Michael Bolognesi, MD, an orthopedic surgeon at Duke Health in Durham, N.C., is paying close attention to healthcare trends that will impact patient care and value-based care.
He spoke on the "Becker's Spine and Orthopedic Podcast" about why those trends are so important to him.
This is an excerpt. Listen to the full episode here.
Question: What three trends in healthcare are you following most closely?
Dr. Bolognesi: One of the things that we're following most closely has been the transition of our operations from the inpatient setting to the outpatient setting. It's obviously something that we've been involved in for quite some time. Certainly it's not a new concept to be able to transition a percentage of patients to the outpatient setting, but that transition certainly has created some great improvements in care delivery to the patients, but also some challenges. Obviously not everybody's appropriate for the outpatient setting, despite the fact that there's a lot of transition of these procedures off the inpatient-only list.
Monitoring that inpatient only list is my next trend. We're approaching 300 CPT codes that were recently transitioned off the inpatient-only list. A lot of those are orthopedic in nature. So hip and knee surgeons have had to be able to adjust and transition care to the outpatient setting for appropriate cost and level of care reasons. We're now going to see that in the other subspecialties — spine and foot and ankle, and some of these procedures that traditionally may have been an inpatient procedure. They're also going to have to go through this transition and the associated challenges and the location of care delivery.
The last trend is RVU value assignment for these different procedures and that process of how values or RVU value amounts are assigned to different procedures by the RUC. I think we're moving into this transition to value-based care, where we may have to think about different ways to assign value to these procedures. I think that the RUC evaluation of how to create RVU values for the CPT process may not completely work. If you think about all of the care that is delivered, when you're taking care of a patient, leading up to the surgery, doing the surgery, and for the 90 days after, we do so much in these bundled healthcare programs. So it's an interesting, fascinating thing.