Challenges and Opportunities in Orthopedics: Q&A With Dr. Brett Levine of Midwest Orthopaedics at Rush

Practice Management

Brett Levine, MD, an orthopedic surgeon at Chicago's Midwest Orthopaedics at Rush with a special interest in complex knee and hip surgery, discusses the biggest reasons for concern and excitement in orthopedics today.

Q: What are the key challenges facing orthopedic surgeons right now?

Dr. Brett Levine: Our biggest challenges are related to the healthcare environment and declining levels of reimbursement and the concomitant impending Medicare crisis. The decreased reimbursement and Medicare cuts may potentially lead to restricted care for some patients in the future. There may also be limited resources and restriction of examinations ordered depending on the ultimate outcome of the current Medicare crisis. As reimbursement cuts have decreased salaries, more orthopedic surgeons are beginning to specialize in areas that have not experienced as drastic a decline or offer an enhanced quality of life, such as spine, hand and sports medicine surgery.

Q: How does the decline in reimbursements affect orthopedic surgeons and healthcare providers?

BL: There may be a shortage of hip and knee replacement specialists who will do revision surgery because of the low levels of reimbursement associated with these procedures. There will be less of a push for physicians to perform complex surgeries in all subspecialties because the reimbursement increase is small compared to the extra effort and risk one incurs when treating these patients. In some scenarios, hospitals may discourage physicians from performing procedures with low reimbursements and high associated hospital costs. There's a concern that down the road to meet appropriate budgetary guidelines, hospitals will evaluate more stringently what they receive for specific procedures.

Q: How are the government policies on healthcare impacting orthopedic surgeons' ability to communicate with their patients?

BL: The government policies with regard to high-tech regulations have guidelines in place to protect e-mails and patients' health information. While these policies mean well, they make things so secure that it's hard for us to share information with our patients and between healthcare systems. You really have to have a very secure portal, and it can often be challenging for patients to access. I thought it would make things easier, but the steps patients need to take to communicate via e-mail are quite difficult. This is definitely a challenge because patients want an open line of communication but it's hard to provide that while also meeting all of the latest regulations.

Q: With the recent scrutiny placed on orthopedic surgeons' relationships with the device industry, are there still opportunities available for collaboration in the future?

BL: It seems like there are less and less opportunities to collaborate with industry device companies. Research dollars from big companies are being cut and there is less funding available for orthopedic surgeons to access both publicly and privately. The relationship between orthopedic surgeons and device companies is changing, but there are still some opportunities that remain. Collaboration on the next generation of implants and instrumentation is a possibility. Great innovations are possible when scientists, engineers and surgeons are part of a design team to pioneer new medical devices. The future of orthopaedic holds the possibility of "smart implants."

If developed in the future, smart implants will tell us how they are functioning, detect infections and adapt to work better/bond better to the bone. For fractures, there's similar work being done with plates and rods that may be able to guide us as to when a fracture is securely healed.

Q: What are the developments in orthopedic surgery that surgeons are most excited about today?

There is research ongoing regarding managing and preventing many of the perioperative issues we see. These developments include perioperative work up for certain conditions that will minimize complications and control blood loss so that we can lower transfusion rates. Investigations into new cocktails for antibiotics, pre-operative site preparation and antibiotic impregnated cement are ongoing to continue to further our efforts in infection prevention.

There is also a lot of excitement around biologics that will optimize our current procedures regarding treating bone defects, cartilage transplantation and joint preservation. New osteoporosis, osteoarthritis and inflammatory arthritis medications are being developed that may actually modify the disease process and not just treat symptoms. All of these things are pretty exciting avenues that are in their initial phases, but look realistic for sometime in the near future.

Learn more about Dr. Brett Levine.

Related Articles to Trends in Orthopedics:

The Year Ahead: 9 Biggest Issues for Orthopedic Surgeons in 2011

11 Biggest Trends in Sports Medicine for 2011
7 Critical Orthopedic and Spine Device Industry Trends

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