WesternNews Orthopaedic Association Spring 2011 www.woa-assn.org Volume 13 Number 2

President’s Message 75th Annual Meeting Theodore L. Stringer, MD July 27-30, 2011 Dear WOA Colleagues, Rosa, former chairman of the American The Royal Hawaiian Board of Orthopaedic Surgery, as the Presi- & Sheraton Waikiki Did it seem like a long winter? dential Guest Speaker. His presentation is Honolulu, Hawaii It always helps to have some- entitled, “Ruminations of an Orthopaedist”. thing special to look forward to The Howard Steel Lecture will be provided and now that it is officially spring, it must be by Dr. Harvey Schiller whose long resume In addition to podium presentations, we are time to make your plans for participation in includes tenures as executive secretary of the privileged to welcome many national experts this summer’s WOA Annual Meeting. We USOC and CEO of YankeeNet. His topic will on a multitude of symposia and current con- are returning to the beautiful Hawaiian Is- be “Leadership from a Sports Perspective”. cept topics. We are pleased to have AAOS lands where we will be staying at the adja- His lecture will be of interest to all attendees President Dan Berry as a participant in this cent properties, the Sheraton Princess and and guests. year’s program. the Royal Hawaiian on Waikiki Beach. A “special” aspect of our meeting is the celebra- We promise you a diverse, interesting and The social program will likewise be diverse tion of our 75th anniversary and one of the relevant scientific program under the direc- and memorable including the utilization of highlights will be a presentation by Larry tion of Program Co-Chairmen, Jim Duffey the recently renovated and spectacular Royal Housman, former President and current and Mike Dohm. We have received and re- Hawaiian (the Pink Lady). Arranged excur- Managing Director of the WOA, on the his- viewed a record number of paper/poster sub- sion opportunities include nearby Sea Life tory of our organization. Additional “special missions and competition for the WOA Park, island tours, golf at the renowned presentations” will include Dr. G. Paul De- Resident Awards has been uniquely intense. Ko’olau Golf Club, Diamond Head hike and

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WOA 2010-2011 Board of President’s Message continued Directors on Sunday morning, a trip to Pearl Harbor to see the USS Arizona and Battleship Missouri I encourage all of you to sign up and partici- Theodore L. Stringer, MD Memorials. Our local orthopaedists will pro- pate in this unique family oriented event and vide their perspectives on self-directed tours celebration. You can access additional infor- and sightseeing. Don’t forget that one of the mation and registration at our web site, Peter J. Mandell, MD world’s greatest beaches will only be steps www.woa-assn.org. away! We look forward to seeing you there! Our meeting is enhanced and supported by Ellen M. Raney, MD our dedicated vendors. The WOA meeting Aloha! experience is well recognized by industry to Ted and Pam Stringer be a highly regarded educational event and William C. McMaster MD networking opportunity. Their participation is greatly appreciated.

Kim L. Furry, MD New Member Benefit - Ortho-Preferred® continued

Valerae O. Lewis, MD • Claims-Made, Occurrence and Convert- your professional liability insurance. ible Claims-Made policy forms available • Coverage capabilities in all 50 states* • True consent-to-settle provision* *Products may be underwritten by The Medical Protective Marc J. Rosen, MD Company or its affiliates, National Fire & Marine Insurance Company and MedPro RRG Risk Retention Group. Product ® As a member of the WOA, Ortho-Preferred availability varies based upon business and regulatory approv- David D. Teuscher, MD professional liability insurance is offered to you al. Free extended reporting endorsement available to physi- as a member benefit. To take advantage of this cians who permanently retire (at any age), have been insured opportunity call or visit with MedPro for one year and have a retroactive date at least Kevin L. Smith, MD 48 months prior to the date of retirement (subject to state to complete an indication filing approval). form and find out how much you could save on Jeffrey M. Nakano, MD

