5 most-pressing topics for orthopedic surgeons

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From advances in surgical technology to frustrations with payers, here are five things six orthopedic surgeons told Becker's Spine Review they're paying closest attention to.

1. Robotics and technology
Frank Kolisek, MD, of Indianapolis-based OrthoIndy, said he recognized robotics as here to stay. Four areas in robotics have his attention.

"First, how will the increase per case costs be handled?," he said. "Second, what will patient results look like in the midterm compared to 'regular' instruments? Third, will it actually improve efficiency and save time for the physicians? Fourth, will this technology allow us to perform certain surgeries in such a way that we just can’t do without a robot?"

Another OrthoIndy surgeon, Mihir Patel, MD, is keeping his eye on two areas of technology in orthopedics: artificial intelligence and voice-driven care.

"Much like Siri, voice driven care will help providers see patients, order appropriate tests, and document the episode of care in a timely manner without the hassles of pointing and clicking. Voice driven documentation has improved the professional lives of many providers over the past few years and the expansion of voice technology is a great frontier in more efficient medicine."

Dr. Patel said he thinks artificial intelligence has the potential to help further customize patient treatment plans.

Sigurd Berven, MD, of University of California San Francisco Health, also said he was interested in artificial intelligence and its abilities in predictive outcomes in care.

"The convergence of large data analysis and machine learning is empowering clinicians to develop algorithms that have predictive value in the outcomes of care for a wide range of pathologies, including spinal disorders," Dr. Berven said. "Accurate information on expected benefits and risks of care that is precise for the individual patient will empower physicians and patients to make informed decisions, and will guide the appropriate use of both operative and non-operative interventions."

2. Telehealth
The COVID-19 pandemic opened up new possibilities for telehealth. Dr. Kolisek said there are still questions about how telehealth will remain post-pandemic.

"Can this technology be used in a way that improves patient access and improves timely care for patients while allowing providers to decrease bricks and mortar and staff and, therefore, overhead, in a time where reimbursement for services rendered continues to go down? That is the big puzzle to figure out," he said.

3. Outpatient care
Many orthopedic procedures, such as total joint replacements, were migrating to ASCs before the pandemic.

"With the elimination of many inpatient only codes, the outpatient setting in all aspects of medicine is an exciting time," Dr. Patel said. "Virtual provider visits, outpatient procedures with disposable kits, home rehabilitation devices and wearable devices to monitor acute and chronic conditions are all providing patients a continuum of care with the help of technology in the outpatient setting."

Dr. Berven echoed that, pointing to the cost-efficiency of ASCs and the importance of patient-focused care in the outpatient setting.

"The important priority in developing ASCs is to keep the patient centered in decision making," he said. "There is a significant risk of moral hazard in ambulatory surgery where there is a disassociation of risk and benefit regarding the parties of patient and provider. Keeping the patient centered and prioritized in decisions regarding care needs to guide how we choose the appropriate cases for ASCs."

4. Payer relations
Payer relations and reimbursements have remained a pain point for some orthopedic surgeons.

For G. Jason Hunt, DO, a surgeon at Tampa, Fla.-based OrthoLink, price transparency is the area he's looking at closest.

"With the laws that require hospital systems to post contracted prices for certain services, the general public got a small glimpse into the non-government payer contract," Dr. Hunt said. "This information has the potential to have a negative effect on employed orthopedic surgeons who are unable to pay their fee schedules or negotiate contracted rates. It may also help private practice orthopedic practices by leveling the reimbursement gap that exists. Legislation that takes effect in January 2022 will also allow patients to get information directly from the insurance companies to price shop physicians. For the first time, new contacts will eliminate gag orders and the negotiated rates with commercial payers will be public. It has the potential to be the biggest cost saver in the history of rural medicine."

Dr. Berven said he was critical of fee for service medicine since it "has led to unsustainable increases in healthcare costs."

"There is no informed consumer of healthcare that would enter a fee for service payment model, and consumers are finally developing alternative models of payment. Integrated care models and ACOs are value-based healthcare models that will be preferred by purchasers who have a choice. Development of novel ACOs that balance patient preference and cost-effectiveness will be the most important healthcare trend in the next decade.

Prior authorizations are also an ongoing concern for some surgeons.

"An example is joint replacement reimbursement that has been cut an additional 5 percent in 2021," Andrew Bush, MD, of Sanford, N.C.-based Central Carolina Orthopaedics said. "Since I first started practicing in 1995, reimbursement for joint replacement surgeries have been cut about 60 percent (down from $3,200 to $3,500 to current reimbursement at about $800 to $1,000). For physicians that do not have any other revenue stream, this would result in an overall 5 percent reduction in income with no cut in costs.

5. Practice consolidation
Davis Hurley, MD, of Denver-based Orthopedic Centers of Colorado said he thinks the trends of consolidation will point towards patient care most.

"Certainly consolidation continues to occur; we see a shift in the trend however being more focused around care delivery as opposed to consolidation for size," Dr. Hurley said. "With CMS removing the inpatient only procedure lists the efforts around consolidation are geared toward building out robust outpatient strategies."

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