TOA Board of Directors Meeting Conference Call| Saturday, August 17, - - PowerPoint PPT Presentation

1

www.toa.org | Bobby@toa.org

TOA Board of Directors Meeting

Conference Call| Saturday, August 17, 2019 | 8 a.m. – 9 a.m. CDT

1

Texas Orthopaedic Association 2

2012 –2019 An Overview of TOA’s Evolution

Texas Orthopaedic Association 3

2013

Legislature

• Focused on several scope of

practice expansion issues.

2013

TOPAC

• TOPAC began its first

strong fundraising push.

2015

Legislature

• Continued focus mostly on scope of practice

issues.

2019

Legislature

• TOA took a leadership role
• n a number of issues in the

Legislature.

TOA’s Evolution 2012 -2019

2017

Legislature & Messaging

• TOA took a stronger lead on legislative and

regulatory issues.

• TOA began its communications overhaul.

Texas Orthopaedic Association 4

2012 –2019 What Has TOA Learned & Done?

Organized Operations TOA placed an emphasis on organizing all of its operations: The financials, database, and communications. As a result, virtually anyone can come in and take over TOA’s operations – it’s all organized. Identifying the Value-Add: Advocacy After much searching, TOA clearly identified its advocacy efforts as the top priority for TOA members. As a result, TOA has focused its efforts on advocacy. The culmination of TOA’s advocacy efforts led to the 2019 Texas Legislature, which featured TOA’s leadership on every health care issue related to musculoskeletal care. This is complimented by communications, which TOA has been working on. What Has TOA Learned?

• Recognize TOA’s limitations. Focus on what is important. See additional slides to view what didn’t work.
• Quit analyzing everything and focus on what you do well.
• Don’t be disappointed by what larger organizations can do.

What’s Next for TOA’s Evolution? Has TOA hit its ceiling and is at peak performance? Perhaps. But the following slides do offer some new ideas.

Texas Orthopaedic Association 5

Important Takeaway

TOA would love to find a “must have” product or service that it can offer Texas orthopaedic surgeons so that they do not view TOA membership as optional. However, that ”golden ticket” is unlikely to be identified. As a result, TOA must work harder than other organizations to market its value- add.

Macro Level What Is TOA’s Value Add?

Overview Summary

A crowded field. As evidenced by the following slide, orthopaedic surgeons face numerous choices regarding medical society membership. Unfortunately, TOA does not offer a product

• r service that an orthopaedic surgeon

cannot live without. Therefore, TOA must demonstrate its value-add to separate itself from the crowded field.

Advocacy - Primary. TOA only has anecdotal evidence, but it is clear that TOA’s advocacy work as the only organization that dedicates 100 percent of its advocacy work to Texas

• rthopaedic surgeons is what drives TOA’s

membership. Information – Secondary. The unique information that TOA delivers to its members is viewed as a benefit by a smaller set of members. But it is still a benefit.

Texas Orthopaedic Association 6

Texas Orthopaedic Association 7

2013 to 2019 A Transformation Has Led to a Baseline?

Texas Orthopaedic Association 8

Recognizing TOA’s Ceiling

TOA has a limit to what it can do, and it is important to recognize that so that TOA does not embark on adventures that result in wasted resources.

What Works: Advocacy

If TOA only did advocacy, then it would be in great shape.

What Works: Communications

Communications and messaging compliments TOA’s advocacy work. TOA’s PR efforts also serve as a membership service. TOA will continue to develop this.

What Works: Education & Intelligence

TOA’s education efforts consist of the following: annual conference, resident efforts, and TOA’s newsletters, which contain important information for practices.

What’s Ahead for TOA’s? A Look at TOA’s Services

Texas Orthopaedic Association 9

TOA’s Ceiling Overview

Summary The large orthopaedic societies are able to offer a number of services due to extensive resources and their legacy: they have been doing these things for decades. TOA has tried to copy some of those services over the past few decades. However, TOA experienced a tepid response for many of these services. Education & Online CME TOA directed a number of resources in the form of capital and staff members to create an extensive online CME library approximately 15 years ago. TOA witnessed an extremely weak response. The reality is that the national orthopaedic societies already create a tremendous amount of content, and TOA cannot beat that.

Texas Orthopaedic Association 10

Bullish View TOA’s Long-Term Future

• Advocacy. TOA is the only organization that focuses 100 percent of its on public policy

issues that affect Texas orthopaedic surgeons, and no other organization has attempted a foray into this field. Most TOA members cite TOA”s advocacy as its primary service, and TOA’s advocacy work is unlikely to be less useful in the years to come. Member communications. Through its advocacy work, TOA is able to deliver intelligence about the public policy and industry developments to orthopaedic practices, and much of this information cannot be found elsewhere. As a result, a number of practices view TOA’s news and analysis to be useful. This is unlikely to change in the year to come. Messaging and branding. TOA creates and delivers messages about orthopaedics to complement its advocacy work. For now, the messages target lawmakers and health care

• stakeholders. However, the messaging has the potential to transform into a PR campaign to

educate the public about orthopaedic surgeons. This could become a valuable member service. TOA will identify a tangible service. While it has never happened in TOA’s existence since 1936, TOA could stumble upon a product or service that Texas orthopaedic surgeons cannot live without.

