A Changed Plan

Outgoing AAOS president discusses his "challenging" year at the helm.

Michael Barbella

Last winter, members of the American Academy of Orthopaedic Surgeons (AAOS) elected Joseph D. Zuckerman, M.D., as president. A graduate of Cornell University in New York, N.Y., and the Medical

Joseph D. Zuckerman, 2009 president of the American Academy of Orthopedic Surgeons. Photo courtesy of AAOS.

College of Wisconsin, Zuckerman chairs the Department of Orthopaedic Surgery at New York University Hospital for Joint Diseases in New York, N.Y. He also is the Walter A.L. Thompson professor of orthopaedic surgery at New York University’s School of Medicine.

Upon assuming leadership of the AAOS, Zuckerman outlined for members his goals for coming year. Besides focusing on emergency care, advocacy, funding for research, and diversity in orthopaedics, Zuckerman vowed to expand on the area of practice management—an issue he believes is “centrally important to…members, particularly in these challenging times.”

Orthopedic Design & Technology recently caught up with Zuckerman to discover whether he accomplished those goals. In the discussion that followed, Zuckerman assessed his year as AAOS leader, provided details about next month’s annual meeting in New Orleans (see our calendar item on page 64 for particulars) and weighed in on the national debate over healthcare reform—a political curveball that he claimed made his tenure at the top a challenging one.

ODT: Upon being elected president, you said you wanted to expand on the area of practice management because it was centrally important to members. Did you fulfill that goal?

Zuckerman:Practice management has been a theme that we’ve worked on for the past three years, ever since I became second vice president. We’ve devoted more workshops to it, we’ve developed new programs and products for our members, such as a practice advisor database that makes consultants available to our members. These consultants have been used by our members and have passed muster with them, so to speak, so they have been recommended. We’re planning a technology course to bring new office-based technology to our members so they understand what is out there and what needs to be done. This is in addition to all the other practice management activities. Yes, [practice management] has been a theme over the past three years and it’s been an important focus. In my year as president, no matter what you plan on, you have to respond to whatever occurs. As you know, this year the major issue has been healthcare reform. We spent an awful lot of time on that because it was very important to this organization.

ODT: You also said you wanted to focus on emergency care, diversity in orthopaedics, advocacy and funding for orthopaedic research. Were you able to do that as president?

Zuckerman: We initiated dialogue with the American Hospital Association. We think that if physicians work together with hospitals they could probably find creative solutions to the emergency call problem. We started those conversations last April and May. Although we had a list of action items we were going to follow through on with the American Hospital Association, it has taken a back seat to healthcare reform both on our end and their end. They’ve been as consumed by [healthcare reform] as we have. But it is going to be an ongoing effort to try and bring two important stakeholders together—the hospitals and the orthopedic surgeons.

ODT: What kind of impact will healthcare reform have on the orthopedic industry?

Zuckerman: Nobody knows what healthcare reform is going to look like. We thought we had an idea previously but with the change in the number of Democrats and Republicans in the [U.S.] Senate, that’s now in question. Nobody knows what’s going to happen. We have significant concerns about the Senate bill. The Senate bill does not address what we think are the important aspects of healthcare. We completely believe that every American should have access to healthcare. We believe healthcare is a right and everybody in this country should have it. How you structure that, how you deliver it remains to be seen. That’s where the details are. It is difficult for us to understand how you can develop healthcare reform without basically doing something about Medicare. Medicare is a problem because it can’t support itself. Almost every year the reimbursement schedule is decreased in order to adhere to the sustainable growth rate (SGR) formula. Healthcare reform needs to address the SGR formula. If healthcare reform does not address the formula, access for patients will be decreased and physicians are going to have difficulty taking care of Medicare patients. At the same time Medicare reimbursements have decreased, expenses of running practices, departments or hospitals have increased. It’s two curves going in the opposite direction and Congress has just not taken the steps to correct that. I think the critical piece of healthcare reform in this country has to be making the population healthier. Issues like obesity, smoking, alcohol use have a profound effect on this country. It’s one thing to provide health insurance, which is certainly a laudable goal. But you have to make the population understand what it is to be healthier because ultimately, if you’re healthier, you’re not utilizing the resources that you’ve used before. That’s the long-term solution to this.

Of course, the big question is—and this is unfathomable to me—how do you have healthcare reform and not have meaningful liability reform? If you’re trying to save money in healthcare, how can you possibly not do something about tort reform? The congressional budget office says that even some liability reform will save $54 billion over the next 10 years. And to me, that is a very conservative estimate. I think without the specter of malpractice and liability, prescribing patterns, the tests that are ordered and the so-called notion of defensive medicine changes significantly. I don’t quite get it.

ODT: What kind of expectations do you have for the orthopedic industry this year?

