Migration of orthopedic cases to ASCs to continue influence on value-based care, 1 surgeon exec says

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The increase in value-based care for orthopedic cases will continue to be pushed by the transition of cases to ASCs, but staffing shortages could threaten care delivery, according to one orthopedic surgeon leader.

Brian Larkin, MD, is the chief medical officer of the Orthopedic Centers of Colorado, a 19-location practice based in Denver. 

He recently spoke with Becker's about the trends he is following in orthopedic surgery, the challenges facing practices and how he sees the industry evolving in coming years.

Editor's note: Responses were lightly edited for clarity and length.

Question: What are the biggest challenges facing the industry? How do these challenges compare to five to 10 years ago? 

Dr. Brian Larkin: The biggest challenge facing orthopedic surgeons today is staffing. This is showing up at every level of hiring, from entry-level positions to physicians. Finding the right people to help build a group’s brand and culture is critical, and the staffing challenges we are all facing currently are unprecedented. Five to 10 years ago, it was relatively easy to find willing, excited and competent staff to help support the growth that we were seeking. Now, the lack of available work force is so persistent that day to day healthcare delivery is truly challenging.

Q: What technologies/ innovations are coming into the industry that will improve efficiency and quality of patient care?

BL: Technology and innovation have always been a key aspect of orthopedic surgery. I think that this will continue, but the critical question is where the cost of these innovations falls. Given the current financial situation in healthcare, there is a large focus on what the cost of a new technology may be and who will bear it. Will this fall on patients? Any innovation must be centered on patient care improvement, and I believe that we will see increased utilization of technology to connect with physicians for care coordination, care delivery and education.

Q: How do you see your practice/the industry evolving in the next three to five years?

BL: Over the next three to five years, we will continue to grow our value-based care initiatives and seek to provide and deliver high quality orthopedic care at the most cost effective sites of service. This will likely entail continued transition of orthopedic cases to ASCs. Beyond site of service changes, I think that we will see more patient engagement on decisions about surgical techniques, implants and technology. Having engaged patients that are active, willing participants in their care will become the norm.

Q: If you could change one thing about the industry, what would it be?

BL: Price transparency. The number one complaint that I hear from patients is that the process of paying for healthcare (and health insurance) is difficult to understand ahead of time, unclear as they are going through it and often an experience that offers more questions than answers. There is no question that this topic is incredibly difficult, but if we want to define the value of care, we need to start by defining the true cost of care. Unfortunately, this is difficult at best and requires a massive amount of change to occur.

Q: What industry trends are you following?

BL: I am an enormous proponent of the transition from volume-based care to value-based care. This has been talked about for some time but still is not happening fast enough. I would love to see the industry trend toward rewarding true value in healthcare versus the historical fee-for-service model that has been present. I welcome alternative payment models and ways that reward providers for value.

Q: What is the greatest piece of advice you have been given during your career?

BL: Always be open to differing ideas. Healthcare is a complex web of entities with a tremendous amount of stakeholders. In order for us to make progress in healthcare, we need to understand where different viewpoints come from and work toward a solution that helps generate solutions to as many stakeholders as possible. Too often, decisions are made that do not fully take into consideration the complexity at hand, and these solutions often do not end up solving anything.

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