Texas Orthopaedic Association 11

Bearish View TOA’s Long-Term Future

Too many orthopaedic and medical societies. Could the dozens of societies that are competing for the same small pool of orthopaedic surgeons eventually drain too many resources away from TOA?

Texas Orthopaedic Association 12

Operations & Leadership Overview

Texas Orthopaedic Association 13

Important Takeaway

If

TOA’s Operations Overview of the 2012-19 Changes

Overview Summary

Ensuring that TOA was organized was a top

• priority. TOA’s board had the goal of
• rganizing TOA’s operations at the beginning
• f 2013.

Advocacy - Primary. TOA only has anecdotal evidence, but it is clear that TOA’s advocacy work as the only organization that dedicates 100 percent of its advocacy work to Texas

• rthopaedic surgeons is what drives TOA’s

membership. It isn’t tangible. The unique information that TOA delivers to its members is viewed as a benefit by a smaller set of members. But it is still a benefit.

Texas Orthopaedic Association 14

TOA’s Leadership Pipeline Upcoming Leaders

Presidential Line Adam Bruggeman (San Antonio) – 2019-20 Ken Kaminski (Tyler) – 2020-21 Luis Urrea (El Paso) – 2021-22 John Hinchey (San Antonio) – 2022-23 It’s too early to name presidents beyond 2023. However, we have potential candidates ready to go. AAOS Board of Councilors Andrew Palafox (El Paso) – Ends in 2020 Omer Ilahi (Houston) – Ends in 2020 Kyle Dickson (Houston) – Ends in 2021 Ken Kaminski (Tyler) – Ends Much Later John Hinchey (San Antonio) – Ends Much Later On Deck: Adam Bruggeman (San Antonio) – 2020 Henry Ellis (Dallas) - 2020

Texas Orthopaedic Association 15

Member Ownership What About Those Who Want to Engage?

• Overview. Some TOA members are seeking a greater “ownership” in TOA and want to

become more involved. But it isn’t always clear to them as to how they can play a greater role. TOA Leadership Council. TOA created the leadership council e-mail list in 2018 to give “more engaged” orthopaedic surgeons and practice administrators an opportunity to weigh in on issues. In addition, it creates a leadership pipeline. Approximately 80 individuals are on the e-mail list. The e-mails have provided valuable input for TOA’s advocacy efforts. AAOS Orthopaedic PAC Advisor’s Council. For a large donation to the AAOS PAC, a practice is recognized as a member of the Advisor’s Council. This provides ”soft money” to AAOS’s PAC. In exchange, the members are listed on AAOS materials and receive special e-mail updates

• n public policy issues.

This is just an example. TOA Champions Circle. Perhaps we could figure out a name like this to identify the groups that have 100 percent participation in TOA membership and TOPAC giving. (Only one group meets this criteria.)

Texas Orthopaedic Association 16

How Can TOA’s Leadership Council Help?

TOA’s residency activities need several volunteers to help create structure and identify resident activities for TOA. Current resident leaders: Jacob Murphree (Tech), Jordan Handcox (San Antonio) & Max Danilevich (UTMB)

TOA’s Resident Overview Has It Lost Momentum?

Overview Current State

TOA had a sharp increase in resident

• activities. TOA is in a unique position in that

it is the only specialty society that focuses

• n orthopaedics in Texas. Therefore, it can

provide unique insight to residents in Texas. From 2013 to 2017, TOA had a sharp increase in its resident activity:

• Approximately 40 residents attend TOA’s

annual conference every year.

• TOA was visiting resident programs

several times each year.

• At least three residents serve on TOA’s

leadership council and visit Capitol Hill with TOA every year.

TOA doesn’t have a formal structure for the

• education. TOA is able to attract a lot of

residents to the annual conference. However, the conference does not feature a formal resident breakout session. The residency programs have stopped inviting

• TOA. TOA has a public policy presentation and is

willing to travel. But the residency programs have stopped calling.

