Michael Oberlander, MD, is an orthopaedic surgeon and sports medicine specialist from Walnut Creek, Calif., and editorial board member for the American Journal of Sports Medicine. He discusses meniscus repair surgery and what it will take to build a successful business practice in the coming years.
Question: How is meniscus repair surgery changing and what devices are contributing to a better procedure?
Dr. Michael Oberlander: Meniscus repair is preferred over partial meniscectomy for many reasons. The most important is an increased awareness based on peer reviewed literature showing that even partial meniscectomy results in an increased incidence of arthritis and knee instability than meniscal repair. There are new techniques and devices currently available on the market to facilitate meniscal repair. The standard techniques utilized in the past include inside-outside, outside-inside or open repair. Current techniques allow all inside repair in many situations, facilitating the surgical procedure with fewer complications.
Q: What are your keys to a successful orthopedic practice?
MO: Practice paradigms have changed quite a bit in recent years. Tremendous changes are occurring in healthcare and at a rate unprecedented in the past. It's more advantageous for physicians to align with other single or multispecialty groups forming true practice mergers or affiliating under a corporate umbrella to maximize purchasing power, insurance negotiation of fee schedules, sharing of computer systems including hardware and software as well as mitigating risk.
In this paradigm, practices that scale are better able to negotiate with hospital systems, insurers and directly with industry.
Other significant changes include capitalizing on ancillary income opportunities, running efficient and fiscally sound business practices and being proactive in bundled care payment programs. Practices are incorporating software to improve efficiency and should be collecting patient-reported outcomes. This outcome data will soon be required for at least half of the patients in their practice to maximize reimbursement as we move from volume to value based medicine. Most practices haven't figured out how to best collect this data efficiently without tremendous expense and adding FTEs to their practice; they are just getting over the shellshock of ICD-10. Software programs like ours at Trainer Rx are tracking patient-reported outcomes measures and collecting that data in a patient-centric way and delivering the information back with analytics to allow practices of any size to participate in the shared risk arrangements with insurers, hospital systems and corporations.
Q: How do you see independent orthopedic practices evolving over the next five years?
MO: Independent orthopaedic practices will become larger and include all orthopaedic subspecialists. There will be much improved data collection and risk management. It will include working relationships and contracts with hospital systems as well as sharing risk with the hospitals and ASCs to gain a larger percentage of the pie in the bundled payment programs. In the process, doctors can save the hospital, ASC or health system significant money by decreasing hospital stays and increasing patient satisfaction. The government is becoming increasingly involved in lowering the cost of healthcare, as the current model of volume-based reimbursement is unsustainable. It is placing more emphasis on patient satisfaction and less on true patient reported outcome data that we as Orthopaedic surgeons generally believe is a better gauge of patient outcome and quality care.
Learn more from Dr. Michael Oberlander at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.