Annual Leadership Meeting Symposia

Moderator: Charles L. Nelson MD, FAOA: Penn Orthopaedics
Panelists: Mary I. O’Connor, MD, FAOA: Yale School of Medicine; Kevin J. Bozic, MD, MBA FAOA: The University of Texas At Austin Dell Medical School; Said Ibrahim, MD – Senior Associate Dean of Diversity and Inclusion: Weill Cornell Medicine

Objectives:

1. Discuss the current and developing value-based care initiatives relevant to orthopaedic surgery as well as documented successes in promoting improved value (quality/cost)
2. Review potential unintended consequences related to various forms of value based health care initiatives and the threats to access for vulnerable patient populations (minorities, rural communities, patients with lower socioeconomic status, less social support or challenging living situations, etc)
3. What strategies can we implement now to assure that access is not only maintained, but improved with Value-Based Care changes?

Summary:
The moderator and speakers will develop a program giving an overview on the current state of Value Based Care (VBC) with a focus on programs relevant to orthopaedic surgeons (voluntary and mandatory bundled care programs (BPCI), Medicare Hospital Readmissions Reduction Program (HRRP), etc) as well as other recent changes in healthcare reform (removal of TKA and THA from the inpatient only list) and its impacts on patient access. The growing movement towards VBC has significant implications for all health systems. The session will engage the audience with audience response questions prior to and after the symposium with a goal of accessing whether participants opinions changed following the symposium. In 2020, the AOA presented a symposium on how VBC will impact large academic hospital systems and training of our residents/fellows. In 2021, the expectation is to build off this symposium to focus on how VBC can lead to an erosion of patient access due to some of the proposed changes in care. The symposium would include some focus on how VBC will need to be adjusted for more video/virtual care approaches with the recent effects of the COVID-19 pandemic.

Moderator:
Panelists:

Objectives:

1. To engage the audience and encourage more active participation with session participants.
2. To listen to diverse opinions and different strategies regarding these issues.
3. To create an action plan or consensus statement as appropriate for the topic from orthopaedic leaders and educators regarding these issues.

Summary:

Moderator: Charles S. Day, MD, MBA, FAOA: Henry Ford Health System:
Panelists: Lisa L. Lattanza, MD, FAOA: Yale School of Medicine, Charles A. Goldfarb, MD, FAOA: Washington University School of Medicine, L. Scott Levin, MD, FACS, FAOA: Penn Medicine

Objectives:

1. Understanding the overall financial impact of the COVID-19 pandemic at 4 different orthopaedic surgery departments.
2. Understanding at least 4 different strategies for deficit recovery for an orthopaedic service line.
3. Acknowledging specific barriers to deficit recovery in the healthcare system.

Summary:
Orthopaedic service lines and departments were greatly affected financially by the COVID-19 pandemic as many of their clinical operations were deemed nonessential; and thus departmental leadership were left to devise strategies to recover as much of its deficit for the remainder of the year. Four orthopaedic surgery leaders from four different health centers (Geisinger Integrated Healthcare Systems in Pennsylvania, Henry Ford Health System in Michigan, Penn Medicine in Pennsylvania, and Washington University School of Medicine in St. Louis) implemented unique strategies in order to recoup their accrued 2020 fiscal year deficit in orthopaedic surgery. While financial recovery strategies may be more pertinent presently due to the pandemic and ensuing lockdown, these general deficit reduction strategies may apply to any orthopaedic service line aiming to increase revenue and engage patients. The panelists will share their accrued deficit from the elective surgery shutdown, their strategies for financial recovery, the barriers that made recovery difficult, and ultimately how effective their strategies were at reducing their deficits through the end of 2020.

Moderator: Antonia F. Chen, MD, MBA, FAOA: Massachusetts General Hospital/Brigham and Women’s Hospital/Harvard Medical School, Colm J. McCarthy, MD: Brigham and Women’s Hospital

Panelists: George Dyer, MD, FAOA: Massachusetts General Hospital/Brigham and Women’s Hospital/Harvard Medical School; James D. Kang, MD, FAOA: Brigham and Women’s Hospital

Objectives:

1. Provide participants with a better understanding of how to start recruitment, advocacy, and wellness in a practical way regarding diversity within orthopaedic departments.
2. Provide experiences with pitfalls and successes in implementing increased diversity and inclusion within orthopaedic departments.
3. Provide participants with information on how to maintain and grow diversity and inclusion within their orthopaedic departments.

Summary:
Orthopaedic surgery remains one of the least diverse fields in medicine. This is additionally impressive given the dramatic increases in diversity within medical schools. While it has become generally accepted that increased diversity benefits the field, this change cannot occur overnight. The road to diversity within orthopaedics must start with early recruitment and inclusion. Residency has become the gatekeeper of diversity within our field, as there are only 6.5% female membership of the AAOS and 12.6% of AAOS membership not identifying as Caucasian. In order to meaningfully increase diversity, a ten-year plan must be implemented to engage in medical student, resident, and faculty recruitment. This symposium will discuss how to improve diversity within orthopaedics from early undergraduate and medical student recruitment to faculty positions as well as allyship in a meaningful way.

Changes within orthopaedic surgery regarding diversity and inclusion are, by definition, slow moving. Cultural change is limited by acceptance of these changes by those in decision making positions, as well as the 5-year delay of changing residency populations.

In order to change diversity in a meaningful way, we should strive to emulate institutions and individuals who have successfully managed to diversify their residency and faculty and identify groups of individuals who need greater representation in our field. Allyship is only useful if those we are trying to advocate for are helped by it.

In this symposium, we look to several surgeons who have helped build a more diverse faculty and residency program and hear firsthand from them how to build such a program, how to support our colleagues, and how to be better allies.