Texas Orthopaedic Association 17

Annual Conferences Past Review & Future Discussion

Texas Orthopaedic Association 18

2019 Annual Conference Financial Review

Revenue Registration $25,836.88 Sponsors $154,000 TSSM $5,000 AAOS $4,975 Total Revenue $189,811 Margin $67,876.61 Expenses Hotel Rooms $19,630 Banquets $47,307 Communications A/V $11,595 Design + Mail $6,725.41 Residents Quiz Bowl $1,500 Papers $3,000 Speakers/Staff Coding Course $6,867 Strategic Planning $4,000 Travel $1,402.10 Social Events Thursday Night $5,799 Topgolf $8,701 Misc. Eventbrite $909.94 Print Shop $1,643.66 Key Cards $794.93 Lanyards $1,402.22 Etc. $656.68 Total $121,934.39

Texas Orthopaedic Association 19

2014-19 Net Margin

2016 Annual Meeting Revenue $168,781.65 Expenses $168,273.44 2016 Margin $508.21 2015 Annual Meeting Revenue $180,000.00 Expenses $100,290.23 2015 Margin $79,709.77 2014 Annual Meeting Revenue $154,617.00 Expenses $116,192.95 2014 Total $38,424.05 2019 Annual Meeting Revenue $189,811.00 Expenses $121,934.39 2019 Margin $67,876.61 2018 Annual Meeting Revenue $174,616,00 Expenses $101,524.38 2018 Margin $73,091.62 2017 Annual Meeting Revenue $180,755.40 Expenses $136,081.73 2017 Margin $44,673.67

Texas Orthopaedic Association 20

2018-19 Annual Conference Attendance

Texas Orthopaedic Association 21

21

2016

Hyatt Regency Lost Pines

25 Admin, COO, DOO, CEO etc 93 Other Admin Titles 16 Billing/Coding 168 MD or DO 8 PA, PT, DPT, OCS, FAAOMPT 11 RN, PT, PA, etc. 60 Coding Course 25 In State Faculty 2 Out of State Faculty 15 Paper Presenters

2015

Austin Hilton - Austin

AT 6 DO JD 148 MD 17 PA 2 RN 56 Coding Course 13 In State Faculty 4 Out of State Faculty 8 Paper Presenters

2014

Westin Riverwalk - San Antonio

1 AT 10 DO 4 JD 163 MD 1 PA 1 RN 98 Coding Course 26 In State Faculty 5 Out of State Faculty 18 Paper Presenters

2013

Four Seasons - Austin

AT 2 DO JD 114 MD PA RN 26 Coding Course 19 In State Faculty 3 Out of State Faculty 8 Paper Presenters

2012

Houstonian - Houston

1 AT 5 DO JD 153 MD PA RN 46 Coding Course 15 In State Faculty 1 Out of State Faculty 10 Paper Presenters

2011

Hyatt Regency - Lost Pines

AT 2 DO JD 77 MD PA RN Coding Course 7 In State Faculty 4 Out of State Faculty 7 Paper Presenters

2010

Great Wolf Lodge - Grapevine

1 AT 3 DO JD 118 MD PA RN 43 Coding Course 12 In State Faculty 1 Out of State Faculty 6 Paper Presenters

Notes: MD/DO figures include all physician attendees and Thursday coding course-only physicians for 2016 and prior years.

Texas Orthopaedic Association 22

2020 Annual Conference Overview

Thursday, February 6

• 10:00 a.m. board meeting
• 2 p.m. field trip to the Centre for the Intrepid (SA Military Medical Center)
• Leadership Dinner (downtown)

Friday, February 7

• Coding course (breakout)
• Strategic planning course (breakout)
• General Sessions (clinical)
• General Sessions (business)

– Mike McCaslin (OrthoForum)

• Can we do a Stryker cadaver lab? (Planning has to start now.)
• Dinner at the Pearl Stable in the Pearl Brewery

Saturday, February 8

• General sessions (clinical)
• 18th Annual Resident Quiz Bowl

Texas Orthopaedic Association 23

Can We Increase the Conference Net? An Analysis

Costs Can’t Go Lower

Current State

TOA probably can’t reduce the production

• costs. Looking at the P&L on the previous

slide, we can make the following analysis:

• A/V – After years of failures with the big

a/v companies (Freeman), we have identified the lowest cost and best product possible 2018 & 2019 were great.

• Comms – Our graphic designer charges a

low rate. The graphics, video, and communications are critical for marketing.

• Hotel Costs – TOA uses a large negotiation

company to negotiate outstanding rates for TOA.

• Hotel Rooms – TOA provides a hotel room

night to each speaker and resident.

Sponsorships – We can’t squeeze out too much

• more. Unless we witness a sharp increase in

physician/practice administrator attendance, we can’t increase the sponsorship rates. They are already more expensive than any other state or regional meeting. “Don’t get greedy.”

• Registration. TOA started charging a nominal fee

for attendees in 2014. The extra income was important, and the fee made members commit to attending (we had too many no-shows without a fee). We try to keep the fee for the conference and coding course low so that it is a member benefit. Therefore, we have not raised it. We will be able to charge a fee for dinner to

• ffset the cost of tickets.

