How orthopedic surgeons can un-silo the industry


Three physicians connected with Becker's to discuss how orthopedic surgeons can work to un-silo the industry.

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: What is the biggest barrier to orthopedic ASC growth?

Please send responses to Riz Hatton at by 5 p.m. CDT Thursday, July 27.

Note: Responses have been lightly edited for length and clarity.

Ronald Hillock, MD. Adult Joint Reconstruction Surgeon and Musculoskeletal Oncologist at Nevada Orthopedic & Spine Center (Las Vegas): Fragmented healthcare, aka siloed care, is an important reason why the cost of healthcare has increased in recent years. As orthopedic surgeons, we focus on the musculoskeletal issues that are presented. We are expected to treat the one complaint. Sadly, this can lead to not fully addressing confounding variables outside our scope of practice. The patient exists within a continuum of medical and social problems that can be easily overlooked without care coordination.

Our system is ultra-specialized. In more than half of my consult cases, I do not know the patient's primary care physician. Peer-to-peer communications are usually limited to focused transfer of information, i.e., preoperative clearance for surgery.

The reality is we need to expand the engagement between peers and seek coordinate care. No one is not directly rewarded economically to take the time to reach out and call the primary care provider directly. If an attempt at a care conference is made, both parties frequently play phone tag. Eventually, brief written exchanges are written. Much can be lost in this process. 

Here are some of the more pressing care coordination issues I will deal with today:

  • Ms. X needs to stop the blood thinner and use an injectable bridge drug until the time of surgery.  
  • Mr. Y needs to adjust his insulin schedule the evening prior to surgery.  
  • Ms. Z needs to have dialysis the day prior to surgery.  

In light of these facts, I offer a solution. What if we could create routine preoperative care conferences with primary care providers as a coded/compensated event? Documentation of exchange could be recorded. Everyone's efforts could be tracked and value applied. This would only improve patient outcomes and safety. The errors prevented would likely more than offset any new costs incurred.

Nicholas Grosso, MD. President of The Centers for Advanced Orthopaedics (Bethesda, Md.): Surgeons have already begun to un-silo the orthopedic industry. This process started about a decade ago with large group consolidation, when organizations like The Centers for Advanced Orthopaedics started bringing sub-specialties under one roof. For example, we have podiatry and physiatry in our group.

I predict that, in the future, groups with vision will realize that consolidating within their geographic footprint is a stepping stone, not the finish line. One solution to un-silo the industry is for practices to work with larger integrated groups to increase their footprint and power. These types of partnerships will provide access to tools that smaller groups don't usually have, including cutting-edge analytics, high-end digital solutions and more. This streamlined care will also save patients money and improve the quality of care.

I anticipate that in the next decade, we will see large musculoskeletal groups working together to create a large national market, positioning them to work with payers. This will allow them to work within their markets to cover the entire episode of care.

Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Seattle): The orthopedic industry is certainly not unique in the struggles with working within silos. There is a large amount of data to support various benefits of multidisciplinary work and diverse teams. Although working in silos provides a comfortable situation, more than ever, we need to critically evaluate how other disciplines are succeeding on several fronts, in order to improve the safety, value, and innovation surrounding orthopedic care.

This topic may be better evaluated with a specific example. Let's take the example of patient engagement and how diverse technologies are driving how we engage our patients and how our patients engage with their orthopedic care as well as care teams.

Multiple studies have demonstrated that patient satisfaction is not directly to outcomes, even in light of complications. Ultimately, I think there is a movement towards the consumerization of healthcare to provide patients with a desired experience.

As weird as it sounds, I think that we can certainly learn a bit from our business colleagues. For surgeons (or any medical provider), there is a shift in focus on the individual consumer (patient), rather than the market (healthcare landscape) as a whole. From a patient's standpoint, they are asserting more influence and control over their medical and wellness care. Overall, COVID-19 has accelerated this movement of consumerization of healthcare as consumers/patients increasingly focus on health.

We have been taking some lessons from the business world: in order to be successful in a growing, competitive marketplace with increased regulations and declining reimbursements, healthcare providers have seen a shift in its customers (patients) becoming shoppers of services. Healthcare systems all over the world are working to reduce risks and improve patient health outcomes.

Cuts in healthcare funding and competition for budgets are forcing us to find ways to improve the efficacy and efficiency of healthcare services provision. Engaging patients in the responsible management of their health is widely acknowledged as a way to answer those challenges.

The patient engagement niche has become a booming industry over the past few years. The most common examples include patient portals, secure email/messaging, social networks, video replays and various mobile technologies. Findings showed that these tools can improve care, self-management, self-efficacy, behavior promotion (quality of sleep, diet, physical activity, mental health) and medication adherence. The various platforms have proven effective for disease prevention, lifestyle changes, management of cardiovascular disease and diabetes, and is a suitable tool for elderly and younger populations alike.

Although patient care directly addressing their pathology remains paramount, engaging them to provide a better patient experience is a growing focus. Innovation in this field continues to grow — and I am excited to see how these ideas will continue to improve the safety, value and experience of patient care. But we must un-silo our efforts.

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