Mississippi Orthopaedic Society

Fall 2010 Newsletter
Mississippi
Orthopaedic Society
President’s Letter
Dear Fellow MOS Members:
I am very pleased to have been elected at our Annual Meeting in
May as your President, and I look forward to serving in this capacity.
The Mississippi Orthopaedic Society had a very good year last year
under the leadership of Jeff Noblin and I am excited about the year
ahead. This past Annual Meeting was very informative and successful
and we will return the meeting to the Beau Rivage in Biloxi in 2011.
We received warm hospitality there and had one of our largest crowds
in attendance.
I hope you will mark your calendars for May 19-21, 2011 and make plans to join us. We
are assembling an interesting scientific program for the meeting and plan to have a number
of enjoyable social activities to give our members a chance to network with one another. We
were joined this year by some of our practice administrators, physician assistants and nurse
practitioners and hope they will be able to join us again at our 2011 meeting. We also plan to
host a Regional Meeting and Coding Seminar in Jackson on January 22, 2011. We hope that
you and your staff will take advantage of this offering by the Mississippi Orthopaedic Society.
2011 is a statewide election year. The Mississippi Orthopaedic Society will keep you informed
of various political events which may be of interest and of candidates that are supportive of
issues impacting the practice of orthopaedics.
If you have any questions, concerns, or suggestions this year, please feel free to contact me at
the Orthopaedic Clinic of Southwest Mississippi at (601) 684-4613 or [email protected].
You may also call on our Executive Director, Clay Williams at 228-822-4703 or cwilliams@
capitolresourcesllc.com.
Again, thank you for allowing me to serve as your President this year. Best wishes.
Sincerely,
Tom Jeffcoat, M.D.
Save
President, Mississippi Orthopaedic Society
Post Office Box 5034
Jackson, MS 39296
Executive Board
B. Thomas Jeffcoat, M.D.
President
Orthopaedic Clinic of
Southwest Mississippi
E. Jeff Kennedy, M.D.
Vice President
Capital Orthopaedics &
Sports Medicine Center
James W. O’Mara, Jr., M.D.
Secretary/Treasurer
Mississippi Sports Medicine &
Orthopaedic Center
Alexander D. Blevens, M.D.
Councilor to AAOS
Bienville Orthopaedic Specialists
Robert K. Mehrle, M.D.
Member at Large
University Physicians Orthopaedics
Donnis K. Harrison, M.D.
Member at Large
Bienville Orthopaedic Specialists
Jeffrey D. Noblin, M.D.
Past President
Bienville Orthopaedic Specialists
George V. Russell, M.D.
Councilor to AAOS-Elect
(February 2011)
University Physicians Orthopaedics
Clay Williams
Executive Director
Capitol Resources, LLC
Mark Your Calendar
the Date!
Mississippi Orthopaedic Society
Regional Meeting & Coding Seminar
Saturday, January 22, 2011 • 8:00 am to Noon
Mississippi Sports Medicine • Jackson, MS
Invitation to Follow
January 22, 2011
Mississippi Orthopaedic Society
Regional Meeting & Coding Seminar
8:00 am to Noon
Mississippi Sports Medicine
Jackson, MS
February 15-19, 2011
AAOS Annual Meeting
San Diego, CA
April 6-9, 2011
NOLC
Washington, DC
May 19-21, 2011
MOS Annual Meeting
Beau Rivage Resort
Biloxi, MS
National Orthopaedic
Leadership Conference
F
rom April 28 to May 1, 2010, hundreds of leaders in the
orthopaedic community converged on Washington for the
2010 AAOS National Orthopaedic Leadership Conference
(NOLC).
Attendees enjoyed symposia on the future of health care following
the passage of health care reform, the Canadian healthcare system,
quality and efficiency measurement, and reporting in orthopaedic
practice.