Texas Orthopaedic Association 24

Future Meetings An Analysis

Scenarios

Future Possibilities

Texas Isn’t California, Colorado, or Florida. We do not have the same vacation destinations as these other states. Texas doesn’t have the option of a summer meeting at a resort. Same course for the foreseeable future. The board held an extensive discussion at the 2017 meeting and decided to stay with the current format. Winter date. TOA switched to a winter date for 2019 and 2020 in an attempt to avoid the busy spring/summer meeting schedule.

2021: Austin? The AT&T Conference Center on the UT campus is willing to provide an

• utstanding rate for February 5-6, 2021. Austin

is considered to be a “fun” destination. Austin-San Antonio rotation? If we are seeking ”fun” destinations, then Austin and San Antonio may make the most sense for a rotation (Austin in odd and San Antonio in even years) if we keep winter months. (The threat of winter weather is much less in these cities.) Return to resorts? If there is a strong desire to return to a resort, there are several considerations:

• We would need to switch to the spring. The

spring can have a lot of conflicts, and the prices may be too much.

• Horseshoe Bay may actually be a good

destination for TOA (nice resort and lower costs).

Texas Orthopaedic Association 25

Bullish View Future of TOA Conferences

Quality, not quantity. While we may wish we had larger audiences of physicians and practice administrators, the reality is that almost every practice is represented at TOA’s meeting, and those who attend are very engaged in TOA. In addition, approximately 40 residents attend TOA’s conference every year, and this is important for the future of orthopaedics in Texas.

• Baseline. TOA’s attendance and sponsorships remain similar every year. The conference

appears to have found its baseline.

Texas Orthopaedic Association 26

Bearish View Future of TOA Conferences

Will the sponsors quit on TOA? As long as the sponsors continue to attend every year, the conference is sustainable. However, if the sponsors ever stop participating due to what they perceive as a lack of value or if they witness an attendance drop, the conference will not be possible. Too much competition and not enough time. Numerous conferences for orthopaedic surgeons and practice administrators are competing for the same small pool of attendees. Will this eventually affect TOA (if it hasn’t already)? The winter is risky. While winter storms in Central Texas are rare, the reality is that insurance will not cover a cancellation due to ice. The hotel must be completely shut down due to a hurricane or other type of disaster that makes it impossible to be open.

Texas Orthopaedic Association 27

What if the Current Meeting Changes? Analysis

The current course probably exists through 2021. Since TOA is able to book a good deal in Austin for 2021, it probably makes sense to go with the current template for 2021. $50,000 net. TOA is able to derive approximately $50,000 from the annual conference, and this figure is important for TOA’s operations. If TOA changed to a “strategic planning retreat” at a “fun venue” that focused on business and public policy issues with a smaller number of attendees representing each practice, could TOA derive enough sponsorships to create a $50,000 profit? For example, several sponsors at $10,000 each? This would involve eliminating the clinical program and the residency program. Major change is risky. Major changes are always risky. TOA cannot afford to have a “failed” conference from a financial standpoint.

Texas Orthopaedic Association 28

Membership Overview

Texas Orthopaedic Association 29

Dropped Failure to Pay Dues for Three Straight Years

47 were dropped for non-payment in July 2019.

Texas Orthopaedic Association 30

July 2019 Dues Owed Before the 2020 Dues Went out

Notes: $500 = 1 year; $250 = 1st year; $1,500 = 3 years

Texas Orthopaedic Association 31

New Members Lots of “Low-Hanging Fruit” in 2016 & 2017?

Texas Orthopaedic Association 32

Dues Breakdown Per Year

2019 2018 2017 2016 2015 2014

Regular ($500) $320,150 $327,500 $302,300 $320,725 $334,350 $357,105 New ($250) $4,000 $11,250 $39,600 $15,942 $9,050 Allied Health ($75) $600 $450 $225 $150 $150 Administrator ($50) $200 $300 $350 Military ($175) $700 $525 $350 $350 Total Per Year 672 715 775 709 707 714 Notes: $250 was for first- and second-year dues in 2015, 2016, and 2017. TOA made $250 for first- year only in 2018. TOA is continuing to collect 2020, 2019, and 2018 dues.

Texas Orthopaedic Association 33

P&L Margin Per Year

Year Margin Notes 2018 $12,267.82

* Will climb slightly in 2019 since TOA continues to collect 2018 dues.

2017 $1,464.93

* Could climb slightly in 2019 since TOA will continue to collect 2017 dues.

2016 ($40,544.55)

* High cost due to Hyatt Lost Pines meeting.

2015 $43,657.15 2014 $44,677.06

Texas Orthopaedic Association 34

Finances Attempt to Raise New Revenue

• TOA prides itself on not raising dues. TOA has had only one raise in 15 years, and

that was a $25 increase for 2013.

• TOA is attempting to raise more money for the Texas Orthopaedic Foundation,

which will cover TOA’s residency costs and education at the conference.

• TOA was selling approximately $10,000 in ads on the website each year. However,

the ads have largely dried up.