Brian A. Jewett, MD Annual Meeting Hotel Reservation Cut-Off Omer A. Ilahi, MD Register Today for the 75th Annual Meeting July 27-39, 2011 at the Royal Hawaiian and Steven J. Morgan, MD Sheraton Waikiki in Honolulu, Hawaii. Go This exquisitely appointed guest room over- online at www.woaassn.org to view the Pre- looks Helumoa the former playground of liminary Program along with all the meeting Hawaiian royalty, now the hotel’s tranquil Lawrence R. Housman, MD information. Coconut Grove gardens.

is cutoff date to receive the Paul C. Collins, MD Annual Meeting discount rate at the Royal This alluring and palatial oceanfront room in Hawaiian and Sheraton Waikiki. the Historic Building offers stunning view of world-famous Waikiki Beach and the azure Robert Slater, Jr., MD Pacific Ocean. Bold and indulgent design is accompanied by exquisitely appointed details.

Contemporary room design infused with To make reservations, call and mention you Michael P. Dohm, MD view of the beautiful Pacific Ocean. are attending the WOA Annual Meeting, or go to the WOA website and click the James P. Duffey, MD link.

2 www.woa-assn.org / Spring 2011 / Volume 13 / Number 2

2011 Program Chairs’ Message 2011 Program Committee The Western Orthopaedic Associa- Mike Dohm and I were very py, then move into Less Invasive Spine tion gratefully acknowledges the fol- pleased when our President Surgery. There will be a very practical ses- lowing orthopaedic surgeons for Ted Stringer asked us to co- sion on Upper Extremity Fractures with re- their contributions to the develop- chair this year's WOA Annual spect to acceptable alignment. Our papers on ment of the scientific program.

James Duffey, MD Meeting's Scientific Program. Friday will cover topics in Foot and Ankle, We are also very excited to Trauma, Tumors, Joint Arthroplasty, Upper Michael P. Dohm, MD, Co-Chair present this year's program Extremity, and Pain Management. James P. Duffey, MD, Co-Chair to you. Ted has already intro- Nitin N. Bhatia, MD, FACS Brian A. Jewett, MD duced his excellent panel of We begin Saturday with a great panel to Valerae O. Lewis, MD special Guest Speakers. We discuss Current Topics in Hip Arthroplasty. Steven J. Morgan, MD will start out of the gate on There will be a special talk by Ross Wilkins Michael Dohm, MD Thursday with a distinguished about allografts and biologics. As Ted men- panel of spine surgeons speaking about spine tioned, the number of resident papers sub- patho-physiology, pain generators and treat- mitted for award this year has easily year who are truly leaders in their respective ment. Dave Wong will give a special lecture surpassed those of all previous fields. In the spirit of the WOA summer about future reimbursement models. This is years. Therefore, you can expect to hear a meeting, while we have tried to pack in a followed by stimulating talks on arthroplasty group of award-winning papers that were broad and meaningful program, we have also and spine guidelines, networks and reg- very well done and I'm sure will also be well left time in the day for family and catching istries. Due to the tremendous number of presented. Our last symposium will cover up with old friends and colleagues. Certain- quality papers submitted this year, we will knee arthroplasty. ly, we are looking forward to a special social have concurrent sessions of papers with top- program this year. ics of Basic Science, Spine, Sports and Pediat- Along the way, we will have an update from rics. AAOS President Dan Berry, and also updates Aloha! on MOC, Board of Counselors, and medi- On Friday we start with the timely topic of colegal issues. We are fortunate to have a Mike Dohm and Jim Duffey Non-arthritic Hip Pain and Hip Arthrosco- great many distinguished faculty this

