1. Don't react with fear. When you are merely reacting to the fear of uncertainty, you will miss potential opportunities for taking advantage of a tumultuous time. Instead of fearing potential changes, orthopedic practices should identify their competitive advantages, especially over hospitals, and find ways to exploit them. "It's hard for large hospital organizations to feel friendly to patients, like a smaller practice does, which is a competitive advantage we could exploit," says John Wipfler, CEO of OA-Centers for Orthopaedics in Portland, Maine. "Large hospital organizations can also be clunky, and one of the things we can do is create a high level of customer service that hospitals find hard to compete with."
Another point that Mr. Wipfler often highlights is the group's ability to spread throughout the community while the hospital is fairly grounded within the walls of a single facility. "A hospital is locked where it is, but we are able to have satellite offices in a number of areas," he says. "Local hospitals can't as easily build somewhere else, but we can be nimble and create facilities that are closer to our patients."
2. Work on an improved relationship with hospitals. Changes from healthcare reform, including the public release of hospital data, will improve the relationship between hospitals and orthopedic surgeons. "I see hospitals and orthopedic surgeons having common goals," says James J. Purtill, MD, an orthopedic surgeon at Rothman Institute in Philadelphia. "As physician and hospital rating systems become more popular on the internet and more important for patients as they chose hospitals and orthopedic surgeons, I think surgeons and hospitals are going to work together to achieve common goals." The two entities will work to decrease morbidities, improve outcomes and ensure a continuum of care for the patients. Patients will take note of these efforts and choose to see the orthopedic surgeons and hospitals with the best ratings, he says, which means hospitals are going to associate with physicians who have good ratings and vice versa.
3. Overcome reimbursement issues with increased efficiency. As reimbursement for healthcare services continues to change, orthopedic surgeons will need to conduct their practice efficiently and increase patient volume because payors are unable to support the current system. "Reimbursement levels are going to put a lot of pressure on physicians and practices to become more efficient and have more visibility than what they have now," says James Silliman, MD, an orthopedic sports medicine physician and CEO of Steadman Hawkins Clinic of the Carolinas in Greenville, S.C. "There's also a move toward ACOs in what the Centers for Medicare and Medicaid Services and other payors are putting into place to try to move some of the risk or accountability over to provider groups."
Medical specialists, such as orthopedists, can participate in multiple ACOs, and the physician requirements for these types of arrangements are continuously evolving. "The requirements are very different from those associated with fee-for-service," says Dr. Silliman. "Physicians are going to have to be aware of and familiar with the requirements of the payors, or they'll have to opt out. For example, if you opt out of Medicare, you won't be taking care of those patients."
Private insurers are paying attention to Medicare reimbursement levels and often follow suit. The adoption of these new processes and expectations will occur over several years, but physicians should be aware of the changes before they take place.
4. Taking advantage of telemedicine. Telemedicine will also become increasingly important as surgeons and providers look for the most economically sound methods for delivering care, says Stephen Hochschuler, MD, co-founder of Texas Back Institute. Patients who live in rural areas or suburbs will be able to consult with their physicians or healthcare professionals over the Internet instead of traveling long distances to the office. These channels of communication will also be helpful when patients are experiencing symptoms and wondering whether a visit to the hospital is necessary, or if simple change in their routine will do.
5. Share ideas with other specialists. Just because your orthopedic group may be one of the only independent orthopedic groups in the community doesn't mean you're alone in your struggles. There are most likely other independent orthopedic groups or other specialty groups in the state that are facing the same challenges you are, and sharing information amongst specialists can help each group grow stronger. The physicians and leaders at OA have been instrumental in forming an IPA in Maine for specialty practices only to support one another.
"We've been involved in the founding of a specialty-only IPA where we come together with other specialists to share resources and ideas, and we collaborate to help each other reduce our expenses and find other opportunities to thrive," says Mr. Wipfler.
6. Become a physician advocate. While most physicians agree that physicians should have input on healthcare reform policy and changes, many are not willing to spend the time and capital necessary to advocate for their position. "There are so many changes that happen and surgeons don't get together," says Dr. Hochschuler. "When Texas work comp was changing, we tried to organize physicians in Texas to contribute financially to our cause and only 18 contributed. That tells you physicians are their own worst enemy."
Physicians need to take a proactive approach to advocating for their interests by working with local and national politicians who can influence legislation change. Physicians can also become active in professional medical organizations, which often spearhead efforts in Washington, as well as contribute financially to campaigns supporting their interests.
For example, if the government had decided to provide a tax deduction for physicians, healthcare reform may have been prevented, says Dr. Hochschuler. He suggests physicians and hospitals, whether they are for-profit or not-for-profit, receive a tax break on the bills for treating patients without insurance or those who lack the ability to cover the cost of their care.
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6 Ways Orthopedic Practices Can Positively Confront Healthcare ChangesWritten by Laura Miller | October 03, 2011
Here are six ways orthopedic practices can meet and overcome the challenges presented by the changing healthcare environment.
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