Texas Orthopaedic Association 35

Communications Overview

Texas Orthopaedic Association 36

INTELLIGENCE TARGETED MESSAGES PR FOR ORTHOPAEDICS

TOA’s Communications Three Targets

• Many TOA members view

TOA’s newsletters as an important member service.

• TOA delivers unique

information about public policy and industry developments that are valuable to practices.

• TOA’s advocacy success would

not be possible without TOA’s messaging, which serves as a

• complement. It is critical to be

in charge of the musculoskeletal brand in the advocacy arena.

• Advocacy has evolved, and

the days of “back door deals” are gone. Communications are key.

• TOA has played with the idea of

branding the orthopaedic arena in the eyes of patients and the general public.

• A widespread PR campaign is

much more complicated. TOA would need to determine its goals and spend money for advertising efforts.

• This could be viewed by members

as a useful member benefit.

Texas Orthopaedic Association 37

How Can TOA’s Leadership Council Help?

Everyone identifies potential content to provide for TOA’s newsletters, social media, and other feeds. Create a committee that focuses on communications. James Saucedo, MD is interesting in leading it.

What Works Communications

Overview Current State

What does TOA do? Communications means a lot of different things for TOA:

• Education/Intelligence. TOA’s newsletters

provide unique and important information about public policy and industry changes that many practices utilize.

• Messaging. TOA’s messaging tells the
• rthopaedic story, and it targets three

different audiences: policymakers (primary target), health stakeholders (secondary target) and patients/general public (there is potential here).

Intelligence gathering. TOA will continue to place an emphasis on producing newsletters that contain valuable information. This is a strong member service.

• Messaging. TOA has placed an emphasis on

branding public policy issues, and this has helped in TOA’s advocacy efforts. Examples can be found in the following slides. TOA will continue to evolve in this arena. TOA may be in a unique position to take the

• rthopaedic brand to patients and the general
• public. But is TOA ready? More in the following

slides.

Texas Orthopaedic Association 38

ADVOCACY’S EVOLUTION

Political science is a soft science: every issue is different. Personal relationships and “back room deals” are still the norm in advocacy. However, the advent of the internet has led to a greater role for the grassroots. Social media tools such as Facebook and Twitter took the role of grassroots in politics to an entirely different level. Compared to a decade ago, messaging and communications play a far greater role now in politics. TOA has adapted.

Texas Orthopaedic Association 39

National organizations such as AAOS and the American Society for Surgery of the Hand already have media campaigns that discuss clinical topics. For example, ASSH has a web page dedicated to hand injuries. These organizations have the resources to make clinical recommendations regarding musculoskeletal injuries and

• conditions. In addition, there is no need for TOA to re-invent the

wheel to simply repeat the same injuries. TOA has identified a void regarding general messages about musculoskeletal care. In response, TOA has created general messages about orthopaedics. These messages have been used to educate lawmakers about musculoskeletal care. In addition, TOA’s messages are influencing the orthopaedic brand among stakeholders and the general public. However, this could be viewed as more of a long-term project. Examples of TOA’s work in the summer of 2019 can be found on the following pages.

Communications What TOA Can and Can’t Do

Don’t Re-Invent the Wheel: TOA Doesn’t Dig in the Weeds Fill the Void: Brand Orthopaedics in Texas

Texas Orthopaedic Association 40

Getting Organized What Is TOA’s Focus with Advocacy Messages?

What are our audience targets? To use our resources wisely, TOA has defined what it is trying to accomplish with its messages. As a result, TOA has focused on messages that complement TOA’s advocacy work, and the intended targets are both policymakers and

• ther stakeholders who could help influence the issues.

Samples include:

• Orthopaedic surgeons have the highest level of training. These messages

address inappropriate scope of practice expansions (without specifically mentioning the scope issues).

• Coordinated care models. TOA reminds lawmakers and patients that the

future of medicine is everyone working together, not mid-level providers working in a fragmented model. It becomes difficult for mid-level providers to argue against this team-based environment in which everyone works

• together. Again, this targets scope of practice issues without mentioning the

specific scope.

• Prior authorization reform. TOA created messaging on prior authorization

reform during the 2019 Texas Legislature. Examples can be found on the following pages.

Texas Orthopaedic Association 41

Texas Orthopaedic Association 42

Texas Orthopaedic Association 43

Texas Orthopaedic Association 44

Texas Orthopaedic Association 45

Social Media Stats Twitter, Facebook & Linkedin

Texas Orthopaedic Association 46

Newsletters Useful Education for Members & Education for Our Members

Texas Orthopaedic Association 47

Sharing the Message Video

Texas Orthopaedic Association 48

Messaging What’s Next?