2011 Scientific Program Highlights

THURSDAY – JULY 28, 2011 FRIDAY – JULY 29, 2011 (Open daily to all participants before Spine 1 - Biologics in Spine Non-Arthritic Hip Pain And and after the Scientific Program.) Spine 2 – Spine Pain Manage- Hip Arthroscopy: State Of The Art (And Sci- ment ence) SATURDAY – JULY 30, 2011 Practice Management 1 Spine 3 - Less Invasive Spine Osteoarthritis Management 1: AAOS President Address Surgery Adult Reconstruction Hip & Howard Steel Lecture Board of Councilor’s Re- Special Lecture Lessons In Leadership port & Presidential Guest Speaker Allografts: “What’s New From A Sports Perspective” “The Ruminations of an With Stem Cells, Fresh Cartilage and Scar Special Lectures Orthopaedic Surgeon: The Evolution of Or- Tissue Prevention” , “History of thopaedic Surgery” Resident Awards WOA-75th Anniversary” Angles and Evidence: Accept- Osteoarthritis Management 2: Practice Implications of able Alignment for Upper Extremity Frac- Adult Reconstruction Knee Current Health Policy” tures Updates & Presidential Spine, Sports Medi- Medical Legal Forum Address cine & Pediatrics Trauma, Foot and An- Achieving Opti- Basic Science kle, Tumors & Pain Management mism in Difficult Times” (Following Total Joint, Upper Ex- (Following Scientific Program) tremity & Miscellaneous Scientific Program) (Open daily to all participants before (Following (Open daily to all participants before and after the Scientific Program.) Scientific Program) and after the Scientific Program.)

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2011 Presidential Guest Speaker G. Paul DeRosa, MD

WOA is pleased to have Dr. G. pediatric fellowship at the Hospital for Sick President of the American Orthopaedic As- Paul DeRosa as the 2011 Presi- Children. After his fellowship, he went back sociation, chair of the ACGME/RRC for Or- dential Guest Speaker for the to the states for a two-year stint in the US Air thopaedic Surgery, as well as President of the Annual Meeting to be held in Force. He then returned to Indiana Univer- National Residency Marketing Program in Honolulu, Hawaii. He is a long- sity as an Assistant Professor in Orthopaedic 2007. In 1990, he was elected to the Ameri- term teacher, mentor and friend of the Pres- Surgery, followed by Associate Professor, can Board of Orthopaedic Surgery where he ident, Dr. Ted Stringer. He retired from Duke Professor and finally Chair of the Depart- became involved with the certification and University faculty in 2006, but remains Pro- ment of Orthopaedic Surgery form 1966 to recertification of Orthopaedic Surgeons, fessor Emeritus. He also retired from the 1995. He then relocated to North Carolina to where he focused efforts on ethics and pro- ABOS in 2008 but remains Emeritus status on become Executive Director of the American fessionalism until his retirement in 2008. the Board. Board of Orthopaedics in Chapel Hill as well as Professor of Surgery at Duke University On a personal note, Dr. DeRosa and his wife Dr. DeRosa was born in Napolean, Ohio. He School of Medicine. Mary Ann have five children and twelve received a BS degree from the University Of grandchildren who keep them very busy. Notre Dame followed by medical school at During his active years, Dr. DeRosa served as His hobbies include golf, snow skiing and Indiana University School of Medicine. Upon President of Mid-America Orthopaedic As- making chocolates. completion of his orthopaedic residency, Dr. sociation, President of the Pediatric Ortho- DeRosa relocated to London, England for a paedic Society of North America and

2011 Resident/Fellow Award Recipients Upcoming WOA Meetings

Congratulations to the following 2011 WOA Sanford and Darlene Anzel Award Winner Resident/Fellow Award Recipients. The award papers will be presented during the Scientific Program on Saturday 9:40-11:05 The Biomechanical Consequences Of Rod am. Reduction On Pedicle Screws: Should It Be Avoided? Lloyd Taylor Award Winner Resident Award Winners

Protective Role Of IL­1β Against Post­Ar­ throplasty Staphylococcus Aureus Infection July 27-30, 2011 Sheraton Waikiki & Royal Hawaiian Vernon Thompson Award Winner Transfer Of The Coracoid Attachment Of Honolulu, HI The Coracoacromial Ligament To The Distal Clavicle Improves Anterior-Posterior Stabili- Distinct Gene Expression Patterns In The ty Of Acromioclavicular Joint Reconstruction Surface, Middle, And Deep Zones Of Bovine Articular Cartilage

Harold and Nancy Willingham Award Medical Management of Osteoporosis After Winner Hip Fractures: Are We Meeting National Guidelines?

