Can orthopedic surgeons withstand the changing value-based healthcare system?

Practice Management

Orthopedic surgeons discuss the current and upcoming trends in the orthopedic industry that raise concerns.


Question: How will the ICD-10 switch impact healthcare?





David Fisher, MD, OrthoIndy: The uncertainties that disturb me the most include the never-ending stream of regulations coming from Washington that continue to strain my ability to provide care to my patients. The countless documentation requirements are driving up our costs as we have to hire trained coding experts to oversee billing and collection processes, not to mention the additional time required by physicians to "get it right."








David Geier, MD, Sports Medicine Specialists of Charleston & East Cooper Sports Medicine: There is a lot of apprehension about the upcoming switch from ICD-9 to ICD-10 codes. From what I hear, orthopedic surgeons are impacted more than other specialty because many changes are orthopedic in nature. Youhave to modify codes for left knee versus the right knee. If you have a patient with arthritis, you have to specify what kind of arthritis.



There is going to be a period here in the fall, winter and spring that could affect efficiency and the number of patients you can see. You will need a lot of

manpower orextra staff to learn it the new codes. Each of the codes are broken down in different ways and it is important to make sure the electronic medical records systems allow you to get the codes correct in a way that you can see a large number of patients. You don’t want to spend five or 10 minutes per patient to figure out what the code is. No one is arguing you shouldn’t do it, and the ease of the transition will vary for every practice depending on staff members.


Q: How has the patient-centered model of care influenced reimbursement rates?



DG: There is also great concern about how data will impact practices, especially when government uses data to determine reimbursement rates. Data becomes important in reimbursement, especially as reimbursement gets tied to patient satisfaction and readmissions. Surgeons are concerned about that because it is not as cut and dry in patient satisfaction. Surgeons are not the only factor for patient satisfaction rate. People can have a bad experience based on a lot of factors. Surgeons often consider, what do we have control over? How do we optimize patient scores and readmission rate? That is where the ASC and hospitals have to be involved because they can control some things on their end.




James Chappuis, MD, SpineCenterAtlanta: The entire healthcare economy continues to keep most surgeons up at night. Surgeons are concerned about how the Affordable Care Act, when fully implemented, will affect reimbursements. The constant cannibalization of healthcare sources by others with vertical consolidation and buyouts create huge obstacles and hurdles for the billing and collection teams. Everything that has been done at the federal and state level to contain healthcare cost has been relatively unsuccessful. There was a recent radio announcement that healthcare cost continues to rise at between 6 percent and 10 percent, with an average of 8 percent annually. We have to find out how to pay for those healthcare costs as a nation.



Q: What other issues about healthcare raises concerns?



DF: I am very concerned about patient care in the future with the expansion of the ACO models. Patients will no longer have direct advocates when the physicians work for healthcare systems that give the physicians marching orders. Many times, large hospital systems will make decisions that may or may not be in the best interest of the patient, but rather in the best interest of the bottom line.



DG: There are still concerns for some orthopedic surgeons about potentially switching to hospital-employment due to increasing demand for data that the government required. Many surgeons question whether they should join a hospital.






Andrew Cash, MD, Desert Institute of Spine Care: The landscape of healthcare is mutating with an eye towards value. Surgeons have to combine forces to leverage their collective positions with healthcare payers. The trends in consolidation are merged group practices and acquisitions by hospital medical centers or accountable care organizations. Individual physicians must evaluate their options to realize optimal future positioning. Opportunity favors the prepared.








Dan Margolin, DPM, New Jersey Foot & Ankle Center: I believe that there is a storm on the horizon for the small practice owner. Healthcare is unfortunately becoming corporate care. Being a great physician is no longer a guarantee of success. Rather, success is determined by being a great physician and a great businessman. I think the mantra of the future practice is going to be "the bigger the better." Smaller practices that have the foresight to train to deliver high quality and high volume can withstand the corporate healthcare storm.




drjamespickneyJames Pinckney, MD, Diamond Physicians: In the healthcare space, bureaucracy and managed care have eliminated almost all the competition. Hospitals can charge whatever they want in the United States. There is so much convolution and the systems are so complex that they might have 15 different charges for 15 different insurance carriers. There's no telling what your hospital bill is going to be once you leave the facility and that's a huge issue that has to be solved in this country.






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