Enhance TOA’s “city impact” one-pagers. These one-pagers show the number of

• rthopaedic surgeons, ASCs, and physician-owned hospitals in each city, and they can be

found on TOA’s website. However, they need to be made to “look better.” Continue focusing on general messages. TOA will continue to create general messages about musculoskeletal care. A communications committee? James Saucedo, MD is interested in leading a communications committee to identify messages. Do we have any volunteers to join him?

Texas Orthopaedic Association 49

What’s Next? TOA Has Figured out Its Advocacy Messages; A General Campaign?

What are TOA’s next targets? Advocacy is TOA’s primary mission, and TOA targeted lawmakers and stakeholders with messaging pieces to advance TOA’s advocacy priorities. This target was “low-hanging fruit.” What are the next targets? TOA will have to determine two things: What are TOA’s next targets, and what is the message? Some potential thoughts include:

• Patients and the general public. AAOS has already attempted to reach patients and the

general public through its messages.

• Large employers in Texas. Large employers in Texas control millions of health care lives.

It can be difficult to track down all of the employers and their employees who handle HR, but they could be a new audience to educate about orthopaedics.

Texas Orthopaedic Association 50

Advocacy Victories Overview

Texas Orthopaedic Association 51

STATE GOVERNMENT MOVES QUICKLY

Congress is slow and methodical. State government moves quickly. Texas, for example, only meets for 140 days every other year. It is a chaotic pace.

INSIDER ISSUES

Relationships are more important at the state level. In some cases, a handful of individuals hold the keys.

LIMITED RESOURCES

We need more brainpower. Limited resources make it difficult to hire more consultants.

TOA The Challenges & Realities of State Government Advocacy

Texas Orthopaedic Association 52

ADVOCACY VICTORIES COMMUNICATIONS ENGAGED MEMBERSHIP

Public Policy Major Presence in the 2019 Texas Legislature

• TOA continues to grow in

an exponential manner each legislative session in Texas.

• 2019 represented TOA’s

greatest jump: TOA led all segments of the health care industry on a number

• f issues.
• TOA has recognized that we

have entered an information age by creating unique and timely content to shape issues and public

• pinion.
• TOA places an emphasis on

educating its membership about the issues so that they will be engaged.

Texas Orthopaedic Association 53

Alliances Strong Relationships Messaging

Advocacy at the State Level What’s Required

Texas Orthopaedic Association 54

Craft Beer vs. Beer/Liquor Distributors | Grassroots vs. Cities

Advocacy at the State Level in T exas The Power of Grassroots & Numbers in 2019

Texas Orthopaedic Association 55

Strategies: DC vs. Austin Alliances Are Becoming More Common

Texas Orthopaedic Association 56

2019 T exas Legislature Messaging

Texas Orthopaedic Association 57

How Can TOA’s Leadership Council Help?

If TOA quit doing everything else and only focused on advocacy, TOA would still have the same value-add in every members’ eyes.

What Works Advocacy

Overview Summary

TOA is at its peak, and there is no decline in

• sight. TOA has been building its advocacy
• perations since 2012, and TOA has reached

its peak performance capability:

• TOA is the advocacy leader in Austin on a

number of health care issues.

• TOA controls the message on

musculoskeletal issues in Austin.

• Few other organizations can match TOA’s

intelligence gathering and analysis related to public policy.

Advocacy - Primary. TOA only has anecdotal evidence, but it is clear that TOA’s advocacy work as the only organization that dedicates 100 percent of its advocacy work to Texas

• rthopaedic surgeons is what drives TOA’s

membership. It isn’t tangible. The unique information that TOA delivers to its members is viewed as a benefit by a smaller set of members. But it is still a benefit.

Texas Orthopaedic Association 58

2019 Texas Legislature Commercial Insurance

2019 Legislature

2020 and Beyond

Prior authorization transparency. Health plans will be required to unveil their prior authorization requirements. Amendment to SB 1742. Utilization review reform. Health plans and workers’ comp carriers will be required to use physicians of the same or similar specialty and licensed in Texas to perform UR reviews. This will require a rule-making process. Amendment to SB 1742. Surprise billing. The new Texas law is now physicians’ preferred concept for the debate at the national level. SB 1264. Prompt pay. TOA led the effort to defeat HB 1914, which would have changed the state’s prompt pay calculations on behalf of freestanding ERs. Prior authorization was a huge lift. Several key lawmakers made prior authorization transparency their top priority, which put the issue across the finish line. TOA has yet to identify another commercial insurance issue that needs similar attention. Upcoming rulemaking. The rules are being developed for these bills.

Texas Orthopaedic Association 59

Texas Orthopaedic Association 60

Mediation Arbitration

Texas Orthopaedic Association 61

2019 Texas Legislature Workers’ Comp

2019 Legislature

2020 and Beyond

Sunset Was Pushed to 2023. TDI-DWC’s sunset was pushed to 2023 (originally scheduled for 2021). APRN and Form 73. The PAs achieved Form 73 status in 2017, and the APRNs followed suit in 2019. Agency Reviews. TDI-DWC conducts regular utilization reviews, and they are currently looking at neuromuscular testing and therapy utilization. Fairly Quiet in 2021. Once the 2021 Legislature ends, TOA and other stakeholders will begin making sunset recommendations in the summer

• f 2021. TOA needs to be ready.

