What lies ahead for orthopedic surgeons in 2015?

Orthopedic

What do orthopedic surgeons foresee as some of the greatest opportunities and challenges in the year ahead? Two surgeons share their thoughts.

James C. Ballard, MD, Oregon Outpatient Surgery Center (Tigard): I am most looking forward to the explosion of outpatient hip and knee replacements that is coming, and we intend to be right in the middle of it all.

 

Mark Wolgin, MD, orthopedic spine surgeon (Albany, Ga.): I would like to share something about which I am excited, but it's actually the opposite. I have to fight with insurance companies for approval more frequently these days, and it's getting tiring. I see this problem as only getting worse.

 

They use "guidelines," but instead they should call them "laws," as there seems to be no room for judgment, even if you can actually talk to a physician working within the insurance company. They set up "peer-to-peer" reviews with docs who are not peers, like a retired orthopedic surgeon who is not spinal fellowship trained.  

 

They will deny care for years, and then request a psych evaluation, and the patient, who has no hope and is in pain and has been denied care understandably shows signs of depression and hopelessness. Care is denied for the reason of the patient being depressed. Similarly, they will deny care for years and then make the case that the patient should be at MMI because it has been years, ignoring the fact that the patient has a treatable condition.

 

More patients have deductibles that are ridiculously high, like for one patient who makes $30,000 a year with a $10,000 deductible.  Their insurance is fake, and they are essentially uninsured.

 

Congress is bought and paid for, so unless you're a billionaire, good luck getting them to listen to interests of patients.

 

I guess I could go on, but thought you might be interested in a surgeon's opinion of what to look for in 2015.

 

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