In addition to attending committee meetings and issue-specific
symposia, orthopaedic leaders participated in meetings with
Representatives and Senators from their home states. In their nearly
150 meetings, orthopaedic surgeons urged Congress to act on issues
concerning the practice of orthopaedics with particular attention
focused on the following issues:
--Development of a Permanent Fix to the Sustainable Growth Rate
Formula: -- - The flawed physician payment formula jeopardizes
patients’ ability to access their physicians. Comparing today’s rates to
those of 1992, physicians are paid on average $800-1000 less for the
same services. Congress has instituted a number of temporary fixes
to the SGR, but NOLC participants encouraged their congressional
delegations to devise a permanent solution that reimburses for
services based on actual practice costs.
-- The Independent Payment Advisory Board (IPAB) is an appointed
body with the jurisdiction to make decisions regarding Medicare
reimbursement and coverage benefits with a mission to reduce
Medicare spending. NOLC participants encouraged Congressional
leaders to oppose the IPAB as it is an unelected board and therefore
unaccountable body in charge of Medicare decisions whose sole goal
is to cut costs.
Also, as part of the NOLC, the traveling
art show, Wounded in Action: An Art
Exhibition of Orthopaedic Advancements,
came to the U.S. Congress for a one week display in the rotunda of
the Russell Senate Office Building. Orthopaedic surgeons wanted to
remind Congressional officials of the sacrifices made by our men and
women in uniform and urge them to continue to support research to
improve the ability of the wounded to reach their full potential.
Representatives from the Mississippi Orthopaedic Society who
attended the Leadership Conference were: Dr. Alex Blevens,
Bienville Orthopaedic Specialists; Dr. George Russell, University
of Mississippi Medical Center; Dr. Robert Mehrle, University of
Mississippi Medical Center and Clay Williams, Executive Director
of the Mississippi Orthopaedic Society.
The MOS members met with Representative Gregg Harper,
Representative Bennie Thompson, Representative Gene Taylor and
the offices of Senator Thad Cochran, Senator Roger Wicker, and
Representative Travis Childers.
MOS Representatives meet with
Congressman Gene Taylor
Alex Blevens, MD, Robert Mehrle, MD, George
Russell, MD, and Congressman Gregg Harper
2
MOS 2010 Annual Meeting Recap
T
he Mississippi Orthopaedic Society held the organization’s
2010 Annual Meeting at the Beau Rivage in Biloxi. The
meeting drew over 40 physicians as well as practice
administrators, physician assistants and nurse practitioners from
practices across the state. Attendees enjoyed both the scientific and
social programs throughout the weekend.
The scientific program was chaired
by Dr. Jason Craft with University
of Mississippi Medical Center and
MOS President, Dr. Jeff Noblin.
The slate featured two visiting
guest speakers. Dr. Frank Kelly
of the Forsyth Street Orthopaedic
Clinic in Macon, Georgia, joined
the Mississippi Orthopaedic Society
for the event. Dr. Kelly was former
Chair of the Communications
Cabinet for the American Academy
of Orthopaedic Surgeons and was
also former President of the Georgia
Dr. Frank Kelly
Orthopaedic Society.
He also
served as team physician for a number of high school, collegiate, and
professional teams.
Dr. Kelly provided an update from the Academy and spoke on the
ramifications of the recently passed healthcare reform legislation.
“Though some aspects of the recently passed healthcare reform
legislation - such as the elimination of pre-existing conditions
clauses of insurance policies - may be advantageous, I share with so
many of my colleagues grave concerns about the potential negative
long term consequences of this reform. I have serious doubts that
healthcare costs will actually be reduced and I am very concerned
about the significant impact this legislation will have on our everescalating national debt. Will our patients still have access to the
quality specialty care they deserve?”