Agency Reviews. If TOA has concerns regarding patient care of any aspects of the system, TOA can make recommendations for TDI-DWC to study items.

Texas Orthopaedic Association 62

2019 Texas Legislature Opioids

2019 Legislature

2020 and Beyond

Three Bills on CME. Three different bills that will require approximately two hours of CME during a two-year licensing period passed. TMB will release instructions later this summer. 10-Day Limits. Rep. John Zerwas, MD listened to TOA and agreed to extend the limit from seven to 10 days. e-Prescribing in 2021. The Legislature will require e-prescribing for Schedule II in 2021, which matches the Medicare date. Informed Consent Defeated. The ”11-point” informed consent bill, HB 2811 by Rep. Four Price (R-Amarillo), was defeated in the Senate. However, it is likely to return again in 2021. Was 2019 the End of the Debate? Lawmakers unfortunately took a shotgun approach to the

• pioid issue in 2019, which resulted in a number
• f different bills.

However, the Legislature is unlikely to take another lengthy look at the issue in 2021. Informed Consent Is Likely to Return. Rep. Four Price (R-Amarillo) is likely to once again introduce his informed consent bill, HB 2811.

Texas Orthopaedic Association 63

20192021 Texas Legislature Podiatry

The Issue

2020 and Beyond

Is the Foot Part of the Ankle? TOA’s conference call will review the situation. Click here to view an attorney’s opinion of the issue (page 3); http://toa.org/pdfs/newsletters/TOA- Newsletter-2014-Spring.pdf 2021 Texas Legislature. The phone call will discuss the potential scenarios.

Texas Orthopaedic Association 64

2019 Texas Legislature Physical Therapy

The Issue

2020 and Beyond

A Unique Way to Look at Look at Direct Access. Texas was one of the last states that did not allow direct access. Lawmakers presented an

• pportunity to accept TOA’s proposal:
• 15 business days for PTs who have a

residency or fellowship.

• 10 business days for all other PTs.
• An informed consent form for patients

indicating that they understand that direct access does not replace a physician’s diagnose, a PT can’t diagnose, imaging isn’t involved, and insurance may not cover it. The Existing Referral Was Struck. The existing law, which allowed a patient to return directly to a PT for a previous diagnosis for 30 days (or 20 sessions) was removed as a result of the new law. An Industry Debate over Training. Due to the different levels of direct access, the new law has generated a discussion within the PT community regarding what level of training is appropriate for patient care. PTs Would Like Unlimited Access. Some like to seek unrestricted direct access. However, lawmakers will point to the 2019 law as a compromise.

Texas Orthopaedic Association 65

2019 Texas Legislature Chiropractors

The Issue

2020 and Beyond

“Neuromusculoskeletal System.” A Travis County court concluded that the chiropractors’ scope of practice does not include the nervous

• system. This came as a result of TMA’s lawsuit

with the chiropractors’ board. The chiropractors approached TMA and TOA to define the “musculoskeletal system” prior to the 2019 Texas Legislature. However, an agreement was not reached. Lawmakers held hearings on the chiropractor issue in both chambers. However, neither committee took a vote on the issue in 2019. A 2021 Debate. The issue is likely to return in the 2021 Texas Legislature.

Texas Orthopaedic Association 66

Luis Urrea (El Paso) – Chair John Early (Dallas) John Hinchey (San Antonio)

Texas Orthopaedic Association 67

TOPAC’s Budget for the2019-20 Cycle Proposed Criteria

#1 Willingness to Get to Know Orthopaedic Surgeons

• While this candidate may not always support orthopaedic surgeons’ positions, their willingness to get to know our issues and

communicate with us is critical, which makes this the top category.

• This rating can be subjective. It is mostly determined by how well a candidate expressed a willingness to get to know orthopaedic

surgeons. #2 Issue Rating

• Most PACs will select several issues to create a scorecard.
• For the purposes of this rate, we will use three different issues that created a lot of work for TOA: physical therapy direct access,

prior authorization, and opioids.

• For issues that have been going on for years, such as physical therapy direct access, the rating can also be based on years prior to

the 2019 Texas Legislature. #3 One of Our Own

• With limited exceptions, a physician (one of our own) should receive special consideration.

#4 Seat at the Table –

• Some key lawmakers may not necessarily support TOA’s issues or even be willing to communicate with TOA. However, due to their

position, it is critical for TOPAC to meet with them.

• TOPAC’s donations give TOPAC a literal seat at the table.

