'They'll get tired of getting sued': What we heard in April

Carly Behm -  

Spine and orthopedic experts and leaders spoke with Becker's Spine Review on key topics in April from consolidation to artificial disc replacement.

1. "I think it's only a matter of time before [Aetna] crumbles because they'll get tired of getting sued by patients that are good candidates for disc replacement, that are forced to get fusions, when in reality they can have an operation that's much longer lasting compared to fusion. We looked at all the lumbar artificial disc replacements that we did since March of 2000, and our revision rate is 1.5 percent." — Richard Guyer, MD, of Plano-based Texas Back Institute, on insurer pushback on artificial disc replacement.

2. "Scale is very important. Whether it is through affiliated networks, [management services organization] structures or group aggregation, it will be critical for independent orthopedists to align. We must be the leaders in musculoskeletal value-based care and population health. The only way to do this is through large groups or networks. So, at present, I do not believe 'too big' is a barrier." — Bruce Cohen, MD, CEO of Charlotte, N.C.-based OrthoCarolina, on orthopedic supergroups.

3. "The most important trend at this time in healthcare saving orthopedics is the transition to outpatient surgical care whenever feasible. Traditionally, open musculoskeletal procedures have been associated with postoperative pain interfering with rehabilitation. Minimally invasive techniques to achieve excellent outcomes are evolving rapidly with an advantage of less surgical morbidity and quicker rehabilitation. Specifically for the spine, endoscopic techniques are appealing. … Outpatient surgery not only can potentially save the hospital setting resources for sicker patients but also has a positive psychological impact on the patients facilitating rehab and return to daily activities." — Niranjan Kavadi, MD, a spine surgeon in Oklahoma City, on healthcare trends saving orthopedics.

4 "We're constantly re-examining our business model and strive to be accretive, not dilutive. For example, if you have a professional group of about 20 physicians of the same specialty working hard, then everyone will make approximately the same amount of money. But when you have 200 physicians in a group, you're going to have some really busy physicians and some not so busy physicians, and reimbursement for different specialties will cause further discrepancies in income. 

What is important is that everyone contributes to the well-being of the group so no one specialty feels like they are shouldering a greater burden of the cost of business. You try to come up with an overhead structure that is fair, with people feeling that they're getting their money's worth, they're covering their overhead and taking home what they think is appropriate. If one division feels they're providing more services and not getting fairly compensated, then it'll never work." — Alex Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedics, on the practice's business model and outlook on supergroups.

5. "I truly recommend all physicians and especially surgeons read Being Mortal by Atul Gawande, MD, a practicing surgeon. In this very important book, he fearlessly discusses the emotional struggles of his profession and the lost art of supporting dying patients. It moved me from tears to enlightenment about the ultimate experience that every patient, friend, family member and one's self will confront eventually." — Anthony Melillo, MD, of Houston-based Bay Oaks Orthopaedics & Sports Medicine on reading recommendations.

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