Dr. Kelly also addressed the members of the Mississippi Orthopaedic
Society on the importance of having an active state society. “Not only
do the state societies provide outstanding educational opportunities –
as evidenced by your excellent and informative meeting – but they
also enable us to form lasting friendships with colleagues throughout
the state, enriching our lives personally and professionally, “ noted
Kelly. Dr. Kelly also praised the Mississippi Orthopaedic Society
on their past coordinated legislative accomplishment, “We share so
many common problems and concerns and state societies provide
us an opportunity to share these experiences, to find ways to solve
problems, and to take a leadership position in advocacy efforts on
behalf of our patients and our profession. Nowhere has this been
better demonstrated than by the efforts of your state society to achieve
meaningful tort reform legislation.”
Dr. Pat Smith of the Columbia
Orthopaedic Group of Columbia,
Missouri, and head team physician
for the University of Missouri
Athletic Department provided the
President’s Guest lecture on All
Inside Anterior Cruciate Ligament
Reconstruction and he also spoke
on Medial Patellofemoral Ligament
Reconstruction.
Dr. Smith
performed the first “All Inside”
double bundle ACL reconstruction
placing two tendon grafts across
the knee joint to replace the ACL
Dr. Pat Smith
which more closely reproduces
normal ACL anatomy. Also, as part of the annual meeting, Dr. Smith
facilitated a cadaver lab at Cedar Lake Medical Center in which many
MOS members participated.
Brigadier General Kory Cornum who recently became the
Commander of the 81st Medical
Group at Keesler Air Force Base
in Biloxi delivered remarks at the
annual banquet. General Cornum
addressed MOS members regarding
the status of healthcare in the
military and the distinction with
which our men and women serve
in the field. He went on to tell how
Active Duty, National Guard and
Reserve orthopaedic surgeons are
serving in Iraq and Afghanistan in
large field hospitals and near the
front lines. “These surgeons are
performing life saving surgeries
that have helped bring the died of
Brigadier Gen. Kory Cornum
wounds rate down to about 4% vs the 21-26% died of wounds rate
our military has experienced from the Revolutionary War all the way
to Desert Storm.” Also, rapid evacuation now gets patients back to the
United states in 2-3 days vs the 42 days it took in Vietnam.
“Not only was the weekend very informative, it provided attendees
with an opportunity to network with old friends and colleagues,” said
MOS Member Alex Blevens. The weekend had a number of activities
for members to participate, beginning with a welcome reception at
the home of Dr. and Mrs. Jeff Noblin in Ocean Springs for members
and guests. A round of golf was played at the renowned Fallen Oak
Golf Course which was designed by Tom Fazio. Just weeks before
the Mississippi Orthopaedic Society arrived to play, the course had
seen the likes of Nick Price, Fred Funk, Mark O’Meara, and Hale
Irwin for the Mississippi Gulf Resort Classic which was part of the
PGA Champions Tour. Also, some members and guests were able to
take advantage of a sailing cruise on the Glenn L. Swetman, which is
an old Biloxi schooner which sailed along the Coast in the late 1800s
and early 1900s.
The Mississippi Orthopaedic Society 2011 Annual Meeting will return to the Beau Rivage, May 19-21.
3
Annual Meeting Highlights
ancon, MD visit the exhibit hall
John Kosko, MD and Keith Mel
Frank Kelly, MD and John
Drake, MD
Dr. and Mrs. Bruce Newell
Katherine Woodall and Aus
tin Barrett, MD
Henry Leis,
MD tees off
at Fallen Oak
Tom Jeffco
at, MD spea
ks with exh
ibitors abou
new product
t
and service
offerings
dy, MD
Jeff Kenne
lin, MD and Charles Rhea,
Jason Craft, MD, Jeff Nob
MD
etcher, MD
and Russ B
EXHIBITorS
The Mississippi Orthopaedic Society Would Like To Thank Our
2010 Annual Meeting Exhibitors:
DoUBLE DIamoND LEVEL
goLD LEVEL
SILVEr
BroNZE
6
15
FErrINg PHarmaCEUTICaLS
marCHmaN mEDICaL
THE LINCoLN groUP
16
7
Political “What Ifs?”
By Marty Wiseman, Ph.D.
W
e are in the middle of a hot and dry Mississippi summer.
