From opioid use to site-of-service concerns, three orthopedic leaders joined Becker's to discuss the most controversial issues in orthopedics right now.
Editor's note: These responses were edited lightly for clarity and length.
Steven Barnett, MD. Chief Medical Officer at Hoag Orthopedic Institute (Irvine, Calif.): Controversy surrounds efficacy of new technologies such as robotics, augmented reality and artificial intelligence as these relate to historical manually based surgical interventions. Debate among practicing orthopedic surgeons regarding these evolving technologies will lead to benefits for our patients as we tease out what is in their best interest from a care standpoint.
One nationally overarching controversial issue that relates to our profession is opioid use, management and treatment of our patients' pain. Among my many colleagues at patient-centric Hoag Orthopedic Institute, opioid reduction is a highly serious issue. After studying the pain medication use with fellow orthopedic surgeons, pain management and anesthesia specialists and our nurses, the hospital has instituted a new safe medication stewardship program that provides safe medication disposal kits at the bedside for all patients who are prescribed opioids and muscle relaxers. We felt an obligation to our patients and their families to deal with this issue up front, providing education and tools to safely dispose of unused medications. Patient care and risk were the center point in our decision-making process. Our HOI nurses ended up leading this effort, and I must share that it is one of the most important programs we’ve ever introduced.
Sara Holman, RN. Director of Neurosurgery at Deaconess Health System (Evansville, Ind.): The most controversial issue in my area right now of ortho/spine include inpatient vs. ambulatory care areas as the optimal location for surgery. Of course, I may be a little biased as I am in the inpatient setting, but I do feel strongly that you can achieve great results on outpatient surgeries just as well as you can on inpatient surgeries. The location does not matter as much as the program itself does. Optimization, managing patient expectations and ensuring they understand the process is key to success.
Felix Savoie, MD. Professor and Chair of the Department of Orthopedic Surgery at Tulane University (New Orleans): I believe the most controversial issue is the declining reimbursement and increasing denial of care from both Medicare Advantage plans and private insurance companies. In most cases these companies put in unfair roadblocks to inappropriately deny care, allowing patients to suffer and requiring extra time, paperwork and personnel to get the appropriate care approved. Once approved, then they refuse to pay for half of the necessary procedures, deny postoperative therapy or set a copay so high no one can afford to attend. This is a significant threat to our patient population and to the practice of medicine.