Below is a letter from the president of the American Academy of Orthopaedic Surgeons (AAOS) in response to some pretty wild misinformation recently presented by President Obama in a televised town hall meeting. With regard to musculoskeletal care, we have a huge burden ahead of us as retiring orthopaedic physicians far outnumber recently trained surgeons. Medical groups lose money treating Medicare patients at the current rates, but many provide this service within their community as just that, COMMUNITY SERVICE. Apparently the president thinks that we (orthopedic surgeons) get paid as much as $50,000 for doing an amputation for a diabetic with gangrene. Truth is that we collect $700 to $900 and the payment includes all post-op work over a 90 day period. In my office of 15 surgeons, this is such undesired work that we have had to resort to paying an "amputation" bounty or bonus to the physician who accepts and treats the patient.

Anyway, Obama's recent town hall statement is below as well as Dr. Zuckerman's position statement from the AAOS.

"Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money." President Barack Obama

AAOS response

August 13, 2009

Dear Mr. President:

On behalf of the American Academy of Orthopaedic Surgeons (AAOS), I am

writing to express our profound disappointment with your recent comments

regarding the value of surgery and blurring the realities of physician

reimbursements. The AAOS represents over 17,000 US board-certified

orthopaedic surgeons who provide essential services to patients every day. As

you yourself have said, "Where we do disagree, let's disagree over things that are

real, not these wild misrepresentations that bear no resemblance to anything that's

actually been proposed." In that spirit, we would like to bring some clarity to

your comments and underscore the value that orthopaedic surgeons bring to

Americans every day of every year.

First, surgeons are neither reimbursed by Medicare, nor any provider for that

matter, for foot amputations at rates anywhere close to $50,000, $40,000 or even

$30,000. Medicare reimbursements to physicians for foot amputations range from

approximately $700 to $1200 which includes the follow up care the surgeon

provides to the patient up to 90 days after the operation. Moreover, orthopaedic

surgeons are actively involved in the preventive care you mention. We are a

specialty that focuses on limb preservation whenever possible and when it is in

the best interests of the patient. Our approach to amputation follows the same

careful, thoughtful approach, always with the patients best interest as the primary

focus.

It is also a mischaracterization to suggest that physicians are reimbursed

"immediately." The AAOS itself, along with numerous other organizations, has

testified in Congressional hearings investigating the delays in reimbursement by

Medicare and other payers that create additional administrative burdens making it

more difficult to provide access to care for patients.

As you continue to pursue your health care reform agenda, we implore you to

disengage from hyperbole and acknowledge that health care delivery can only be

improved by recognizing that health care is a system in which orthopaedic

surgeons play a crucial role. With $849 billion of our national economy impacted

by musculoskeletal conditions, orthopaedic surgeons provide care that improves

lives and puts people back to work. Pediatric orthopaedic surgeons provide lifealtering

care to our nation’s children and play an invaluable role in ensuring

Medicaid patients have access to needed services. Military and civilian

orthopaedic surgeons provide care to our service women and men which

preserves limbs and has improved survival rates over past conflicts. Orthopaedic

trauma surgeons perform limb- and life-saving procedures and help to ensure that

our communities have the medical services that we all deserve. Total hip and

knee replacement surgeries are now two of the most successful operations in

medicine through a predictable reduction in pain, restoration of function, and

return of patients to both work and activities of daily living. And we are working

every day to ensure that medicine provides Americans with disabilities the quality

of life to which they are entitled.

The AAOS is committed to improving the American health care delivery system

and increasing health care coverage. The most expedient way to accomplish your

goal is to ensure that the debate is based in fact and reflects the value of the

services that all physicians, including orthopaedic surgeons, provide. We request

a meeting with you and your staff at your earliest convenience to discuss these

important issues.

Sincerely,

Joseph D. Zuckerman, MD

President, American Academy of Orthopaedic Surgeons

CC: Kathleen Sebelius, Secretary, US Department of Health and Human

Services

Nancy-Ann DeParle, Counselor to the President and Director of the White

House Office of Health Reform

Melody Barnes, Assistant to the President and Director of the Domestic

Policy Council