Why this orthopedic surgeon believes 'medicine should remain in the hands of providers'


Medicine has become the next big investment for several non-healthcare entities. 

Louis Levitt, MD, vice president and secretary at the Centers for Advanced Orthopaedics in Bethesda, Md., connected with Becker's to answer, "How do you feel about non-healthcare entities dipping their toes into the healthcare space?"

Note: This response has been lightly edited for length and clarity.

Dr. Louis Levitt: The entry of non-healthcare entities into the healthcare sector prompts important considerations for the industry. It has always been my belief that medicine should remain in the hands of providers; excluding physician leadership from the equation presents a dangerous trajectory for all of us, leaving critical care decisions up to profit-driven business leaders. The primary objective of corporate medicine is often profit maximization and cost reduction, which can inadvertently jeopardize the quality of care, putting patient well-being at risk.

Musculoskeletal care is expensive — in fact, one of the largest healthcare expenses for any major corporation. That is particularly true for a self-insured organization. A notable strategy adopted by these corporate entities involves establishing narrow networks for musculoskeletal care, intended to reduce overall spending.

They tap into quick-fix solutions that sideline physicians from initial care delivery, exemplified by deals such as Costco's recent announcement offering telemedicine as a primary treatment for employees, as well as emerging digital screening solutions...[that leverage] expertise of lesser-trained medical professionals to control costs. In these scenarios, when physician involvement is necessary, those narrow networks come into play — the corporation controls where the patient receives care, and those decisions are often made based on cost, not quality. As a provider committed first and foremost to the best possible patient care, my biggest concern is that certain entities may prioritize business objectives over a patient's health and long-term well-being. 

Equally important, we are witnessing an increasing trend of private equity investments in musculoskeletal groups. Private equity firms have a singular focus: profits. Mounting evidence suggests that private equity investments lead to an overall increase in the cost of care, impacting both patients and payers, with potential negative consequences for health outcomes. A recent comprehensive study conducted by the Columbia University Mailman School of Public Health in New York City revealed that private equity investments were closely associated with cost increases for payers and patients, sometimes as high as 32%. The study also highlighted "mixed to harmful effects" on the quality of care.

Another significant factor is the emergence of "payviders." And while health insurance companies aren't technically non-healthcare entities, this presents another example of business outcomes prioritized over patient outcomes. In my opinion, there is a clear conflict of interest when insurance companies enter the market of caring for patients by owning provider groups, hiring doctors and further creating narrow networks for referrals — again in the interest of profits. 

In an era when corporations are diligently exploring avenues to streamline their operations and reduce expenses, I believe that large private practice groups, with significant geographic reach and scale, have a compelling opportunity to demonstrate their superiority. We inherently stand out as the most cost-effective healthcare providers, surpassing both hospital systems and private equity. With physicians at the forefront of pivotal care decisions, we can ensure a consistently high standard of care. This presents a golden opportunity for us to showcase to major employers why choosing our services is the prudent decision for their financial bottom line and the enduring health and well-being of their employees.

Editor's Note: This article was edited slightly to remove the name of a digital screening company on Oct. 29.

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