'Putting profits before patient care': What we heard in October

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Spine and orthopedic experts and leaders in October spoke with Becker's Spine Review about topics from bundled payments to private equity.

"I spent 15 years at a major academic center in Pittsburgh and had to decide if I wanted to spend 15 more dealing with the same administrative and leadership politics and bureaucracy. I put some feelers out and considered a change to another university system but also wanted to consider options that were more empowering for true physician leadership. What drew me to Hoag was not just their earnest desire to listen but their commitment to take action. So many university appointments are filled with commanding titles, chairmanships and directorships, but these titles are often meaningless if they don’t fall in line with the administration’s agenda. I came to Hoag because when I asked the CEO pointed questions about hospital care policies and direction, he looked me in the eyes and said, 'Let's just do what's right.' We shook hands, and I've never looked back," Adam Kanter, MD, on why he left Pittsburgh-based UPMC for Hoag Pickup Family Neurosciences Institute in Orange, Calif.

"Before going into practice and to become a successful spine surgeon, I wished that training programs would have focused at least some on the business aspect of medicine, and the ever more challenging coding and reimbursement climate we are facing. Many of us become small business owners starting out in our practices and unfortunately have insufficient knowledge about the business aspect of practicing medicine. Apart from the terrible pre-authorization process and the bullying by insurance companies to prevent us from properly taking care of the patients that are sitting every day in front of us, the human resource component and employee management part of the practice requires so much attention nowadays. We have no knowledge about how any of that works in the real world at the end of our training. All of us had to learn on our own and trial by fire to eventually build our successful business into an all-round satisfying profession," Kornelis Poelstra, MD, of Allegiant Spine Institute in Las Vegas, on what he wished he knew before going into practice.

"There will always be a healthy amount of skepticism when looking at some of these deals. The proof is in the results. I tell physicians evaluating this that it's critically important to partner with a platform that is physician led and owned. When I say physician led, it's not just at the top. We have a physician CEO, but our practices are governed by orthopedic surgeons in clinical governance committees. In addition, our private equity partner has a physician on their advisory team. I tell physicians who are considering this to talk to your peers. Ask them if they're happy and how much autonomy they have. Has their practice changed after they joined the platform, and did it change for the better or for the worse? At the end of the day, physicians trust other physicians," Emil Engels, MD, CEO of Aligned Orthopedic Partners, addressing skepticism of private equity investment in the specialty.

"To me this is very straightforward. Unfortunately many of these bundle programs were putting profits before patient care. It was about, "How can we save the most amount of money?" which unfortunately ended up resulting in patient care getting compromised. At the end of the day, we as surgeons will be liable for anything happening to our patients. Every patient expects their surgeon to provide the best care at the highest level. And yes this might be a little bit expensive at times, but it delivers high superior care when the right intentions and the right ethics have been utilized," — Hooman Melamed, MD, of The Spine Pro in Marina Del Rey, Calif., on why orthopedic groups are dropping bundled payments.

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