5 insights from Dr. Alex Vaccaro to know in 2021


Alexander Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, has marked a significant year from the practice's Florida expansion to being named the No. 1 spine expert in the world.

Here are five quotes from his conversations with Becker's this year:

On why he doesn't regret dropping bundled payments at Rothman: "My view of bundle payments has not changed. It is an effective way of developing patient-facing, value-based healthcare decisions," he said in June. "The innate problem, however, is the intrinsic 'race to the bottom' effect of bundled payments that reduces long-term reimbursements to important stakeholders in the process. This, unfortunately, misaligns incentives to participate. I have not seen any material changes in the approach from CMS that would make continued participation in the BPCI program compelling. At Rothman, we are proud to deliver the highest quality care, and affordability is part of our mission statement. We believe a commitment to increased value in healthcare should be rewarded for the long term, not just in the short term, for initial savings."

On one mistake surgeons should avoid: "The worst decision or investment I've made in my life is listening to financial advisers when I first entered practice, believing they were truly fiduciaries of my hard-earned money and abandoning the simple strategy of index fund capital allocation as a method of building long-term financial security," he told Becker's. "When you're young and naive, you're often influenced by savvy, smooth-talking financial advisers and disability brokers on the importance of letting them manage your money. What I found over time is that simple dollar-cost averaging, exploiting index funds and therefore minimizing unnecessary fees, and maximizing tax-deferred investment opportunities, including 529 plans for educational purposes, was the most efficient way to develop wealth over time."

On what medical students should learn: "Starting in medical school, students should be provided the opportunity to learn basic business skills ranging from healthcare microeconomics, macroeconomics, GAAP accounting, leadership, motivation and population health," Dr. Vaccaro said in a December interview. "Healthcare is the largest business in the world — 18.5 percent of our GDP is dedicated to healthcare, and no one takes care of patients better than physicians. So we have to have an understanding of how to do this in a value-based healthcare paradigm. This can be efficiently administered through physician leadership and know-how. Physicians understand what it's like to take care of a patient in the middle of the night with limited resources to get the best care for that patient. So I think that's what we need to do. We need basic business skills for every physician, not just physician MBA leaders."

On the next game-changer in spine surgery: "Telemedicine is an inevitable game-changer in spine surgery," he told Becker's. "As the field advances, the traditional doctor's visit is due for a much-needed update. With the pandemic, the implementation of telemedicine was kicked into overdrive, and its utilization will continue to reshape clinical practice. This will ultimately allow patients to receive the best care possible at their convenience, despite common boundaries such as busy work schedules, living in rural areas or having functional limitations. Patients can now receive second opinions from world-class thought leaders at a fraction of the price, and a surgeon's office hours can now be mobile, exploiting downtime at medical meetings and between surgical cases if necessary."

On why he embraces competition: "I always liked competition because it allows us to understand the good things about our rivals," he said in a September interview. "Rivals encourage us to be more competitive in terms of value-based healthcare. What do they do better than we do? Let's imitate the best in class, and let's try to beat them when it comes to quality of care and cost.

"When you're the only one around in your area, you develop a sense of complacency, and I think costs go up. I encourage competition. Florida is a great market. Orlando is growing at an estimated 300,000 people per year, so the market is expanding, and they need healthcare, especially the aging population. I've always been a big supporter of competition. It sort of stimulates us at the Rothman Institute to be more competitive ourselves."

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