The big shifts in healthcare to watch for 2019: Q&A with Dr. Louis Levitt of The Centers for Advanced Orthopaedics

Practice Management

Louis Levitt, MD, vice president of The Centers for Advanced Orthopaedics in Bethesda, Md., is a leader at one of the largest orthopedic practices in the country. Here, Dr. Louis examines the trend toward value-based care and alternative payments in orthopedics, as well as outlines where his practice will be headed in the future.

Question: What do you see as the biggest shift in healthcare as it relates to orthopedics in 2018? How will that impact care in 2019?

Dr. Louis Levitt: In 2019 and over the next two to three years, the industry will enter a battle to determine who is going to control the market share in orthopedics and who will control the musculoskeletal marketplace. I believe orthopedic physicians like those that make up The Centers for Advanced Orthopaedics (CAO) should maintain this control over musculoskeletal care from the time a patient sees a primary care physician complaining of pain to the time they need a joint replacement.

With all the integration and consolidation happening across the industry, the trend seems to be that many larger companies are looking to manage healthcare by influencing referrals and studying best practices through acquisition of large primary care groups. In addition to traditional methods of healthcare delivery, we're also seeing large self-insured groups reaching out to specialty groups like CAO to directly contract for services as long as those particular organizations can prove their value with current data.

The biggest questions for the market in 2019 will be who is going fight for control and who can prove their value? Additionally, I believe the future of all healthcare providers will be related to documenting and measuring patient outcomes to ensure they are satisfied with their care.

Q: What is your biggest concern heading into 2019?

LL: I am most concerned with finding the expertise that can manage a company of our size without compromising our standards and values. We have a unique business model, but we don't want to give up the control of our company, and we will guard against any practice or expense that risk producing best outcomes. Since we are a large organization, we need to gather the best expertise in country, but we won't do it at the expense of quality.

Q: Where does The Centers for Advanced Orthopedics plan to grow in 2019? What are the biggest opportunities?

LL: We are looking to expand into adjacent communities regionally close to us, and we will consider opportunities to have joint ventures and co-partnerships with individuals in new regions. By the end of 2018, our ranks should increase to more than 200 doctors. We are also aggressively seeking to develop co-management partnerships with hospitals in the D.C./Maryland/Virginia area to work with their orthopedic service lines. The biggest opportunity in the future is to influence healthcare not only regionally but also nationally.

Q: How do you see value-based care affecting orthopedics over the next two to three years? What is CAO doing now to participate in value-based care, and what are its plans in the future?

LL: In the near future, value-based care will go beyond just participating in structured government programs like bundled payments. At one point, we thought we could do bundles in the private sector for joint replacements, scopes, ACLs, rotator cuffs. But we learned there were challenges with collecting all the information required to successfully run a bundle.

So, CAO decided we need to prove that we are as good as we say we are, and to do that, we'll have to take risks so we can improve musculoskeletal medicine. We think we can financially improve the cost of medicine in the musculoskeletal space.

It is becoming very clear that value-based medicine will become about managing the entire episode of musculoskeletal care. The future for orthopedic surgeons in a value-based world is now to become care managers — managing the entire episode of care, not just the surgical experience.

Q: What are your top goals for 2019? How will CAO grow?

LL: My personal goal is to spend more time at CAO. I will probably be practicing a little less and instead working to take our business to the next level. To accomplish that next level, CAO's goal in 2019 is to secure the expertise and capital that we need to advance the company. We want to demonstrate what our data shows, prove our concept and by 2021 be able to complete full at-risk contracts.

Since we launched five years ago, we've spectacularly exceeded our mission of becoming a community of the most qualified orthopedic surgeons. Long term, our goal is to fulfill our vision of being the national leader in orthopedic care and we're excited to move the needle on that in the coming year.

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