Orthopedics, like many other medical specialties, finds itself facing several new and increasingly complicated changes. For example, CMS' Comprehensive Care for Joint Replacement model went into effect on April 1, changing the way providers in certain hospitals are reimbursed for joint replacement procedures. Add to this the plethora of new orthopedic techniques and technologies and it is safe to say the specialty is in an exciting, if at times uncertain, place.
"Medical advancements and increased regulations have dramatically changed the practice of orthopedics over the last 15 to 20 years. And it's just the beginning. Experts predict extraordinary changes in medicine in the next two to three years — changes that will far surpass the profession’s transformation over the last century," says Gerald R. Williams, Jr., MD, president of the American Academy of Orthopaedic Surgeons and a shoulder and elbow surgeon at Philadelphia-based Rothman Institute.
The latest techniques and technologies aim to treat injuries and conditions while providing the best possible outcome and quality-of-life post-surgery.
Recent orthopedic advancements include devices and techniques that involve 3D printing, robotics and surgical grafting. These have the potential to revolutionize surgical precision, outcomes as well as mobility and life quality, notes Dr. Williams.
Current challenges
According to Dr. Williams, despite the substantial growth in musculoskeletal research funding over the last several decades, the research still remains woefully under-funded.
A United States Bone and Joint Initiative report estimates 126.6 million Americans are affected by a musculoskeletal condition, which is comparable to the total percentage of Americans living with a chronic lung or heart condition. The care for Americans suffering from orthopedic conditions totals $213 billion in annual treatment, care and lost wages. In 2011, musculoskeletal conditions drove 18 percent of all healthcare visits and 16.3 percent of healthcare costs.
"Yet research funding in the field totaled less than 2 percent of the total NIH budget each year since 2000, declining even more in recent years when NIH's overall budget was either level or cut in constant dollars," says Dr. Williams. "This is a profound mismatch that must be addressed."
Additionally, surgeons are dealing with new administrative tasks mandated by the federal government and private payers, as well as alternative payment models and more detailed standards of quality. Ultimately, outside pressures limit a surgeon's time with the most important stakeholder in the healthcare industry — the patient.
AAOS under Dr. Williams
Dr. Williams intends to help surgeons overcome as many of the aforementioned challenges as possible during his time at the helm of AAOS.
First, it is important that the orthopedic provider community makes a case to Congress and the society-at-large for greater research funding, he says. Individually, orthopedic surgeons can do their part and help support research-focused organizations, such as the Orthopaedic Research and Education Foundation.
"Nobody will support our research efforts if we do not support them ourselves," he says.
In this coming year, AAOS will focus on working with CMS to ensure new guidelines acknowledge the role of experience-based clinical judgment. Increasing the number of active members in the AAOS' political action committee could help highlight issues facing the orthopedist community on Capitol Hill and even among payers.
"Overall, we will be most successful if we remember two things — that there is strength in numbers and that the patient is king and queen," he says. "We must remind all those who have lost sight of our role, both outside and within medicine, that we are the patient's advocate. Period. End of story."
Dr. Williams plans to work closely with the 23 separate groups on the AAOS' Board of Specialty Societies. He hopes to ensure collaboration and a united effort on behalf of orthopedic patients and the orthopedic profession in the face of challenges, old and new.