Margin Convergence To Bone For Recon- struction Of The Anterior Attachment Of A Biomechanical Comparison Of Multi-Di- June 13-16, 2012 The Rotator Cable rectional Nail And Locking Plate Fixation In Hilton Portland Unstable Olecranon Fractures Portland, OR

4 www.woa-assn.org / Spring 2011 / Volume 13 / Number 2

2011 Howard Steel Lecturer Harvey Schiller, PhD

WOA is pleased to have Harvey products and services to many in the sports of the planning and award of the 1996 Cen- W. Schiller, PhD as this year’s and entertainment industry. Before Assante, tennial to the city of Atlan- Howard Steel Lecturer. He is he served as Chairman and CEO of Yan- ta. In 1994, he was awarded the prestigious Chairman of the Board and keeNets, an integrated sports-based media Olympic Order, the highest decorated honor CEO for GlobalOptions Group, company; vice president of sports program- presented to an individual by the Interna- a multidisciplinary international risk man- ming for Turner Broadcasting System; and tional Olympic Committee. agement and business solutions company. He president of . oversees GlobalOptions’ office Dr. Schiller received a bachelor’s degree with a focus on the company’s new business Before joining Turner in 1994, Dr. Schilling from The Citadel and is a member of their development. He also recently served as was Executive Director/Secretary General of Athletic Hall of Fame. He then earned his President of the International Baseball Fed- the Olympic Committee master's degree and doctorate from the Uni- eration, the international governing body for (USOC), and served as a member of the versity of Michigan. He also served as a pilot the Olympic sport of baseball. NCAA Executive Committee. In 1994, he in the U.S. Air Force, including combat ser- was awarded the prestigious Olympic Order, vice in Vietnam, and attained the rank of Prior to joining GlobalOptions, Dr. Schiller the highest decorated honor presented to an brigadier general. He is a recipient of several was the Chairman of Assante US, a leading individual by the International Olympic military awards including the Legion of Mer- provider of financial and life management Committee, and worked directly in support it and Distinguished Flying Cross.

Multimedia Education Sessions The WOA will provide multimedia education sessions from approximately 3:00 pm – 5:00 pm on Thursday, Friday, and Saturday, July 28-30. A comprehensive selection of AAOS DVDs will be available for your review. These DVDs highlight surgical procedures and current concepts in orthopaedics. Registered attendees will find these DVDs informative and helpful in their practice.

The Best Asset Protection is Not Asset Protection... Is Yours?

David B. Mandell, JD, MBA Jason M. O’Dell, CWM

Too many physicians over the last decade Taken a step further, superior asset protec- Simply put, when determining whether or have sought cookie-cutter asset protection tion planning would involve tools that are not a particular transaction with significant plans to give them some “piece of mind” that primarily used by people for non-asset pro- tax benefits was an illegitimate tax shelter or if they ever endure an outrageous malprac- tection purposes. In this way, the best asset not, the IRS or tax court typically uses a tice case, they won’t lose everything. While protection plan involves tools typically not simple test – “Would a taxpayer have done we admire these doctors’ commitment to thought of as “asset protection tools.” In this deal if not for the tax benefit?” In other pro-actively managing their risk, we have to other words, “the best asset protection is not words, they are asking whether or not this remind doctors we speak with that all “asset asset protection.” transaction was simply done to save taxes or protection plans” are not created equal. In did it have another economic purpose? If fact, many will not even “work” if they ever Just Like Tax Planning there was such a purpose, the transaction are relied on. While few physicians realize this crucial fact stands; if was only tax-motivated, it fails. of asset protection planning, all of the leading Why is this? Essentially, it is because of a attorneys in the field know it quite well. In This same test applies when evaluating basic tenet of asset protection: that any asset fact, we are not alone – as tax attorneys and whether or not a creditor protection tactic protection plan that will truly stand up if CPAs know this adage is also just as true will be upheld if ever challenged down the challenged must have economic substance. when it comes to tax planning.

