Day two of the annual American Academy of Orthopaedic Surgeons (AAOS) conference in Chicago has wrapped up with political advocacy being the theme of the day only there were two very different stances on how that should play out.

Let me explain.

Incoming AAOS president Dr. Joshua Jacobs, an orthopedic surgeon specializing in large-joint reconstruction and chairman of the Department of Orthopaedic Surgery at the influential Rush University Medical Center, laid out the primary goals for his time at the healm to a packed crowd. First and foremost, Dr. Jacobs plans on countering the Obama administration's attempts to reign-in health care spending, particularly in the orthopaedics industry which the new AAOS president felt was being "singled out" in discussions about cost savings. In particular, he suggested that joint replacements were being increasingly (and unfairly) targeted. Dr. Jacobs made clear his desire to enhance the AAOS' advocacy and lobbying efforts in an effort to combat restrictive and costly regulations placed on the orthopaedics industry, and, more ambitiously, achieve a repeal of the Independent Payment Advisory Board (IPAB). For those of you who need a refresher, the IPAB is a fifteen-member federal agency created by the Patient Protection and Affordable Care Act (PPACA) and would be tasked with reducing Medicare payment rates, to put it simply. Although Dr. Jacobs admitted that the US government needs to return to fiscal balance, his message was clear, if not put so bluntly: balance the budget, but don't make the orthopaedic industry your whipping boy. Of course, Dr. Jacobs was preaching to the choir and received a rousing ovation from the standing-room only crowd.

The next speakers didn't receive quite so warm a response.

Following Dr. Jacobs' speech, Alan Simpson and Erskine Bowles, the co-chairs of the 2010 National Commission on Fiscal Responsibility and Reform, sat down for a talk as the presidential guest speakers. Bowles and Simpson made a strong case for bipartisan cooperation in achieving fiscal balance, identifying the growing national debt as a "national security issue", a point of view that seemed to be shared by the somber audience. However, while the diagnosis sounded correct, the prescription was less welcome. Both Simpson and Bowles were uniform in identifying health care spending as the predominant (and growing) threat to US fiscal balance, calling it the "mastadon in the kitchen" and "totally unsustainable", and carefully stood by their calls for over $600 billion in cuts to health care spending. While the two advocated a "surgical" approach to cuts rather than an across the board reduction in health care spending, the message to the hundreds of orthopaedic surgeons in attendance was clear, and more than a few snickers were heard in the audience. At the conclusion of their talk, the pair received only polite applause in large part due to Simpson's indelible wit?a far cry from the deafening reception to Dr. Jacobs' speech.

So it was a day of remarkable contrasts at AAOS 2013. It seems regardless of where you stand on this issue, cost-containment will inevitably continue to impact the US orthopaedic industry for years to come. Business-as-usual won't be so "usual" for some time...

We'll have more from Chicago as AAOS wraps up on Friday. Stay tuned!a

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