Payer resistance to orthopedic reimbursements, the role of private equity in the industry and changes to medical school are three aspects of the current and future orthopedic landscape that have some surgeons and leaders worried.
While these trends may not be having immediate, negative impacts on orthopedics, there is the potential for long-term concern.
These five orthopedic leaders and surgeons recently connected with Becker’s on a number of trends throughout the orthopedic industry.
Note: Responses were lightly edited for clarity and length.
Kim Mikes, RN. CEO of Hoag Orthopedic Institute (Irvine, Calif.): As CEO of one of the largest volume providers of orthopedic care on the West Coast, I’ve watched the influence of private equity in orthopedics and ambulatory surgery centers from the sidelines. Hoag Orthopedic Institute is physician-led and physician-owned with an unwavering focus on the patient. We are the anti-private equity model. Our enterprise succeeds both fiscally and operationally while prioritizing quality patient care and outcomes, not profits. I worry that private equity’s need for better numbers jeopardizes physician autonomy. Private equity’s influence in orthopedics is not driven by a relentless commitment to patient care, but by a return on investment. Only time, cost/value and surgical outcomes data will yield a clearer picture of private equity’s influence on our industry.
Ronald Gardner, MD. Founder of Gardner Orthopedics (Fort Myers, Fla.): [Consolidation] is both a threat and opportunity. For the poorly motivated, less capable and/or uninspired, being employed by a hospital system or university or large conglomerate for RVU [relative value units] compensation is a safety net for a paycheck and job security. For the motivated, capable, creative and inspired, private practice is still an opportunity to excel.
Brian Curtin, MD. Hip and Knee Specialist at OrthoCarolina Hip and Knee Center (Charlotte, N.C.): There are three things with medical school training today that concern me:
- Some schools are moving away from cadaver labs and thus reducing the early excitement of learning human anatomy, which can’t be replicated on a simulator. Musculoskeletal education will likely suffer for all fields and potentially reduce the number going into surgical fields as often if that fire is not lit early in medical school.
- Residency applications are now becoming so overloaded and inflated with research publications and projects that often had little student involvement. This introduces a bias to those med schools with strong research programs and may limit the chances for those really good applicants from less research-heavy programs to match in top residencies.
- There has been a big shift by medical students toward lifestyle specialties with better call, set office hours and predictable pay. Orthopedics requires physically demanding work, long hours, routine call responsibilities and sometimes fluctuations in pay. If the current system continues to train physicians who increasingly value flexibility and predictability over procedure driven specialties, orthopedics may face a significant shortage of surgeons in the future.
James Andry, MD. Orthopedic Surgeon at DISC Surgery Center at Carlsbad (San Diego): As reimbursements diminish and scrutiny of claims goes up, we have been forced to automate our business processes and strategy to maintain a positive cash flow. This has resulted in the elimination of front-office positions, but these adjustments are unfortunately necessary in order to stay in practice. To help preserve our staff, we have benefited from joining TriasMD’s physician-first network of ASCs, which helps negotiate better reimbursements for our services.
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: We have had great difficulties in getting major players to give reasonable or any contracts for TLIFs in the ASC. My suspicion is there is hospital interference as spine surgery is a cash cow for hospitals and this collusion is happening without a paper trail. When it’s cheaper and it’s better for the patient the contracting difficulties should not be there. Hospital systems saw a major exodus of orthopedics and are trying to stop the same in spine which will happen regardless over time.
