The biggest issues facing orthopedic surgeons today

Five orthopedic surgeons discuss the biggest issues they're facing and how the field is changing to meet these challenges.

Stephen S. Burkhart, MD, The San Antonio Orthopaedic Group: The ability to adapt to the rapidly changing healthcare environment. The risk of falling short on performance-based measurements such as PQRS, VBPM and Meaningful Use in addition to the learning curve of ICD-10 can have negative implications to the surgeon and practice. Leveraging technology within the modern practice has become the key to evolving and surviving in this new landscape.

Greg Tchejeyan, MD, Los Robles Hospital, Thousand Oaks, Calif.: 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.

William Long, MD, Orthopaedic Computer Surgery Institute, Los Angeles: The loss of ability to practice medicine freely in a private practice setting. Young surgeons entering the workforce face out-of-control startup 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.

Subir Jossan, MD, The Center for Advanced Orthopaedics, Prince William Orthopaedics, Hand Surgery & Sports Medicine Center, Manassas, Va.: Providing the highest quality service at the most efficient cost for the healthcare system in general. Orthopaedic surgeons value their autonomy by nature. In this regard, around the nation many orthopedic surgeons have decided to undertake efforts to achieve this goal by joining together in large regional orthopedic groups. This allows for efficiencies on a business level, and, more importantly, a collaboration amongst clinicians to create best practices and monitor the outcomes associated with these practices.

Thomas Cha, MD, MBA, Massachusetts General Hospital (Boston): The challenge for orthopedic surgeons in 2015 will be for societies and surgeons to work on consensus clinical practice guidelines based on outcomes research, specifically cost-effectiveness studies. This has already been started, but the next step is to work with third party payers to align their policies with these guidelines. An example of this is the procedure order entry (PrOE) project we are participating with third party payers in Massachusetts to address the pre-approval process for lumbar spine surgery. ProE is powered by QPID Health's Q-Guide product. We've been using the tool for about a year and a half now and it has helped lessen the documentation burden significantly.

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