President's Message - August 201508.25.2015
The summer is coming to a close as we approach the ASES Closed Meeting on 9-11 October in Asheville, North Carolina, and I hope it’s been a good one for you. For those of you who have not been to the Grove Park Inn, you and your spouses or partners will enjoy the experience, I assure you.
The ASES Executive Committee and various other committees have continued to be busy. Hopefully, with most of you now returning from summer holidays, you can catch up on what we’ve been doing.The new membership category, to be called Candidate Membership, has been approved by the Ad-hoc Membership Guidelines Committee and then the Executive Committee. We have formed a prospective new bylaw and membership guidelines. The new bylaws need to be approved by the ASES Membership at the Closed Meeting so we will present this for a vote at the 1st Business Meeting on Friday, October 9 in Asheville.
To summarize, in the next few days, I will again send you all of the work that has been done on the new membership category. This will include: 1) a written summary of the rationale for adding a new membership category; 2) the results of the survey that was done of the ASES Membership; 3) the proposed new bylaws and several associated changes that need to be made to other bylaws; and 4) the proposed membership guidelines for Candidate Members. In addition, the Ad-hoc Membership Guidelines Committee and Executive Committee approved some other changes to membership guidelines, and these will also be distributed.
The Value-based Shoulder Care Committee has done a lot of work this year. This was started by Larry Higgins and J.P. Warner over 3 years ago and there have been several sub-committees, one headed by Mark Frankle, and one led by Rich Hawkins and Bernie Morrey. The one led by Hawkins/Morrey has produced recommendations for outcome instruments to be used by ASES Members.
Recording outcomes is becoming more and more important for all orthopaedic surgeons. With the repeal of the SGR by Congress, new rules were put into place, including the MIPS (Merit-Based Payment Incentive System), which will be in lieu of Meaningful Use criteria. One of the mandates of MIPS is that it will be necessary to collect outcomes of some sort – exactly what that is has not yet been defined, but having recommendations we can give to shoulder/elbow surgeons, and all orthopaedists doing shoulder/elbow surgery, will hopefully give them a place to start.
The Value-based Shoulder Care Committee has met via multiple conference calls. In addition, we met at the AAOS Ribbon-Cutting Ceremony at Rosemont in February along with representatives from AOSSM and AANA (including Bill Beach, Jay Irrgang, and Bob Arciero) to try to reach consensus on shoulder/elbow outcome instruments. We met again at the AAOS Annual Meeting in Las Vegas, along with representatives from ASSH, AAHKS, and NASS, as well as AANA and AOSSM (including Bill Seitz, Bill Beach, and Dave Chandler). We have had various mailings go out to discuss the current status and how we go forward. Along with Bob Arciero and Alan Anderson of AOSSM, and Bill Beach and Lou McIntyre of AANA, I participated in a conference call in August with the AAOS Outcomes Data Workgroup. It is possible that a discussion of which outcome instruments to recommend will be presented as a symposium this October at the BOS Meeting in Denver.
Many of you know that CMS ruled over 2 years ago that the shoulder was a single anatomic entity, limiting the number of CPT codes that could be charged for shoulder arthroscopy. This has become a hot issue item with AAOS, in addition to ASES, AOSSM, and AANA. In May we had a meeting with CMS at their facility in Baltimore in an attempt to reverse this decision. I was present, along with Gerry Williams representing the AAOS Presidential Line, AAOS Medical Director Will Shaffer, Steve Weber from AOSSM and ASES, Julie Todd from AOSSM, and Bill Beach and Lou McIntyre from AANA. To date, no progress, but we continue to pursue this and other options and will keep you updated.
Along with the work of the Value-based Shoulder Care Committee, ASES has been approached by AJRR (American Joint Replacement Registry) asking us to consider joining their registry. We have had conference calls with them and with the ASES Executive Committee and are currently reviewing this and working towards possibly going ahead with an alliance with AJRR.
There is more on joint arthroplasty. The ASES Executive Committee has approved a relationship with Dartmouth and their biomechanics laboratory which will recommend to our members that they send any explanted shoulder or elbow prostheses to Dartmouth for retrieval studies. Dartmouth has done this successfully in the past with hip and knee implants and this will hopefully let us learn more about failures of shoulder and elbow implants. The Dartmouth contact is Doug Van Citters and we will be providing information to all members about how they can participate and what they need to do to get the explanted prostheses to Doug.
Shoulder prostheses continue to be bedeviled by puzzling infections with the seemingly indolent Propionibacter acnes. Led by Andy Green, an Ad-hoc Prosthetic Joint Infection (PJI) taskforce has been looking at this problem this year. The taskforce has had several conference calls, with the taskforce members assigned various aspects of the problem to study. The PJI Taskforce is attempting to develop an ASES position statement concerning shoulder arthroplasty infection, and is close to that end result, which will be presented as a symposium at the Closed Meeting.
Jon Ticker has continued to be a workhorse for ASES and has led two different initiatives. Jon has been in charge of converting the CESES (Continuing Education in Shoulder and Elbow Surgery) to the ASES Foundation, and soliciting funds both from industry and our membership. He has done a superb job in making this a better functioning educational foundation from which ASES will be able to fund various educational initiatives.
Jon has also been in charge of the shoulder/elbow question-writing committee for the MOC (Maintenance of Certification) test. He has worked on this in concert with AANA and has recruited members from both ASES and AANA to develop fair, representative, and challenging questions for the tests. We all owe Jon a big thank you for his work this year.
Finally, going back to funding, Evan Flatow and the JSES Board of Directors have worked for the past year on setting up a funding system for shoulder/elbow traveling fellowships. This has been tacitly approved by the ASES Executive Committee, pending final approval in Asheville by the JSES Board of Directors. This will be funded via the ASES Foundation, and will provide financial support to the following traveling fellowships: 1) ASES to Europe, 2) SECEC to North America, 3) Japan to North America, 4) Korea to North America, and 5) China to North America.
And that is a summary of all the work we’ve done this year. This will be my last President’s Message prior to the ASES Closed Meeting. It has been my honor to be your President during 2014-15 and I appreciate all your support and hard work.
Bill Mallon, MD