'On the precipice of dramatic change': 2 orthopedic surgeons on the future of independent practices


Orthopedic consolidation has grown in the last year, and management services organizations continue to draw orthopedic groups. This growing trend has some surgeons questioning if independent practices will remain standing.

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next question: How do you anticipate CMS’ 2022 rules will affect orthopedic care this year?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, Jan. 26, 2022.

Editor's note: Responses were edited for style and clarity.

Question: How will independent orthopedic practices look in 2030?

Nicholas Mast, MD. Hip & Pelvis Institute (San Francisco): It is difficult to know the direction that healthcare will take in two years, let alone eight.

I think we are at a critical time for independent practices in this country. I think we sit on the precipice of dramatic change in the healthcare system. It is common for my colleagues to lament these changes, but we are unfortunately just as complicit in these changes as the outside forces that guide us.

The practice of medicine has changed so much that it is no longer profitable 'just' to be a good orthopedic surgeon. There are economic studies showing now that a purely Medicare practice will fail in light of mounting pressures of overhead and practice management expense. This has only been exacerbated by the inefficiencies and inflationary pressures brought upon the healthcare system by our ongoing COVID-19 crisis.

To respond to this, practices have sought to consolidate in order to better drive efficiencies. We are no longer just board certified orthopedic surgeons but now service line co-managers, ASC owner-members, and surgical optimization 'care coordinators. Advocates have stated that we have created enormous value for the healthcare system. We have created incredible efficiencies. However, to our patients, the health premiums keep climbing every month, and profits of major healthcare systems keep climbing. Musculoskeletal care is still a major component of every healthcare system's spend. In improving the care delivery system for musculoskeletal care, the sweat of our collective brows has lined the pockets of nearly every healthcare system CEO across this nation.

I remember my father emphasizing that the most noble pursuit of an orthopedic surgeon is to become an expert in his desired field. There was value in self-investment in the knowledge of anatomy, biomechanics and pathogenesis of disease. Somewhere along the way, it was no longer good enough to be an expert in our field. This is a sorry state for the future of our profession. We have no one but ourselves to blame for this transgression against our future generations of surgeons.

Again, it is difficult to know the direction that healthcare will take. I think for independent practices to survive, they must judge for themselves whether participating in existing contracts with insurers (Medicare included) are actually improving the lives of their patients to the degree that they are improving the bottom line of the healthcare industry.

Jeffrey Traina, MD. Advanced Orthopedics and Sports Medicine Center (Leesville, La.): I have been an independent orthopedic practice both solo and in a group practice for over 30 years. It's not gonna exist in 2030. There are too many regulations and too much decrease in reimbursement.

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