1. Hospital employment vs. private practice. Over the past few years, there has been substantial discussion regarding physician employment by hospitals. A recent Medscape report, titled "Employed Doctors Report 2016: Who's Happier—Employed or Self-employed Doctors?" found that, unlike older physicians, younger physicians preferred employment. Those under age 40 were twice as likely to be employed than self-employed, while those over 40 had only a slight preference for self-employment.
However, not all think this trend toward hospital employment will continue. "In my opinion, as many hospital-employed physicians find themselves on the receiving end of cuts to their pay because of declining reimbursements and less favorable renewal terms of their initial contracts, there is likely to be a loss of enthusiasm for hospital employment," says Alan S. Hilibrand, MD, an orthopedic surgeon specializing in spinal care at the Rothman Institute, an orthopedic group with office locations throughout Pennsylvania and New Jersey. "There will likely be much more interest in private practitioners staying 'private' within larger orthopedic group practices."
2. Outpatient procedures. Keith Berend, MD, an orthopedic surgeon specializing in hip and knee care at New Albany, Ohio-based Joint Implant Surgeons, said that frequent rapid recovery developments, which lead to short lengths of stay and eventually outpatient procedures, is "certainly the most profound" trend he's noticed throughout his career.
"It's very remarkable to me how we've moved into an era where outpatient joint replacement is becoming the norm," Dr. Berend said in an interview with Becker's Spine Review. Recent research has acknowledged the short-term benefits of same-day procedures, as well; a study published last December in Orthopedic Reviews found outpatient orthopedic surgeries are not only cost-effective, but also have improved rates of patient satisfaction. However, there is still more research to be done in the coming year.
"We need to continue to let results bore out in the data, to see what is best for patient care overall," says Keith A. Fehring, MD, an orthopedic surgeon specializing in hip and knee care at OrthoCarolina's Hip & Knee Center in Charlotte, N.C.
3. Payment models. The CMS-mandated bundled payment model for hip and knee replacements, called the "Comprehensive Care for Joint Replacement model," began this past April. The CJR model is the first-ever mandatory bundled payment program issued by the Center for Medicare & Medicaid Innovation. Although the model is meant to be a cost-saving and quality-improvement program, orthopedic surgeons have raised concerns about the lack of data on similar programs.
"With this push toward bundled payments for total joints in the coming year, people don't know exactly what to expect," Dr. Fehring says. "That's something we need to keep an eye on." Outside of bundled payments, MACRA is reforming how providers are reimbursed through Medicare — and many physicians are skeptical of the changes.
"MIPS and MACRA are going to begin affecting downstream reimbursement, and there are likely to be more losers than winners, despite the purported budget neutrality," Dr. Hilibrand says.
4. Pain management. "There will be significant popular support for alternative strategies for pain management, both in response to the opioid epidemic, as well as the move towards more outpatient surgery," Dr. Hilibrand says.
In recent years, stakeholders spanning individual healthcare facilities to federal agencies have voiced concerns about growing rates of opioid dependence — on a typical day in the United States, more than 650,000 opioid prescriptions are dispensed and 78 people die from opioid-related overdose, according to the U.S. Department of Health & Human Services.
Alternative, multimodal pain management approaches have been shown to provide effective analgesia, while also discouraging opioid reliance, by encompassing a range of non-opioid techniques like regional nerve blocks, intraoperative methods, oral medications and intramuscular injections.
5. Infection control. About one in 100 patients that undergo hip or knee replacement surgery may develop a postoperative infection, according to the American Academy of Orthopaedic Surgeons.
"Infection is rare, but when it does occur, it's a big deal — and it's very difficult to treat," Dr. Fehring says. "The traditional treatment for a bacterial infection is a two-stage procedure, which takes about three months and two more surgeries." This two-staged surgical treatment is well-established; however, ongoing research may help to shorten a patient's episode of care after infection. At OrthoCarolina, researchers are studying the efficacy of a single-stage approach, in which a joint infection is treated by removing the original joint, sterilizing the infected area and then implanting a new joint in one operation.
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