5 Western Orthopaedic Association News

Money Matters continued road. Here, the question is “did this transac- IRAs are not using them for asset protection as a part of a financial plan and enjoy (+5) tion have an economic purpose… or was it purposes. This, then, is a great example of protections easily. simply done for asset protection purposes?” attractive economic tools that just so happen If you are using tools that millions of Ameri- to have tremendous asset protection benefits Conclusion can use daily for non-asset protection pur- as well. Too many physicians who have implemented poses, you can convincingly answer “yes.” generic “asset protection plans” may be dis- B. “Hybrid” Qualified/Non-Qualified Retire- appointed if they are ever attacked – as they Asset Protection as a Sliding Scale ment Plans: Non-qualified plans are relative- may be ignored by courts that see no eco- In the 3 books either of us have written for ly unknown to physicians, despite the fact nomic substance. On the other hand, those doctors, including our latest, For Doctors that they are right in the tax code. These who implement techniques such as those Only, we use a sliding scale approach to types of plans should be very attractive to described above may be pleased – not only evaluate asset protection techniques – with physicians, as they can be terrific hedges will their protection be upheld, but they may the lowest (-5) being an asset that is com- against future tax increases and they can be build significant wealth along the way. The pletely vulnerable and the highest (+5) being used IN ADDITION to qualified plans. Once authors welcome your questions. You can an asset that cannot be taken by a creditor again, hybrid plans are generally not used for contact them at (877) 656-4362 or through even in bankruptcy. This is important to asset protection purposes, but they may have their website, www.ojmgroup.com understand here because every (+5) asset such benefits – depending on how they are protection technique, whether in a personal structured. SPECIAL OFFER: For a free (plus $5 S&H) or practice implementation, has significant copy of For Doctors Only: A Guide to Work- economic benefits to the client, irrespective C. Captive Insurance Companies (CICs) : ing Less and Building More, please call (877) of asset protection. CICs are used by many of the Fortune 1000, 656-4362. for a host of strategic reasons. In this tech- Asset Protection Which Isn’t nique, the owners of a medical practice actu- is an attorney, lecturer, and Which asset protection tools are not asset ally create their own properly-licensed author of five books for physicians. protection tools? Let’s examine a few of them insurance company – to insure various types is a financial consultant, lecturer and briefly: of risks of the practice. These can be eco- author of two books for physicians. They are nomic risks (that reimbursements drop), both principals of the financial consulting A. Qualified Retirement Plans: The term business risks (that electronic medical re- firm O’Dell Jarvis Mandell LLC. “qualified” retirement plan means that the cords are destroyed), litigation risks retirement plan complies with certain De- (coverage for defense of harassment claims or Disclosure: partment of Labor and Internal Revenue Ser- HCFA audits) and even medical malpractice vice rules. You might know such plans by (keeping some risk in the captive and rein- their specific type, including pension plans, suring the rest). If it is created and main- profit sharing plans, money purchase plans, tained properly, the CIC is like any insurance 401(k)s, or 403(b)s. Properly structured company -- established in a real economic plans offer a variety of real economic bene- arrangement with its insureds. Also, CICs fits: you can fully deduct contributions to can enjoy tremendous creditor protection these plans and funds within them grow (+4/+5) – although they are almost never tax-deferred. In fact, this is likely why most created for this purpose. medical practices sponsor such a plan. D. Cash Value Life Insurance (CVLI): CVLI What you may not know is that under feder- policies are purchased by millions of Ameri- al bankruptcy law, and nearly every state cans each year for their tax benefits WOA Newsletter law, these plans are protected against law- (generally, tax-free growth, pays income tax suits and creditor claims – enjoying (+5) pro- free to heirs), for family protection and for WOA News encourages and wel- tection status. IRAs are also (+5) protected in estate planning purposes. Nonetheless, in comes all member input. If you have bankruptcy, with some limits, although their many states, the cash value can enjoy the top any information you would like in- cluded in the next issue, please email state protection depends on the state. For (+5) protections. In this way, a physician can material to [email protected] both, the overwhelming majority of millions purchase a product that is widely recognized of Americans who use qualified plans and

