Peer review subject to SOPs

By: G. Jake Jaquet

By G. Jake Jaquet

The AAOS Board of Directors reaffirmed that opinion of an AAOS fellow or member provided as part of a peer review process is subject to the Academy’s Standards of Professionalism (SOPs) on Orthopaedic Expert Witness Testimony on Monday. In adopting the recommendations of the Peer Review Professional Compliance Project Team, chaired by David D. Teuscher, MD, the Board agreed that the more expansive interpretation—incorporated in the revised SOPs on Orthopaedic Opinion on Testimony that will be considered and voted on by the fellowship after the 2010 Annual Meeting—is appropriate.

Under the recommendations, if the peer review material from a state medical board is legitimately and legally provided to the AAOS, then the orthopaedic peer reviewer would be subject to the Expert Witness SOPs unless precluded by state law. Similarly, if peer review material from a hospital is provided to the AAOS, the orthopaedic peer reviewer would be subject to the Expert Witness SOPs. The board recognized, however, that this is an unlikely situation and that most physicians who participate will be effectively immunized from liability.

First Vice President John J. Callaghan, MD; CEO Karen L. Hackett, FACHE, CAE; and President Joseph D. Zuckerman, MD.

The matter of peer review of opinions by orthopaedic surgeons employed by insurance companies and others requires further study, however. But the recommendations state that if an orthopaedic surgeon presents an opinion in the course of reviewing insurance cases, and the opinion is legitimately made available to the AAOS, it should be subject to the AAOS Expert Witness SOPs.

In addition, a stand-alone information statement on the topic of peer review, incorporating the AAOS Code of Medical Ethics and Professionalism, will be developed and promulgated.

AJRR bylaws approved
Bylaws for the American Joint Replacement Registry (AJRR), incorporated in July 2009, were also approved. The AJRR is unique among the joint registry concepts in that it has involved all stakeholders in decision-making related to its formation, including representatives from hospitals, industry, private payers, government (including representatives from the Agency for Healthcare Research & Quality, the Center for Medicare & Medicaid Services, and the Food and Drug Administration), the public/patient lobby, and AAOS staff.

In action on another registry, the board approved AAOS participation in a coalition of societies being established by the North American Spine Society (NASS) to plan and establish a spine outcomes registry. The coalition would decide the data points to be collected; whether, and under what conditions, to accept industry funding; and member participation and incentives and costs. The Academy’s initial participation is only for the development of a proposal and does not commit the AAOS to fund the registry nor to support it.

Board members Jeffrey Anglen, MD; Michael F. Schafer, MD; and Kristy L. Weber, MD.

Affinity programs enabled
The board also moved forward on investigating two affinity programs—a professional insurance program and a billing and collections program. The programs would be designed to offer products or services to members as a benefit they cannot easily obtain elsewhere or at a lower price than they can purchase alone.

More than 25 percent of the respondents to the 2008 AAOS Practice Management Survey said they would be likely or extremely likely to participate in a professional insurance affinity program if one were offered by AAOS.

The Board also approved publication of a second edition of the book Spine Trauma, originally edited by Jack Zigler, MD; Alan Levine, MD; Frank Eismont, MD; and Steven Gravin, MD. The editors of the second edition, in lieu of receiving editors’ royalties, have requested that a portion of net revenues be earmarked for donation to the AAOS education fund that has been established in Dr. Levine’s name.

A request for the addition of a subcommittee to the current committee structure for the Instructional Courses presented at the Annual Meeting was approved and funded. The new subcommittee will evaluate existing courses, suggest new courses, and assist the Instructional Course Committee in identifying and filling gaps in the curriculum and suggest new faculty for courses at the three year limit.

The Board also approved a funding request by the AAOS Electronic Medical Record Project Team to conduct several education and advocacy–focused activities to support members regarding this issue, including development of a second edition of the AAOS EMR Primer.

Two tech overviews approved
The Board also approved two new technology overviews, one focusing on synthetic bone void fillers and the other covering cervical disk arthroplasty. Kristy L. Weber, MD, chair of the Council on Research, Quality Assessment, and Technology, presented the documents, which were developed by physician workgroups under the direction of the Guidelines and Technology Oversight Committee.

Technology overviews do not make recommendations for or against the use of a particular technology; rather, they are considered educational tools that encourage readers to consider the information presented and reach their own conclusions. Details on the technology overviews will be published in an upcoming issue of AAOS Now. The full technology overview documents will be posted to the AAOS Web site at