Rear View Mirror Reflections

Gerald R. Williams Jr., M.D., usually avoids Memory Lane if he can. The American Academy of Orthopaedic Surgeons’ (AAOS) immediate past president prefers to focus on his destination rather than the point of origin (and all stops in between).

“My philosophy in life has always been to look forward,” he opined. “I like to look back only long enough to determine the lesson, and then I continue on ahead.”

It is not surprising then, that Williams would spend more time focusing on the challenges still facing the Academy than the accomplishments realized during his presidency. Before transferring power to a new slate of officers last week at the group’s 2017 annual meeting in San Diego, Calif., Williams outlined the challenges his successor is likely to tackle over the next year: political advocacy, research funding enhancements, joint registries participation, brand strengthening, and new continuing education opportunities, among others.

Despite his penchant for the future, however, Williams was willing to linger long enough in the past to speak with Orthopedic Design & Technology about his presidency, the industry and the trials and tribulations of leading the world’s largest medical association of musculoskeletal specialists.

Michael Barbella: Upon taking office last year, you said you wanted to address unity and collaboration among the orthopedic industry’s various specialties. How did you attempt to fulfill that goal?
Gerald R. Williams Jr., M.D.: Fostering unity between the Academy and the orthopaedic specialties requires an ongoing commitment to listening and appreciating the different voices and perspectives within the house of orthopaedics, while working together to provide a strong, unified voice on the many priorities that we share. This past year, our unified advocacy efforts resulted in some important legislative and regulatory victories. These included important modifications to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment program, positive changes to the Comprehensive Care for Joint Replacement (CJR) bundled payment program, passage of legislation to improve Electronic Health Record (EHR) requirements for orthopaedic surgeons, and reversal of the Centers for Medicare and Medicaid Services (CMS) policy that allowed the agency to deny payments for certain shoulder procedures that often are performed or billed together.
 
Barbella: One of your other goals as president was to improve musculoskeletal research support. How successful were you in accomplishing this?
Williams: Certainly we must continue to work with our leaders in Washington [D.C.] to increase the level of research funding for musculoskeletal diseases. The cost of musculoskeletal conditions represents almost 6 percent of the nation’s gross domestic product (GDP), yet the National Institute of Arthritis and Musculoskeletal Skin Diseases (NIAMS) receives only 1.7 percent of the overall National Institutes of Health budget, and only a portion of that goes to musculoskeletal research. This remains unacceptable.
 
The 2016 U.S. Bone and Joint Initiative report, “The Burden of Musculoskeletal Diseases in the U.S.,” outlined in great detail the societal cost of bone and joint conditions, and the disparities in funding for musculoskeletal research compared to that allocated for other diseases and conditions. However, a silver lining this past year was the Academy securing a U.S. Department of Defense grant of more than $1 million to create six Clinical Practice Guidelines and six Appropriate Use Criteria for major extremity trauma over the next four years.  It is unusual for medical associations to be awarded grants of this size and we are very proud of our team, and the federal government’s commitment to improving orthopaedic patient care.
 
Barbella: Please characterize the past year (2016) for the orthopaedic industry.
Williams: Advances in additive manufacturing, or three-dimensional (3D) printing, continued to dominate orthopaedic news in 2016. These advances, which include the creation of precision surgical tools; implants, from large joints to custom pins for fingers and toes; and customized, synthetic bone material and scaffolds, have the potential to significantly improve patient care. No skeleton is exactly the same; customizing orthopaedics will lead to more precise treatment strategies, and ultimately, improved long-term mobility and patient satisfaction.
 
We also continue to see new research and discoveries using biologics—most notably, stem cells—to regenerate or repair damaged bone and cartilage. While there is much we still have to learn about the regenerative powers of biologics, they have tremendous potential to improve patient outcomes and function, and to delay or avoid surgery.
 
Of course there are ongoing challenges associated with integrating rapidly developing products and patient-specific risk-benefit assessments into both regulation and treatment plans.
 
Barbella: What was the most difficult challenge of your presidency?
Williams: The orthopaedic profession continues to face some significant regulatory obstacles, namely the continued emphasis on value-based medicine. However, we are encouraged and hopeful that the new U.S. Department of Health and Human Services secretary will provide exemplary guidance to the agency, and when possible, regulatory relief to orthopaedic surgeons who feel increasingly burdened by the policies and regulations that threaten the patient-physician relationship and limit access to orthopaedic care.
 
Barbella: What advice would you give to your successor, William J. Maloney III?
Williams: First, I know that the Academy will be in spectacular hands under the direction of Dr. Maloney.

There certainly are challenges ahead and I know Dr. Maloney has his own set of priorities. In general, the Academy must develop performance measures that are acceptable to our membership, as well as the CMS and the National Quality Forum; expand its role in orthopaedic registries; and implement the collection of patient reported outcome measures into routine clinical practice. Finally, education is one of our core competencies and we must continue to strengthen our brand.
           
Most of all, I urge Dr. Maloney to enjoy this year and the tremendous opportunity and privilege provided to those who serve as AAOS president. I have met so many amazing individuals who share a commitment to quality patient care and the advancement of orthopaedics.  It has been an honor for me to serve in this capacity.