma Funding...
March brought yet another gloomy state revenue forecast. The state will
be at least $500 million short of what is needed to cover the Governor's
proposed $11+ billion 2003-05 budget.
Without more revenue, it is clear that the
Oregon Health Plan (OHP) cannot be saved in anything like its current
form. By July, the OHP is
likely to resemble traditional Medicaid. Oregon's health care providers
will face thousands more uninsured patients.
New tax proposals--even a sales tax --have surfaced at the Legislature. But
action on any major tax measure this session is unlikely, in spite
of the revenue picture. First, Governor Kulongoski has said he will
support major tax re-
structuring until he sees that voters have
more confidence in state government.
An even greater obstacle to any tax measure passing is Oregon's initiative
and referendum. As a practical matter, the Oregon Legislature cannot
acquire major new tax revenue without a vote of the people. Even if the
Legislature did muster a two-thirds vote to pass a tax measure, Bill
Sizemore or Don McIntyre would almost certainly circulate petitions to
put it on the ballot in a statewide election.
Here is the record of Oregon voters on state tax measures . . .
last time Oregon voters passed a major new tax in a statewide
election was more than
seventy years ago--the income tax in 1930.
last time Oregon voters increased an existing tax in a statewide
election was thirty years ago--a
cigarette tax increase in 1972. At least a dozen tax increase
measures have been defeated in statewide votes since then.
has voted on a state sales tax nine times--and defeated it every
This session of the Legislature will probably
look very much like recent special sessions: a patchwork of spending
cuts, funding transfers and
smaller revenue measures. Smaller measures could include taking
reserves from SAIF, closing tax credit "loopholes," and even
abolishing the tax refund "kicker."
It is still too early to tell what this Legislature
is going to do to address the malpractice insurance crisis. Here
is what is happening so far:
March, the House Judiciary Committee held hearings
on a series of bills introduced by the OMA
and the hospital association to mitigate the malpractice
insurance crisis. The bills propose several
reforms, including requiring disclosure of expert
civil actions and limiting contingency fees in negligence
against health professionals.
Frank Morse (R-Albany) has introduced SB 497, authorizing
physicians and other health
care providers to require patients to sign waivers
to limit noneconomic damages that may result from negligence.
- Senator Morse has also introduced a
bill referring a measure to the voters to amend the
Constitution to cap non-economic damages in malpractice cases.
The Legislature cannot pass a cap without a Constitutional amendment
in this state. Amending the Constitution requires a statewide election.
A similar measure failed in the 2000 statewide election.
Physicians provide nearly $9 million worth
of trauma care to Oregon Health Plan patients a year, but are currently
reimbursed for only about
$3.2 million of those charges. Rep. Alan Bates (D-Ashland), the only
physician serving in the Legislature, has introduced House Bill 3394
to increase funding for trauma services, including reimbursement
for physicians treating indigent trauma patients.
House Bill 3394:
the 9-1-1 telephone tax from 75¢ and dedicates
most of the revenue to trauma services.
- Increases the Personal Injury Protection
(PIP) minimum required for automobile insur-ance
from $10,000 to $15,000. Payments from this increase would be
to trauma services.
- Defines trauma services as those provided
within 72 hours of a motorvehicle accident to a person
entitledto receive PIP benefits by a hospital designated as a
There are two other bills in the Legislature to
increase PIP to $25,000. However,
these bills do not dedicate the increase to trauma, so much of the
payments could end
up going to attorneys and chiropractors.
It will be an uphill battle to pass any tax increase this legislative
session, even a small telephone tax for a good purpose.
Nan Heim & Gina Cole
AAOS Advocacy Makes Gains
Medicare Reimbursement, Tort Reform and EMTALA Education
The AAOS Washington, D.C. office has been
working tirelessly on your behalf educating members of Congress about
the flaw in the Medicare payment
update for 2003. Due in part to these educational efforts, Congress
has directed CMS to "fix" this problem and what was going to be a 4.4%
decrease in the Medicare conversion factor for 2003 will be corrected
to a 0.5%
increase. This is a prime example of how your Academy is working for
you. For further details on the implementation timetable of this correction
go to www.cms.gov/regulations.
Both the Judiciary Committee and the Energy and
Commerce Committee of the House are considering medical liability reform
legislation. There is also bipartisan interest in the Senate for developing
legislation on this issue. The
AAOS Washington, D.C. office is also focusing on this issue with our
congressional members and is hopeful that there will be some movement
on this issue during this congressional session.
At the suggestion of your Board of Councillors,
a task force on ER call and EMTALA issues was formed. The product
of this committee's work now includes a position statement on ER call
coverage, endorsed by the
AAOS, that calls for compensation from hospitals to orthopaedic surgeons
for being on call that reflects the work and liability risk associated
with providing these services. This committee has also developed
a compendium on EMTALA that is the best summation of EMTALA and its requirements,
duties created, and ramifications
that I have seen. Both of these documents can be accessed on
the AAOS website (www.aaos.org) under the Health Policy section.
The AAOS is taking a preliminary look at the program
on expert witness testimony that The American College of Neurosurgeons
(ACN) has had in
place for the past few years. This program requires ACN members who
give expert witness testimony to agree to disclose during their testimony
when their testimony is not a view that would be held by the mainstream
neurosurgical community. The adoption
of this program by the AAOS was suggested by the Florida Orthopaedic
Society in response to their
members' concerns about medical malpractice cases where plaintiffs'
experts were providing opinions running blatantly counter to mainstream
literature and consensus. The costs and legal ramifications of adopting
and developing such a program are being looked at closely.