Among the things that are certain is that when a few
political junkies get together under a perpetually
humming air conditioner, talk will automatically turn to speculation
over the 2011 Mississippi elections.
Questions like, “What ‘ya hearing?” or “What’s “________”
going to do?” get things started. The answers that follow are little
more than good practice for the front porches of the cabins and dust
or mud surrounding the speaker’s pavilion of the Neshoba County
Fair. That is where you can make the best use of the political wisdom
gathered over the lunch tables of the preceding weeks. It is there that
you can put on the cloak of political wisdom by saying, “I heard….”
In my last few such get-togethers discussion has turned more
toward the mysterious “unannounced” candidate than to those who
have already made some noise. The fact of the matter is that with
the known candidates jockeying for position political season ticket
holders usually feel the need to inject some intrigue into the process
lest things get as boring as the dog days of summer.
Take the Governor’s race, for example. Thus far, most of the
speculation has centered on Lieutenant
Governor Phil Bryant, Gulf Coast
businessman Dave Dennis and Secretary of
State Delbert Hoseman on the Republican
side of the ticket, and Hattiesburg Mayor
Johnnie Dupree and Clarksdale Attorney
Bill Luckett on the Democratic slate. This
list has been fairly stable for a few weeks
now so, predictably, the urge to shake up
things is becoming irresistible. Hence, we
are witnessing the arrival in political conversation of the well-known,
but as yet undeclared, major vote getter. These are the candidates who,
if they decide to run, certainly have the ability to be game changers,
if not winners outright.
There are three big names being bantered about that fit in
this category. Oddly enough, they are evenly spread across the
political spectrum – at least as the conversations of the “political
experts” would have it. There is former State Senator, former twoterm Lieutenant Governor, current Mississippi State University
administrator and Democrat-turned-Republican Amy Tuck. Ms.
Tuck is only in her forties and she has proven time and again to be a
vote getting machine. Her presence in the Republican primary would
change things in a hurry.
Then there is the talk of Mississippi Supreme Court Chief Justice,
National Guard General and son of a former Governor, Bill Waller, Jr.
entering the field as a Democrat. Such a turn of events has the ability
to send tremors through both sides of the ballot.
But perhaps the ominous turn of events for all aspirants for
the big house on Capitol Street is veteran Mississippi Farm Bureau
President David Waide’s, so far undenied, consideration of entering
the governor’s race. Mississippi political expert Sid Salter pulled
the curtain back on this possibility a few days ago. Waide certainly
elevated his profile and the opinion of his political acumen in the
recent tiff with Governor Barbour and a number of legislators in
staking out the populist position against expanding government’s
eminent domain powers. But the element of political speculation that
is popping up around the political lunch tables is that Waide may run
as an Independent.
Think about the possibilities. If Waide runs as an Independent
he will go straight to the November ballot opposite the Republican
and Democratic nominees. Remember that Mississippi’s Governor
candidate must receive 50% plus one of the popular vote to win, or the
race goes to the Mississippi House of Representatives where the winner
must receive a majority of the 122 House members. Conventional
wisdom has it that any credible Democratic
candidate on the Mississippi ballot will
almost automatically be guaranteed at least
40% of the vote. In this day of voter contempt
for both political parties, the opportunity to
park one’s vote, whether out of protest or
genuine support, for a well-known populist
Independent like David Waide will be quite
tempting for many.
If you are calculating the numbers in
you head it is not a huge stretch to see Waide’s best hope as being
that of an election thrown into the House. Such a turn of events
would mean that either the Republican or Democratic nominees
had been eliminated. In this, the first election following eight years
of Republican gubernatorial dominance under Haley Barbour, it is
almost unthinkable that a Republican could actually “miss the cut” in
a House of Representatives decided race for Governor. The same can
be said of a Democratic candidate from the party that reigned over
Mississippi politics for over a hundred years.
“…usually feel the
need to inject some
intrigue into the
process…”
8
Save the Date!
