History of the MOA

MOA BEGINS 25th YEAR WORKING ON THE SOCIO-ECONOMIC
ISSUES AFFECTING ORTHOPAEDIC SURGEONS IN
MASSACHUSETTS

by Paul J. Wetzel, Executive Director

It began over dinner early in 1981 with a group of orthopaedic surgeons from throughout Massachusetts discussing the increasing problems they faced from legislation, regulations and inter-actions with various state agencies that affected their practices. The doctors recognized that they needed their own organization to represent the practicing orthopedist working with the Medical Society, Blue Shield and other organizations. Throughout the following months an ad hoc organizing committee conducted local meetings with colleagues -and met several more times to discuss how best to address these Asocioeconomic@ issues.

Finally, on October 13, 1981 the Massachusetts Orthopaedic Association was organized at a meeting at the Marriott Hotel in Newton. It was followed two weeks later by a general meeting of the membership, Dr. Richard Conway of Salem was elected President. He continues to serve on our Board of Directors today.

Among the other significant first steps taken by the organization was the appointment of three doctors to the Board of Councilors of the Academy and representatives to the Interspecialty Committee of the Medical Society and the Interspecialty Committee of Blue Cross Blue Shield of Massachusetts. In addition, the Board recognized the success of the organization required employing an Executive Director and Lawyer/Lobbyist to do the work the doctors had neither the time nor expertise to do themselves. The early minutes also reflect a recognition to work with other professional societies and carry out a communications program with the members.

Two of the most significant issues providing impetus to the formation of the MOA were the rising cost of liability insurance and an array of problems in treating Worker's Compensation patients. Although, major achievements in solving some of these problem issues have been accomplished over the years, they still remain in the forefront at this time. Another constant has been dealing with the problems arising from the steady decline of Blue Cross Blue Shield. More recently, Medicare issues and an array of problems stemming from the growth of managed care companies have become priority areas to be addressed.

At the time of its inception, MOA was faced with legislation being drafted to reform the Worker's Compensation system in Massachusetts. The on-going negotiations lasted several years and the resulting regulations included reimbursements being changed for the first time in fifty years. Most onerous of the changes was linking treatment fees to the Medicaid fee schedule along with a ban on any balance billing or negotiation of fees by the provider. MOA argued the basic unfairness in this policy citing their willingness to treat indigent people at fees below the cost of delivering the service while noting that Worker's Compensation was an insurance program funded by business.

Doctors were forced during this period to increasingly ration the number of Worker's Compensation patients they could see. Throughout the late 1980's MOA devoted extensive effort year-in and year-out to negotiating with the Rate Setting Commission. By the end of the Dukakis administration the entire Industrial Accident system was in a state of collapse overwhelmed with backlogs of contested claims, premiums rising at alarming rates and cost to business peaking at $2.5 billion annually.

When the Weld Administration came into office solving the problems at the Department of Industrial Accidents and reforming the Worker's Compensation system was a high priority. James Campbell, the new Commissioner, immediately set out to establish a straightforward working relationship with all the participants in the system. He met with the MOA Board several times and his top staff people were always available to resolve disputes. Eventually the backlog of claims disappeared, treatment fees were improved, and other improvements were effected.

meanwhile, MOA and other participants began working on an Ad Hoc Committee to write and pass a Worker's Compensation Reform law. Over a two year period dozens of meetings were held to resolve differences' Eventually the Weld Administration preempted the Committee's bill and passed its own reform law. It contained a key provision which MOA had lobbied strenuously, namely the ability for doctors to negotiate worker's compensation fees.

In recent years MOA has continued to lobby the Rate Setting Commission to increase fees on various common procedures, including office visits. At this time treating injured workers and working within the system is greatly improved from the days of the mid-to-late eighties.

Shortly after its formation MOA was in the forefront of the major explosive issue of the time, the malpractice insurance crisis. The problem stemmed from a court ruling that ordered the physician community to reimburse the JUA for $90 million in liability premiums because the Insurance Commission had unfairly denied their requests for increases over the previous five years. Under a formula established in cooperation with the Medical Society orthopedic surgeons had their annual premium increased from about S 1 6,000 to $32,000 and were assessed an additional $32,000 per year for a five year period.

During a tumultuous period, some doctors refused to take emergency room call, others ceased doing surgery and others moved out of state. During one three year period virtually all the newly graduated orthopedists from Massachusetts programs began practice in other states.

MOA played an active and crucial role in resolving the crisis with the Board members devoting extensive time to meeting and negotiating with the key parties in the dispute. A key financial outcome from these efforts was the elimination of the fifth year of the retroactive assessment. There has also been a stabilization of premiums and in recent years a reduction for most doctors.

During the early 1990's MOA also negotiated a separate premium classification for spine surgery. This was done following a study which indicated less than one-third of the practicing orthopedists performed spine surgery. The premium for orthopedics without spine surgery has been approximately $5,000 less in each of the past eight years.

Another on-going activity of the MOA has been working with third party payers to resolve problems arising from treatment guidelines, procedures and billing complaints. Several times each year the organization has represented orthopedists with Blue Cross Blue Shield, managed care entities and others to resolve situations that interfere with patient care, cause unnecessary expense or require excess paperwork and telephone calls. While these situations continue to happen, especially with the increase in managed care firms, there have been many instances where we have prevailed in having our views recognized.

Starting in the late 1980's the interaction of the orthopaedic state societies and the Academy of Orthopaedic Surgeons has grown closer with recognition by the Academy that many of its activities and programs should be conducted in cooperation with and through the local organization. Working with the State Societies Committee of the Board of Councilors there have been continuous efforts to strengthen the role and influence of the State Societies during the 1990's. Dr. Israel Hurwitz of Marlboro was one of the Councilors who pushed this relationship and it has been continued by MOA Councilors over the years. MOA Executive Director Paul Wetzel serves on the State Societies Committee and attends Councilors meetings during the year.

Another change that has occurred over the years is the recognition of MOA and other specialty groups by the Mass Medical Society. The MMS Interspecialty Presidents Committee and its Specialty Societies Committee were merged in 1990 into the Interspecialty Committee. This group meets six times a year and the MOA plays a lead role on it. We have an excellent relationship with the Medical Society and work closely with them on many issues.

The main event for the MOA is our Annual Meeting held each April at which we present a variety of programs concerning the topical issues of the time. Each year it includes a risk management program at which CME credits are awarded. In recent years other topics have included unionization for orthopaedic surgeons, a look into the future of the hospital system in Massachusetts, reports from key legislators and regulators and a look at changes taking place in the liability insurance field. The meeting also serves as an opportunity for members to spend some time with colleagues they haven't seen in a while.

Going forward 2005 will bring renewed efforts in some of the same areas with several new issues taking prominence. Dealing with issues surrounding managed care including patient access to specialty care and lower reimbursements coupled with increased paperwork and treatment approval problems are significant areas requiring our attention. Constantly changing situations with the Medicare system is another. Liability Reform (our original issue) has become one of the most significant issues we deal with on both the state and Federal level. Rising premiums have become a major problem for all the high risk specialties and initiatives to change the system are making their way through state and Federal legislatures.