The biggest challenge facing orthopedic surgeons for 2015: 11 surgeons respond

Orthopedic Sports Medicine

There are many distinct challenges for orthopedic surgeons next year, including implant costs, healthcare reform implementation and reimbursement rates.


Eleven orthopedic surgeons and industry leaders discuss the biggest issue for them heading into 2015. If you would like to contribute a response to this or future orthopedics-related articles, contact Laura Dyrda at


Greg Tchejeyan, MD, Los Robles Hospital, Thousand Oaks, Calif.: The biggest issue facing orthopedic surgeons is the challenges of the rapidly changing healthcare environment which include: increasing capital costs, lower reimbursements and increased data reporting requirements. Today, the orthopedic surgeon needs to be just as comfortable running a business as they do running the operating room. We would all prefer to focus our attention on what we do best, which is taking care of our patients, however, in order to successfully run our practices we need to deal with the "business" of medicine.


Scott S. Gordon, MD, Orthopedic Associates of Osceola, Kissimmee, Fla.: Biggest problem is as orthopedic surgeons become hospital employees, their allegiance shifts from the patient to the corporate (or Government) bottom line. We no longer are professionals — we are employees that will do the bidding of our employer, the hospital/government. We are losing our ability to choose the method and specific products to use in our surgeries as these decisions are now made by the hospitals and the government-run insurance policies. You will see more and more "best practice" studies done by doctors on the payroll of government research — not saying it is doing the government's agenda — just saying that there is a huge potential for corruption.


Mary O'Brien, MBA, CMPE, CEO of Fox Valley Orthopaedic Institute, Geneva, Ill.: 1.Cost of Implants continuing to increase while insurance contracts do not. Surely the implant companies have a large enough margin that they do not need to continually raise their rates.
2. Increasing demands for "peer-to-peer" reviews with the insurance companies. Long waits on phone and person at the other end is NOT a "peer" (orthopedic surgeon) this occurs more and more for advanced imaging (often) and surgeries (occasionally).
3. Specific requirements for extended "conservative care." If a patient waits until pain is so bad there is no way conservative care will help they still have to wait and "try" care or there will be no reimbursement for surgeons and/or hospitals.


Kevin Stone, MD, Founder, The Stone Clinic, San Francisco: 1. How to improve quality in a price pressured world.


2. How to advance the field or agree on "standards" when less than 15 percent of all published studies are Level 1. Without actual data what good are "accepted treatment guidelines?"


3. How to push forward the biologic solutions to orthopedic problems when there are no FDA-approved and few insurance reimbursed therapies?


William Long, MD, Founder and Medical Director, Orthopaedic Computer Surgery Institute at Good Samaritan Hospital, Los Angeles: The biggest issue facing orthopaedic surgeons in the United States is the loss of ability to practice medicine freely in a private practice setting. Young surgeons entering the workforce face out-of-control start-up costs and little ability to control costs or income from one year to the next. This results in a compromised doctor-patient relationship because many believe that they must generate income through a high-volume mode that does not allow them to care for the individual patient. Those who employ physicians often have little interest in the traditional doctor-patient relationship.


Roderick Claybrooks, MD, Michigan Spine and Brain Surgeons, Novi: The biggest issues facing orthopedic surgeons today are costs of implants and new technology. The high cost of these technologies often strain budgets and put surgeons at odds with hospital systems and administrators in the face of our need for these devices to advance our field along with the treatment of our patients. In this cost-conscious era doctors' salaries are often front-page news but the majority of the public doesn't understand that doctor's fees are less than 10 percent of the overall hospital bill. The costs of new technologies like biologics and minimally invasive implants often used by orthopedic surgeons, not for financial gain but in attempt to attain better outcomes, will be our biggest issue going forward.


Adam Bitterman, DO, Chief Resident, North Shore LIJ: Plainview (N.Y.): 1. Managing a patient's expectations — this involves their pain level as well as their participation in various activities. For some reason there is a disconnect when patients have joints replaced. They don't seem to understand why they have pain following a knee/hip/shoulder replacement. Yes, we provided them with a nerve block or a particular multi-modal pain regimen but nothing is absolute. It is unfortunate because unexpected pain not only can be a physical barrier to doing well in therapy but a mental one as well.


2. Discharge planning — similar to the statement above, patients don't always consider all obstacles associated with their living arrangement. This leads to a delay in returning home or beginning their therapy at an inpatient facility. As a result the patient's length-of-stay will be increased and place them at a higher risk for nosocomial postoperative complications.


Steven Gausewitz, MD, Chief of Staff, Hoag Orthopedic Institute, Irvine, Calif.: The most annoying issues orthopedic surgeons have to overcome are the increasing burden of dealing with information technology.  We are being asked to assimilate many layers of documentation and governmental regulation which is often is in no way intuitive or has a clear benefit for the patient.  But I think the most important issue is for orthopedic surgeons to be very clear and transparent as to why we are choosing a specific intervention for our patient, why we are confident that it will be effective, and how we will evaluate our results.  I see “evidence-based” going to a new level, which I think is a good thing.


Bert Mandelbaum, MD, Co-Chair of Medical Affairs, Institute for Sports Sciences, Los Angeles: The biggest issue facing orthopaedic surgeons today is responding to change. In one regard there will be an exponential increase in demand for orthopaedic procedures including arthroplasty. On the other hand, there is an ever-evolving business model that includes patient empowerment and centric care, health center integration, narrow provider networks and reimbursement challenges.


Raymond Raven, MD, Orthopaedic Surgery Specialists: Consider this: 80 percent of orthopedic procedures can be performed as outpatient surgery. Moreover, hospitals cost up to 60 percent more than ambulatory surgery centers for outpatient surgery. There is no need for the hospital to be involved in outpatient care. They cost too much, they are less efficient, and the quality is usually mush less. If orthopaedic surgeons move into hospital-based practices, reimbursement will eventually decrease to compete with outpatient facilities. Orthopedic surgeons will be undervalued and pay will decrease while CEO and administrative pay remain the same. Orthopedic surgeons should remain independent even though it is easy to consider business under a hospital-based employee model. As orthopedic surgeons, we are better positioned to keep costs down while maintaining efficiencies and high quality, and thus [providing] better value for patients.


David Forsh, MD, Assistant Professor Orthopaedics, Mount Sinai Hospital, New York City: One of the biggest challenges and concerns facing orthopedic surgeons today is the declining reimbursement rates that are incumbent with continued healthcare reform. I fear this can potentially be a significant issue, particularly for younger surgeons with loans to account for.



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