Mississippi Orthopaedic Society
2011 Annual Meeting • May 19-21, 2011
Beau Rivage Resort • Biloxi, MS
• Bask in the sun on
the tropical pool deck,
overlooking the scenic
Mississippi Sound.
• Experience the coast’s
premier championship resort
golf course, Fallen Oak,
designed by Tom Fazoi.
• Relax at the spa or on a
sailing trip out on the Gulf.
Medicare Physician Payment Updates and
the Sustainable Growth Rate (SGR) System
Jim Hahn, Analyst in Health Care Financing
(Congressional Research Service)
August 6, 2010 Summary
E
ach year since 2002, the statutory method for
determining the annual updates to the Medicare
physician fee schedule, known as the sustainable
growth rate (SGR) system, has resulted in a reduction in
the reimbursement rates (or a “negative update”). With the
exception of 2002, when a 4.8% decrease was applied, Congress
has passed a series of bills to override the reductions. The
SGR system was established because of the concern that the
Medicare fee schedule itself would not adequately constrain
overall increases in spending for physicians’ services. While
the fee schedule limits the amount that Medicare will pay
for each service, there are no limits on the volume or mix of
services. The SGR system was intended to serve as a restraint
on aggregate spending. If expenditures over a period are less
than the cumulative spending target for the period, the update
is increased. However, if spending exceeds the cumulative
spending target over a certain period, future updates are
reduced to bring spending back in line with the target.
In the first few years of the SGR system, the actual
expenditures did not exceed the targets and the updates to the
physician fee schedule were close to the Medicare economic
index (MEI, a price index of inputs required to produce
physician services) in the first two years (2.3% in 1998 and
1999, compared with a MEI of 2.2% in 1998 and 2.3% in
1999). For the next two years, in 2000 and 2001, the actual
physician fee schedule update was more than twice the MEI
for those years (5.5% update vs. MEI of 2.4% in 2000, 5.0%
update vs. MEI of 2.1% in 2001). However, beginning in
2002, the actual expenditure exceeded allowed targets and the
discrepancy has grown with each year, resulting in a series of
ever-larger cuts under the formula.
Some criticisms of the SGR system point to purported
flaws in the technical details behind the formula, while others
have just expressed displeasure with the resultant outcome.
Although modifications have been proposed to replace the
SGR system, no proposal has garnered sufficient support
and almost all proposals would be expensive to implement
compared against the current baseline, which necessarily
assumes that significant cuts to the fee schedule will occur.
Legislative activity in the current session of Congress
includes several bills. The FY2010 Defense Appropriations
Act delayed the implementation of the reductions for two
months, through February 28, 2010. The Statutory Pay-As-
10
You-Go Act of 2010 (P.L. 111-139) exempts the amount it
would cost to freeze payments for five years from PAYGO
rules. H.R. 4691, which became law on March 2, 2010,
delayed the payment cuts through March 31, 2010. On April
15, the Senate passed an amended version of H.R. 4851 that
extended the payment cut delay through May 31, 2010. The
House passed the amended bill, and the President signed P.L.
111-157 into law that day. On June 25, 2010, several weeks
after the expiration of the extension created by the Continuing
Extension Act, an amended version of H.R. 3962 was signed
into law that increases fee schedule payments 2.2% retroactive
to June 1 and continuing through November 30, 2010.
Physician Spotlights
Dr.
James O’Mara, Jr. is an
orthopaedic surgeon practicing in Jackson
with Mississippi Sports Medicine and
Orthopaedic Center.
Dr. O’Mara did
his undergraduate studies at Southern
Methodist University in Dallas and attended
medical school at Vanderbilt University.
He completed his residency in Orthopaedic
Surgery at Georgetown University and
a fellowship with the American Sports
Medicine Institute in Birmingham.
Dr. Charles S. Rhea (Charlie) is an
Dr. James O’Mara, Jr.