Statements and opinions expressed in the advertisements and information regarding products or services herein are those of the author(s) and do not necessarily reflect those of the Publisher or the Association. The Publisher and the Association do not assume any responsibility or liability for such material and do not endorse, guarantee or warrant any product or service advertised in this newsletter.

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CMS Proposes Rule for Accountable Care Organizations By AAOS

On March 31, 2011, the Centers for Medicare waste and abuse of procedures and tests will informing CMS on how they plan deliver high & Medicaid Services (CMS) proposed guide- be eligible for additional Medicare payments. quality, cost effective, care via an ACO. If the lines for doctors, hospitals, and other health However, those who fail to consolidate a application is approved, the ACO must sign an care providers to establish Accountable Care patient’s care effectively could be held finan- agreement with CMS to participate in the Organizations (ACOs). Health care experts cially responsible for accrediting unnecessary Shared Savings Program for a period of three hope that ACOs will put an end to fragmented costs onto the health care system. According years. However, CMS is permitted to termi- care methods by creating a “shared savings to CMS, cost savings are not the sole goal of nate the agreement if an ACO fails to meet its program” to incentivize caregivers across all the program as ACOs would have to meet objectives. care settings to work together to provide high- high quality standards measured by patient quality, coordinated care for Medicare benefi- experience, care coordination, patient safety, According to PPACA, an ACO may include ciaries. CMS has proposed the guidelines in preventive health, and at-risk population/frail the following providers and suppliers of Medi- advance of the program becoming permanent- elderly health to ensure that patients are care-covered services: ly established on January 1, 2012 in order to “happy with the care they receive and have Ÿ receive feedback from providers, suppliers, better health outcomes.” ACO professionals (i.e., physicians and Medicare beneficiaries and other interested hospitals meeting the statutory defini- members. The quality standards proposed by CMS are tion) in group practice arrangements, Ÿ largely based on nationally recognized quality Networks of individual practices of ACO Theoretically, ACOs facilitate better care and measures in other CMS programs such as the professionals, Ÿ bring down costs by establishing financial in- Electronic Health Records (EHR) and Physi- Partnerships or joint ventures arrange- centives for providers and suppliers (ie. physi- cian Quality Reporting System (PQRS). ments between hospitals and ACO pro- cians, hospitals, long-term care facilities) to fessionals, or Ÿ monitor patients from start to finish. ACOs Under the CMS proposal, providers who wish Hospitals employing ACO professionals. Ÿ that make sure that patients receive appropri- to participate in the Shared Savings Program Other Medicare providers and suppliers ate care at the appropriate time and limit would be required to complete an application as determined by the Secretary

Attention 2011 New Members: FREE Meeting Registration Register online at www.woa-assn.org today!

The WOA Mission The Mission of the Western Orthopaedic Association is to promote high quality ethical care for musculoskeletal patients in the western region of the United States by providing educational programs, fostering collegiality and supporting professional development among its members and physicians-in-training, and by influencing health care policy.

7 110 West Rd, Suite 227 Towson, MD 21204 E-mail: [email protected] Internet: www.woa-assn.org

Do You Know a Qualified MD or DO Orthopaedic Colleague Who Is Not a WOA Member?

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Completion of an accredited residency program and privileges to every three years practice as an orthopaedist in a local hospital are the and ask for 1. 24 FREE CME credits through free requirements for both MD and DO candidates. an application. subscription