5 insights from Dr. Alex Vaccaro in 2022


Alexander Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, shared his expertise on a variety of spine and orthopedic topics in 2022. Here are five insights to know:

On his vision for Rothman in 15 years: "In the future, Rothman Orthopaedics wants to remain private and independent and not consumed by a large healthcare system. As long as physicians stay independent, we will have a very strong voice for the patient. I think once you begin to work for a larger organization and lose your identity, the patient loses their voice in a sense. Independent physicians are what makes us Americans and I think that's what patients want. It boils down to choice."

On present growth opportunities for Rothman: "We're expanding pretty rapidly. When we think about expansion, we examine a particular geographic location and what the orthopedic landscape is like. Some areas have a great orthopedic landscape; the communities are being serviced well, they've got great value-based programs and surgeons that buy into that philosophy. If that's the case, we feel that we may not provide further value. We go into places that may be a little bit behind when it comes to innovative value-based bundled payment programs, outpatient ambulatory care services, or there is fragmented care delivery. Those are prime markets we think are appropriate to expand into."

On retail giants entering healthcare in the U.S.: "The ability to provide access at an individual's convenience at an appropriate price point with high quality is key to remaining relevant in healthcare. With Walmart and CVS Health further integrating into the market by providing direct patient care via their Center of Excellence collaboration models and hiring providers on staff of their own, this places increased pressure on traditional care providers to innovate or risk a reduction in their patient volumes.

More specifically, they are changing the landscape of where and how care is provided, within the lens that people want, such as the place, time and affordable price point; including where they shop for everyday items and within the comforts of their home. CVS, for example, has applied for a patent in the metaverse for virtual shopping and remote care. Traditional care providers should take notice of these market disruptors as they have the ability to impact supply and demand, which in turn can directly impact volume, pricing and reimbursement for care. As Walmart and CVS seek to reinvent patient expectations and experience, so must current healthcare providers."

On private equity in orthopedics: "Private equity provides an infusion of capital, which may help some orthopedic groups invest in ASCs, infrastructure and develop value-based care programs. Most private equity organizations want a majority stake in an orthopedic group, but the question is, what's next? Someone has to make money, so when you have an outside investor with a large investment in these groups, there has to be some sort of return. The return prior to private equity was invested back into the business, so care must be taken to make sure these arrangements invest in growth and quality patient care and not for the profit of the investor.

The private equity movement is going to be big for the next five years maybe, but what happens afterwards? Who becomes the final buyer? Nobody really knows right now, but I think physicians have to determine the direction of healthcare and not let big business determine the direction of American medicine. The group has to decide if they want to confront future economic challenges independently or if they want to do this with a large healthcare system that focuses on patient care or with a private equity group that is focused on care efficiency. Private equity partnerships will only survive if they reinvest in the patient."

On his advice for the next generation of spine surgeons: "To the graduating residents, if you have chosen to pursue fellowship training, congratulations on your match and begin to determine whether you would envision practicing in an academic or a private setting. If academics is in your future, identify research mentors early and consider feasible projects that you can complete within the academic year, as most fellowships are only one year long and it will be difficult to create prospective projects or build data sets with your limited time while being busy with clinical duties and training in fellowship. Continue to engage in academic activities such as presenting at research conferences or joining educational committees. If you are interested in private practice, think about the types of procedures you would like your future practice to encompass and focus on maximizing efficiency and repetition in these areas to gain as much exposure and comfort as possible. In both academics and private practice, focus on networking with others in your field as job opportunities after fellowship (as well as your future professional relationships) begin to develop during this time.

For the graduating fellows, do not underestimate the importance of the clinic. While many fellows head into fellowship with the mindset that they should maximize every opportunity to be in the operating room, it is in clinic where you hone your examination skills and decision-making important for surgical indications, cultivate patient-physician relationships and gain experience in practice management. In addition, your goal as a fellow is to be prepared to transition to independent practice at the end of the year, and it is important that you maximize your time as a fellow to develop into an independent surgeon — take note of things that your mentors do that work well for you, and things that you would do differently. Pay attention to the complications and suboptimal outcomes that you see during fellowship, and identify how your mentors deal with these. Finally, identify mentors who you can trust and continue to speak to over the course of your career — you will continue to need and rely on their advice and input in your practice whether you choose private practice or academics, particularly in early practice when you encounter difficult or complex cases."

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