Top 3 trends to follow in healthcare: 5 executive insights

Payer Issues

Value-based care, outpatient care migration and consolidation are healthcare topics executives are keeping a close eye on going into 2022.

The leaders at five orthopedic groups throughout the U.S. spoke to Becker's Spine Review about those topics and why they're significant.

Note: Responses were edited for style and clarity.

André Blom. CEO, Illinois Bone & Joint Institute (Des Plaines): 1) Staffing models will be significantly touched by the COVID effect for probably the next three years. We need to pay attention to the health and well-being of all of our team members. Collectively we are navigating both difficult and unknown waters with regard to the prolonged strain caused by COVID. And just like we didn't really know where things would end up when it started last February, we can't fully predict an end point at this stage. We will be well-served by following the health and energy of our team members in the next couple of years.

2) The "value" buzzword will be replaced by "risk" in the next three to five years. This creates tremendous opportunities for orthopedic surgeons who effectively have a significant portion of control in the management of a multitude of business verticals tied to their practice. Thus, I follow any changes associated with value-based medicine very carefully.

3) Inflation is becoming a real issue. We will be carefully monitoring the ratio between income and expenses in all categories — especially variable elements that we have the ability to control better. Measured spending and tightening our belts will absolutely be an organizational focus in 2022.

Bryan Williamson, MD. Medical Director, OrthoLoneStar (Houston): The top three trends that we are following are the availability and use of data and analytics to improve patient care, the progression of payment models toward value-based care and the importance of maintaining an empowered, healthy and motivated healthcare workforce.

Nicholas Grosso, MD. President, Centers for Advanced Orthopaedics (Bethesda, Md.): The top healthcare trend we're following is the transition from fee-for-service to value-based care.

Separately, but related, we are also monitoring the continued consolidation of orthopedic groups. There is a great deal of financial risk for practices that are adopting value-based care, and we're all making significant investments in personnel and technology needed to succeed through this transition. Thus, many smaller groups are turning to consolidation.

Third, this transition to value-based care is prompting hospitals to purchase smaller practice groups and lower-cost sites of care — such as ambulatory surgery centers — at an increasing volume.

Ed Hellman, MD. CEO, OrthoIndy (Indianapolis): In the orthopedic world, there's the move to outpatient. Over the next several years, I think you're going to see the hospital be a place where orthopedic trauma and surgery on patients with major medical comorbidities are done. Patients who may need intensive care levels will still require hospitalization, but most orthopedic cases are going to move out of the hospital into an ambulatory world.

We're also looking at videoconferencing and telehealth systems. I'm not so sure how big a part of orthopedic care it's going to be, but I do think it will play a role. It's very difficult to do a physical exam over a video link, so it won't really replace a patient coming in to have their knee, shoulder or spine examined. But there are situations where it can be extremely helpful and user-friendly for both the patient and the physician. For example, a patient who's concerned after surgery about swelling, what their incision looks like, or whether or not they're making the right progress with physical therapy, those types of situations can be easily handled over video. You can see an incision and see if a leg is swollen — many times that can help avoid patients coming into the office.

Another issue is how healthcare will be paid for. Obviously, the whole fee-for-service, third-party payer system is coming under a lot of stress as we approach 20 percent of GDP going to healthcare. A lot of our companies are looking at their healthcare spend as something that's really hurting their bottom line, and it gives us an opportunity to develop more innovative models, such as direct-to-employer contracts and bundled payment programs. The buzz term is "value-based care," but it's very difficult to find value, so I think these other ways of looking at care are going to be very important. That's also one of the reasons why smaller orthopedic groups might struggle — it really requires some degree of size to be able to participate in these programs.

Kim Mikes, BSN, RN. CEO, Hoag Orthopedic Institute (Irvine, Calif.): 1) Consolidation of physician practices: Mega groups and consolidation under corporate umbrella companies. 

2) The CMS transition of orthopedic procedures such as total joint and spine from the hospital to the ASC, and the subsequent reversal of those guidelines for certain procedures to go back to the hospital instead of the ASC.

3) Orthopedic population health management.

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