Texas Orthopaedic Association 68

Larger PACs The Reality of TOPAC’s Resources

Larger PACs: Candidate Interviews Larger PACs that feature large budgets, such as TEXPAC and the anesthesiologists’ PAC, have large operational budgets and the ability to give to many candidates, which gives them the opportunity to interview every candidate. TOPAC’s Reality Candidate interviews are extremely powerful. However, TOPAC does not have the resources to interview every candidate. In addition, since TOPAC does not enough funds to get involved in every race, it would be unfair to lead on candidates when the reality is that TOPAC can’t participate in every race.

Texas Orthopaedic Association 69

2019-20 Proposed Budget Give More to Fewer

Focus on Orthopaedic Surgeons’ Champions Several years ago, TOPAC followed the lead of many other PACs and spread out smaller checks to every member of a committee with jurisdiction over health care policy. TOPAC shifted away from this policy for the 2018 election when it recognized: A) Many of the candidates did not even support TOPAC’s positions, and B) the smaller checks at $1,000 were overlooked by candidates. 2019-20 Cycle: Continue Giving More to Fewer Candidates As you will see in the following slides, the 2019-20 proposal is to continue contributing larger amounts to the smaller pool of candidates who demonstrated a true understanding of musculoskeletal care. In addition, some funding will be saved to ensure that TOPAC has a seat at the table with key decision makers. Limited Resources: How Do We Derive the Best Value? A PAC with limited resources has two options to derive the greatest value:

• Give a little to everyone, or
• Give a lot to the smaller pool of champions.

TOPAC chose the latter option.

Texas Orthopaedic Association 70

2019-20 Proposed Budget Explanation of the Tiers

Tier 1 These individuals recognize the candidates to whom TOPAC “must” give. The proposed amounts are not set in stone; they can be adjusted to meet TOPAC’s financial capabilities. But they provide a good estimate of what will be necessary. Tier 2 If we think that we can stretch further, then we may want to consider these individuals. Some explanations may be provided in this PowerPoint. Tier 3 Tier 3 is a list that can be developed further over time.

Texas Orthopaedic Association 71

2019-20 Proposed Budget Tier 1 -House

House Greg Bonnen, MD (R-Friendswood) - $4,000 Surgeon | Made Prior Authorization Happen | Knows Us | House Leadership JD Sheffield, DO (R-Gatesville) - $4,000 Physician | Top Champion of Our Issues | Knows Us |Primary Opponents Tom Oliverson, MD (R-Spring) - $4,000 Physician | Top Champion of Our Issues | Knows Us | House Leadership Senfronia Thompson (D-Houston) - $4,000 Top Champion of Our Issues | House Leadership | Knows Us | Committee Chair Bobby Guerra (D-McAllen) - $2,500 Top Champion of Our Issues | Knows Us | Committee Julie Johnson (D-Dallas) - $2,500 Top Champion of Our Issues | Knows Us | Difficult General Election Phil Cortez (D-San Antonio) - $1,000 Top Champion of Our Issues | Knows Us | Special Note Sarah Davis (R-Houston) Top Champion of Our Issues Knows Us | Primary + General Election Opponent

Texas Orthopaedic Association 72

2019-20 Proposed Budget Tier 1 -Senate

Senate Charles Schwertner, MD - $4,000 Surgeon | Made Many Things Happen| Knows Us Dawn Buckingham, MD - $4,000 Surgeon | Top Champion of Our Issues | Knows Us Bryan Hughes (R-Tyler/Mineola) - $4,000 Top Champion of Our Issues | Knows Us Pete Flores (R-San Antonio/Pleasanton) - $1,000 Top Champion of Our Issue | Difficult General Election Lois Kolkhorst (R-Brenham) - $2,500 Knows Us | Committee Chair Chuy Hinojosa (D-McAllen) - $2,000 Top Champion of Our Issue | Knows Us Kelly Hancock (R-DFW) - $2,500 Knows Us | Committee Chair Jose Menendez (D-San Antonio) - $2,000 Top Champion of Our Issue| Knows Us

Texas Orthopaedic Association 73

2019-20 Proposed Budget Leadership –Must Give

Leadership Governor Greg Abbott - $5,000

• Lt. Governor Dan Patrick - $5,000

Speaker Dennis Bonnen - $5,000

Texas Orthopaedic Association 74

2019-20 Proposed Budget Tier 2 -House

House Steve Allison (R-San Antonio) Knows Us | Committee John Turner (D-Dallas) Top Champion of Our Issues | Knows Us |General Election Opponent

Texas Orthopaedic Association 75

2019-20 Proposed Budget Tier 2 -Senate

Senate Donna Campbell, MD (R-New Braunfels) Physician| Made Things Happen| Knows Us

Texas Orthopaedic Association 76

TOA’s Next Board Meeting:

Thursday, February 6, 2020 |Early Lunch| San Antonio