Zuckerman: We’re an organization of 35,000 orthopedic surgeons. We are very proud of our members because regardless of what’s going on out there, our members provide care. They provide care for patients with musculoskeletal problems, which is a big problem in this country. And they go the extra mile. Look at the whole disaster in Haiti. Right now, there already have been more than 150 members in Haiti volunteering their time. We have a list of over 500 members that are waiting to be able to get down there and volunteer their time. I am very, very enthusiastic and proud about the members and how they’ve responded to the problems that occurred in Haiti. What’s going to happen to the industry? Well, we take care of patients and we’re going to continue to take care of patients as best as we can. Whatever we have to integrate into it—whether it be healthcare reform or a host of other things—we will do that because ultimately, it’s the responsibility and the goal of our members to provide the best care for patients with musculoskeletal problems.

ODT: How would you characterize the past year (2009) for the orthopedic industry?

Zuckerman: I think last year was a challenging year, only because of the uncertainty of healthcare reform and the impact it would have on the industry. Otherwise, it was a year in which we proceeded with much of what we do every year. There’s developments in the different areas within orthopedics—new technologies and new treatments. We educate, we go to courses, we learn and we try to incorporate this knowledge into how we care for patients. I’m not going to say it was otherwise business as usual, but to a certain extent it was. Patient care, education, research in various areas, this was all happening on an ongoing basis. That is the world of orthopedic surgery.

ODT: What new technologies are on the horizon?

Zuckerman: There are new technologies in all areas, but I can’t recite for you chapter and verse what it’s going to be. We’re still understanding computer-based technology for drug replacements, there’s different surface replacements to make hip replacements last longer. We’re also trying to refine the minimally invasive techniques in virtually every joint in the body. The advent of hip arthroscopy has opened up a whole other arena. The recognition that a vast majority of procedures around the shoulder can be done through minimally invasive techniques. Virtually every sub-specialty area of orthopedics there is more and more out there that is being done. What you’re going to see is the merger of surgery and biologics – an understanding of how you can affect tissue healing using biologics which will enhance the outcomes of surgery but possibly make recovery faster. All these things you’re going to see over the next five to 10 years. the other question is, will we have a system in place that can afford this new technology? That’s uncertain, but I also think that new technology can’t be good just because it’s new technology. We have to take a step back and say is this really better than what we have out there and if we’re not sure, we need to use it in a way so we can answer that question. We can’t just keep adding more technology under the heading ‘this is better’ without really showing that it’s better.

ODT: What kinds of regulatory changes might impact the industry this year?

Zuckerman: We’re a little concerned about what’s happening at the FDA [U.S. Food and Drug Administration]. The device component of the FDA is being re-evaluated by the government, which might make it much more difficult for new devices to be brought to market. That will have an impact on the industry’s ability to bring new devices to the market. Depending on how that plays out we may actually see less new technology out there because it will be financially difficult to go through all the requirements and testing.

ODT: What kinds of changes do you anticipate taking place to the physicians payment system this year?

Zuckerman: I think the critical piece is for Congress to enact a permanent fix to the SGR. But keep in mind there was supposed to be a 21 percent decrease in the Medicare fee schedule starting Jan. 1. They put a 60-day hold on that. Come March, they’re going to have to have a solution to that or a 21 percent decrease goes into effect. That would have a profound effect on how the physicians in this country practice.

ODT: Switching gears, is there a theme to next month’s [AAOS] annual meeting?

Zuckerman: This is our showcase meeting. It’s attended by 35,000 individuals and basically, the goal of this meeting are to increase the knowledge of those attending in the fundamentals of orthopedic surgery, bringing clinical science together with basic science in all specialty areas. Another goald is to teach those attending how they can develop effective strategies to prevent musculoskeletal problems. Plus, when you get all these people together it’s an opportunity to strengthen professional relationships. The leaders of AAOS spend the whole week focusing on our relationships with other organizations within orthopedics, so the meeting is also very important for that.

ODT: What is different about this year’s annual meeting?

Zuckerman: Historically, our meeting has been from Wednesday through Saturday. We’ve now added Tuesday to it. Tuesday will be not only orthopedic programming, structural course lectures and symposia, but it will also be our combined session with the Orthopedic Research Society. We’ve moved it back a day so we have an extra day of educational programming. People wanted more opportunities to present their research and we wanted to provide additional education. So we really added a day to the meeting on the front end.

ODT: James Carville and Mary Matalin are speaking at the meeting. Why were they invited to speak and what insight do you think the pair can provide to members?

Zuckerman: The perfect speaker this year is someone who can provide political commentary on healthcare reform. Why should I bring a Republican commentator in or a Democratic commentator in when I can bring one of each in? I wanted the guest speaker to be political, I looked at who was available and they [Carville and Matalin] seemed to fit the bill. Forty-five days from now we’re going to know what direction healthcare reform is going to go in. I think they’re going to give us an analysis of the process as it unfolded, why it took the directions that it did, how partisanship affected the process, and ultimately, they are going to give us their impression about whatever legislation has passed—if it is passed by that time.