Ownership loss, declining reimbursement and more: Orthopedics' biggest threats

Carly Behm -  

From reimbursement challenges to supply and demand challenges, orthopedic surgeons are concerned about threats to the specialty.

Here is what five surgeons told Becker's:

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

Question: What is the biggest threat to orthopedics?

Hooman M. Melamed, MD. The Spine Pro (Marina Del Rey, Calif.): Major hospitals and healthcare corporations are acquiring more and more physician practices, especially primary care, which not only is driving the cost of healthcare up but also decreases the referral to the community orthopedic surgeons, and now instead, those primary care practices have to refer to the hospital or that healthcare corporate system.

Insurance companies are further reducing payment and bundling payments together which is putting some practices on a financial strain since average overhead is going up every year. For example, as staff salaries increase every year, yet reimbursement is getting less.

This forces many orthopedic surgeons to work more and increase the volume which causes higher rate of burnouts, dissatisfaction with the job and increased patient care mistakes.

Davis Hurley, MD. CEO at Orthopedic Centers of Colorado (Denver): Distance and the loss of ownership are the biggest threats to orthopedics. 

There is an increasing distance between patients and orthopedic surgeons in clinics, rounds and insurance networks. Efforts to create more efficiencies and cost savings by putting more computers, assistants and overlapping cases between the surgeon and patient are a threat to patient safety and the patient-physician relationship. For example, compartment syndrome is not often missed by the operating surgeon. A covering assistant does not have the same relationship and specific patient knowledge to have a higher level of concern and the critical time can elapse before the surgeon is reengaged.

The loss of ownership of practices and ancillaries will limit investment in cost-saving opportunities and innovation. Orthopedic surgeons have proven savings by safely moving imaging and surgery into outpatient settings. Surgeons took personal financial risks to create these positive changes. New payment models that focus on prevention, patient-reported outcomes and cost savings must have physician ownership and incentives to drive adoption and success.

David Kalainov, MD. Northwestern Medicine (Chicago): The biggest threat I see in orthopedic surgery is declining CMS reimbursement. This may lead to further erosion of independent orthopedic practice groups. These groups provide value to the community members they serve.

Bruce Prager, MD. Orthopedic Center of Arlington (Texas): The biggest threat to orthopedics right now is the continuous denial of care by the insurance companies.

Almost all of the worker’s compensation companies deny surgery requests initially. This forces us to go through the appeal process and delays the surgery for months.

The commercial payers are doing the same thing, although not as frequently. They will force a patient to go through physical therapy for a diagnosis that is not going to get better with
therapy. Until the period of therapy is completed, they will not precert the surgery.

Sam Gerber, MD. Orthopaedic Surgical Associates (North Chelmsford, Mass.): With baby boomers living longer than prior generations, their demand for orthopedic care will continue to increase. The disequilibrium between supply and demand for orthopedic surgical care promises to represent a major obstacle for the efficient delivery of care. Decreasing reimbursements promise to further exacerbate this supply-demand imbalance, as aging orthopedic surgeons choose to retire, and medicine becomes less attractive to new college graduates. A desire for work-life balance of graduating orthopedic residents may also prove a factor in productivity of newly trained orthopedic surgeons. A confluence of these social, economic and demographic factors promise to represent a major threat in orthopedics.

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