Your Academy has made progress for you over the past few months and
will continue to work to provide educational opportunities and advocacy
in economic and political arenas in the ongoing attempt to provide increasing
value for your dues and support. As always, please feel free to contact
me with any of your concerns.
Michael B. Vessely, M.D.
Board of Councillors
2003 Orthopedic Calendar
Conference,Board of Councilors
||OMA House of Delegates
||North Pacific Orthopaedic Society
||AAOS Board of Councilors
||WOA Annual Meeting
||OMA House of Delegates
||State Societies Strategy Meeting
||OAO Board Retreat
||OAO Annual Meeting
||Oregon Chapter, WOA, Annual Meeting
Better Orthopaedic Networking
Oregon BONES Practice Expense Survey
Questionnaires for the 2003 BONES Cost Survey (compiling 2002 data)
have been mailed to all orthopedic practices in the State of Oregon.
Completed questionnaires will be compiled by Moss Adams.
Remember that all participants receive a free
copy of the report compilation in its entirety so be sure your clinic
responds to the questionnaire. The
highlights of the compilation will be presented at the spring Oregon
BONES conference in May 2003 and at the OAO business meeting in November
2003. This project is such a valuable tool for our specialty. It
has already gained widespread recognition and support. Do you
know your cost per RVU?
Getting to know CCI (Correct Coding Initiative)
The Centers for Medicare and Medicaid Services
(CMS) developed the National Correct Coding Initiative to promote
national correct coding methodologies
and to eliminate improper coding. Many commercial insurance carriers
are now referencing the CCI edits produced for Medicare. Many carriers
are not, however, referencing the modifier indicators that the CCI
tables include. Practices may receive denials for reimbursement of
third procedures based on the CCI edits when in fact some of the
multiple procedures would be allowed if the modifier indicator attached
code is considered. The edits are arranged by two sets of tables.
One table contains the comprehensive primary code/component incidental
pair and the other table contains the mutually exclusive edits. Each
table is arranged in two columns as represented below:
Note that the codes in column 2 in the tables
are not payable with the column 1 code unless the edit permits the
use of a modifier associate
with the CCI. Each code pair is assigned a correct coding modifier
indicator of either a "0", "1", or "9". The "0" indicator means that no modifiers
associated with the CCI are allowed to be used with this code pair, there
are no circumstances in which both procedures of the code pair should
be paid. The "1" indicator means that modifiers associated with
the CCI are allowed with this code pair when appropriate and may be paid. Providers
are responsible for applying the correct modifiers appropriately to support
the codes they bill. The "9" indicator is used on only those code
pairs that have been deleted where the deletion date was retroactive
to the effective date. CCI edits are updated quarterly and most edits
are retroactive. If you find that a code edit has changed and is a code
is no longer deemed incidental you may resubmit the claim for reimbursement. The
CCI Edits Manual must be purchased; you may contact NTIS for a complete
copy by calling 800-553-6847. This article was based on information in
the CMS website "CMS.HHS.GOV" search for correct coding initiative.
Log on for additional information.
Wishing each of you success and a prosperous year.
Oregon BONES Association,"The Business of Orthopedics"
2003 Humanitarian Award:
John R. Tongue, M.D.
John R. Tongue, M.D., was presented the fourth
annual AAOS Humanitarian Award during opening ceremonies of the Academy's
70th Annual Meeting. The
AAOS Humanitarian Award acknowledges an orthopaedic surgeon who has gone
to extraordinary lengths to make a positive impact on the lives and health
of many people. Dr. Tongue was recognized as a tenacious advocate
for transportation safety issues and affected major change among the
three main causes of traffic injuries and fatalities: lack of
safety belt use, drunk driving and excessive speed.
Dr. Tongue founded the Oregon Lifebelt
Committee to create and pass a mandatory seat belt law and Pledge
America, a nonprofit organization
committed to educating civic organizations in the Northwest about
the dangers of drunk driving. As chair of the Oregon Transportation
Committee, Dr. Tongue has vigorously and successfully opposed increased
speed limits in Oregon.
On Call Issue
I urge all members to review the AAOS Position
Statement on EMTALA. You
will find it under the Health Policy section on our academy's web page (www.aaos.org).
Current interpretations of EMTALA by hospitals place a tremendous burden
on physicians scheduled to be on-call.
In most cases, in Oregon, orthopedic surgeons are not reimbursed by
the hospital or managed care organizations for their on-call services.
No other business or occupation is required to perform mandated services
without expectation of remuneration.
Not only are orthopedic surgeons not compensated
for on-call services, but they are exposed to increased liability
have a greater likelihood of being sued because of the complexity
of the injuries and
the lack of a pre-existing physician/patient relationship with persons
treated in the emergency department. Therefore, I urge all orthopedic
departments throughout the state to adopt the AAOS Position Statement
regarding emergency department on-call coverage.
Once that is accomplished, you may begin negotiations
regarding on-call compensation with your hospitals and managed care
negotiations will vary by community and orthopaedic groups throughout
the state. The compensation package will also vary by community. Some
groups will elect to be compensated on a "per day" on-call basis where
as others will be compensated on a "per incident" basis while on-call.
Some members may elect not to participate in on-call compensation. We
certainly respect that decision also.
I urge all members to speak to their fellow orthopaedic surgeons across
the country and get a feel for their compensation packages. They will
vary widely but most are being compensated for these services. Compensation
for on-call services will help offset your rising malpractice premiums.
Good luck in your negotiations.
Richard S. Jany, M.D.