Orthopaedic PAC represents the specialty in Congress

Some say that all orthopedists should contribute $1000 in each election cycle

Issue: April 2003

Giving to a political action committee is another part of practicing good medicine, according to many orthopedic surgeons.

Political action committees (PACs) “are nothing more than the way to get our needs and the needs of our patients met in this competitive environment,” said Paul C. Collins, MD, chair of the Orthopaedic PAC executive committee. “Back when I started in medicine, we got paid what we billed by the old usual and customary system. Then, there was no need for a PAC because there was really no competition for resources; they were limitless.”

The PAC and the Washington office “are a natural response to the evolution in the way and amount of resources we as physicians can get for what we do,” Collins told Orthopedics Today. “We can either compete with all the tools we can muster or we can fail. This is how our political system was set up and how it works best.”

Orthopedics and politics

“Like it or not, orthopedics as an industry is controlled in large part through political processes,” said William Robb, MD, chair of the Council of Musculoskeletal Specialties Legislative/Advocacy Committee.

“We can charge whatever we want for our valuable services, but we are only paid what Medicare pays for the service or a multiple of the Medicare reimbursement. Our costs are rising sharply as medical liability premiums increase and wages for our employees increase,” said Robb, who is a member of Orthopedics Today’s editorial board on the Joint Reconstruction section.

“The only way to balance a checkbook where the cost of doing business is increasing while the reimbursement for services is staying the same or decreasing is to quit, to work harder or to get involved to change reimbursements or costs.”

Collins said the number of actual patients and the percentage that receive funding in some way from the federal government “is what is driving the political input into medicine.” Medical care has been put under the same microscope as other national concerns such as defense spending. The result is a competition for the “limited resources by every party in the medical tent. It is a great example of how our system was set up — constant competition for resources with the hope that the result will be the best mix of services for the nation,” he said.

Medicine has learned a hard lesson over the past several years, Collins said. “Those groups that have a stake in the outcome but have chosen not to compete will lose. The Medicare reimbursement reductions that we have recently fought and reversed are but the latest example. Medicine is years behind other groups, and we have paid for it dearly,” he said.

Steadfast involvement needed

William W. Tipton Jr., MD, AAOS executive vice president and CEO, “the floodgates of the federal government and its policymaker were thrown wide open” with the creation of the Medicare program. Not far behind were the state governments.

“Issues such as liability reform, Medicare reimbursement, patient privacy protection, EMTALA and scope of practice are just a few that require our steadfast involvement, and that means the establishment of meaningful relationships with member of Congress both at federal and state levels,” Tipton said.

“While there are several ways to establish an influential relationship, financial contributions are the most effective method short of a long-term personal relationship,” he said. Tipton is a member of the Orthopedics Today editorial board on the Health Policy, Patient and Practice Issues section.

Involvement by subspecialties

Robb said that the interests of subspecialty societies are best represented under a large umbrella PAC, the Orthopaedic PAC. The PAC raised $750,000 last year for political contributions from about 10% of the entire orthopedic community. “We cannot afford to fragment this political activity into multiple PACs that may mean well but individually are more costly and much less effective. The orthopedic message would be unclear or conflicting,” he said.

The subspecialties have political agendas based on their unique issues, but “few of these issues are truly unique, and few are significant enough that they will be acted upon separately,” Robb said. He called orthopedic surgeons the “new kids on the block. We cannot afford to yell five or 10 messages. No one will listen. We need to work together to choose which message has the best chance of being heard and then support the PAC so that the message is tied to political contributions for those who are willing to listen or, even better, support the message.”

Not participating

Tipton said that there are several reasons why orthopedic surgeons are not participating more fully in the PAC. One reason is that doctors assume that their contributions, unless large, make no difference and have no influence. Some doctors are suspect of losing individual control over how the funds are used and may have negative feelings toward a system based on money.

Some orthopedists are “already having difficulty surviving in the current system with decreasing reimbursements and increasing liability costs. They don’t have extra funds to give away where the outcome and influence are unpredictable.”

Tipton said that many patients are asking “where we have been during this discussion of our health care system.” Many would say that doctors have been the victims, he said. “The time is right to take up the challenge beginning with a meaningful contribution to our PAC.”

Every orthopedist should be a member of the PAC, Robb said. “Most should give $1000 to each election cycle. You have the comfort of knowing that you have done your part and that the PAC leadership will insure that your money is spent wisely,” he said. He advised that orthopedists should also get to know their representatives in Congress.