When asked about the most enjoyable
part of being an orthopaedic specialist, Dr. O’Mara said, “The most rewarding
aspect of my practice outside of taking care of my patients is the work I do
with our fellowship program. It is always rewarding watching the progress
they make mastering their surgical skills during the year they spend with us.”
Dr. Charles S. Rhea
Dr. Rhea said, “The future of medicine has never been more uncertain;
however, what is certain is that orthopaedic surgery is going to be even more
important in providing care to a fast moving and aging population. The
Mississippi Orthopaedic Society allows us an opportunity to address issues
that affect our practices, but more importantly, it is a base from which we
can be more effective patient advocates. MOS provides a forum to respond
to issues that affect orthopaedics with unity and strength.” He attended this
year’s MOS annual meeting in Biloxi and said, “This was one of the best
meetings we have had. It was well planned, had an excellent venue, and
managed a good balance of educational, social, and political activities. It
was great fun.”
Dr. O’Mara feels that involvement in the Mississippi Orthopaedic Society
is important, and said, “Mississippi has one of the lowest per capita rates
of orthopaedic surgeons in the United States. It is vital that Mississippi’s
orthopaedic community communicate and collaborate to adequately serve
our residents. MOS is a vital part of that.” He currently serves as Treasurer
for the Mississippi Orthopaedic Society.
Dr. O’Mara was an active participant in the MOS Annual Meeting in
Biloxi this year. He said, “I thought the whole program from start to finish
was great, but I particularly enjoyed the reception at Dr. Jeff Noblin’s house.
The view was spectacular, and I enjoyed catching up with people I hadn’t
seen in a while.”
orthopaedic surgeon specializing in hand
surgery and orthopeadic traumatology
at the Columbus Orthopaedic Clinic.
After growing up in Aberdeen, Dr.
Rhea graduated from the University of
Mississippi, and then the University of
Mississippi Medical School, completing
his residency in orthopaedic surgery. Dr.
Rhea said that he finds orthopaedic surgery
as challenging, exciting, and fulfilling
today as it was as a resident 30 years ago.
Dr. Rhea has been married to his wife Bette for forty years, and they
have two adult children. In his spare time, he enjoys hunting, golfing, and
cars – fast cars! “My wife surprised me with a gift to Racing Adventure in
Talladega, Alabama, where I drove a real race car 150 mph on a high banked
turn, and that was about as exciting as it gets, ” exclaimed Rhea.
Resident Spotlight
Dr. John Kosko, originally from Greenwood, received his undergraduate
degree from Mississippi State University in Biological Engineering. He
attended and completed his residency at the University of Mississippi
Medical Center. Dr. Kosko is currently doing a fellowship in foot and ankle
reconstruction with the OrthoCarolina Foot and Ankle Institute in Charlotte,
NC. Upon completion of his fellowship, he plans to join Southern Bone and
Joint Specialists in Hattiesburg.
Dr. Kosko received the Outstanding Paper Award by a Resident at the
recent MOS Annual Meeting in Biloxi. Dr. Kosko and his mentor Dr. Matt
Graves of UMC radiographically evaluated simulated pilon fractures in
cadaver lower extremities. They concluded that articular reduction at the
distal tibia could not be reliably assessed by fluoroscopy. “The significance
of our findings lies in the fact that our results call into question the practice
of treating fractures of the tibial plafond without directly observing the
reduction, “ said Kosko. “It also questions
widely accepted literature that says that
the quality of the articular reduction does
not predict functional outcome or risk
of post-traumatic arthritis, because the
results of those studies were based on
plain radiographic assessment of articular
Dr. Kosko
reduction.” The study will be published in the Journal of Orthopaedic
Trauma in the coming months.
Dr. Kosko is married to the former Kendy Jenkins of Starkville and they
have two daughters, Eliza Kate and Caroline.
11
Fall 2010 Newsletter
Mississippi
Orthopaedic Society
Inside…
• NOLC Report
• Annual Meeting Recap
• Political & Medicare Physician’s Updates
• 2011 Annual Meeting Information