Dear Fellow WSOA Members,
Thank you for the opportunity to serve the WSOA for the next two years. I am proud to lead the orthopedic surgeons in Washington State. Greg Brown MD will serve as president elect and Nick Rajacich will serve as Sec/Treasurer.
WSOA has continued to observe and help direct organizations such as the Health Technology Assessment program to insure fair and scientific evaluations of orthopedic treatments that are paid for by the State HCA (Health Care Agency) which is the largest payer in the state. Our resources within WSMA keep us abreast with insurance, legal, and legislative activities in the state that affect our practices. WSOA continues to financially contribute a large portion of resources to the UW Orthopedic program to help fund activities which are not well supported by their funding. I am extremely proud to say that we have a strong relationship with the University of WA Resident program. Residents attend WSOA meetings at no cost and are awarded for their research.
The WSOA annual meeting in November was highly successful for the attendees. Dr. William Maloney, first Vice-president of the AAOS, presented the current mission of the academy. While advocacy is the number one mission, there is much time and resource spent on education, upgrading to digital media, protecting member’s rights to fair peer review, and policing our ranks. Presenter, Dr. David Jevsevar honed his skills in developing bundled payment programs for Intermountain Orthopedics in Utah before moving to Dartmouth and now serves the Academy committee on evidence based quality and value. He gave an insight into the need to precisely quantify our work efforts and costs so that we can set up balance billing contracts with payers. Dr. Greg Brown gave a presentation on the current science of anticoagulation therapy for joint replacement and it seems reasonable to use ASA 81 mg BID.
Bob Perna, from WSMA, addressed many of the complaints that orthopedists have regarding denials and administrative roadblocks to providing surgical services. We are providing form letters that can be used by patients and providers to complain to the OIC (Office of Insurance Commissioner.)
Patients filing complaints
Providers filing complaints
What the WA OIC can and can’t do
Unfortunately many insurers are using ASO companies (Administrative Service Organization) which do not bear risks themselves but are only intermediaries to manage claim issues and they do not fall under OIC regulations. This, sadly, is a clever maneuver to separate insurers from regulatory oversight. The OIC will also not respond to issues they believe are related to clinical guidelines that the insurers have contract with providers to follow. Again, this is another way to block oversight. The OIC can be brought to bear on the guidelines if they are determined to be egregiously restrictive and clearly a mechanism to deny care.
WSOA plans to correspond with Mike Kreidler, Insurance Commissioner, to make him aware of our concerns as practicing orthopedic surgeons in WA.
Please feel free to call me at 360-531-0902 or email me at email@example.com with your concerns
Alan Greenwald, M