Peter Mandell, MD, chair of the American Academy of Orthopaedic Surgeons Council on Advocacy, discusses four issues currently affecting orthopedics.
1. The development of appropriate use criteria. According to Dr. Mandell, AAOS is currently developing "appropriate use criteria" to phase out procedures that are no longer as useful or appropriate as previously thought. "Cardiologists have had appropriate use criteria for a long time, and they've found that one way to save money is to do procedures that work and phase out those that looked promising years ago but might not work anymore," he says. Over the next few years, AAOS will gather data to determine which procedures are most appropriate for each patient population and which should be discontinued by the specialty as a whole.
For example, he says total joint replacement in younger adults has become more popular over the last decade, raising a discussion over whether the procedure is appropriate for people in their 40s. "As a general rule, you're implanting a piece of metal and plastic that won't last 30 or 40 years in most people," Dr. Mandell says. "If you shift those resources to older people who don't have access because of insurance and other medical problems, you may not save money, but you're going to be using the money more appropriately."
2. Medical liability reform. According to Dr. Mandell, the practice of "defensive medicine," or procedures and tests ordered to offset the likelihood of being sued, costs the United States over $50 billion every year. He says physicians should focus on using resources to treat patients appropriately rather than fend off lawyers.
In order to reduce the use of defensive medicine, AAOS is developing guidelines to protect physicians from lawsuits. For example, AAOS has published a guideline instructing surgeons on how to prevent symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty, emphasizing the importance of assessing the patient's risk for bleeding. While physicians can currently only use the guidelines to argue a malpractice case, AAOS hopes the guidelines will eventually be "enshrined in law" so that physicians who follow the guidelines will not be sued in the first place.
"It's a tragedy [when a patient dies or is harmed during surgery], and the individuals or family should be appropriately compensated, but if you've done everything right and follow the guidelines and it was just bad luck, you shouldn't have to worry about getting sued," he says.
3. Influx of newly insured patients. Dr. Mandell says that over the next few years, orthopedic surgeons, like all physicians, will be tasked with handling a large influx of newly insured Americans, some of whom have lacked medical care for many years.
He says orthopedic surgeons will have to increase their focus on preventive care and patient responsibility by managing patient expectations about where and how often patients should receive care. As providers are stretched thin by the influx of new patients, he says many people will no longer be able to go to the emergency room for non-emergency situations because the waits will simply be too long. "They're going to have to take care of themselves more by watching their weight and taking responsibility for their health," he says. "A lot of problems, such as knee arthritis and hip arthritis, are caused by carrying that extra weight." He says orthopedic surgeons can help by encouraging their patients to lead healthy lifestyles and directing them to resources that will help them lose weight and stay active.
While the impending provider shortage is a problem for orthopedics as well as other specialties, Dr. Mandell says the specialty is still gaining quality orthopedic physicians every year. "We are getting very high quality folks coming into orthopedic surgery," he says. "We're working hard to have the best and the brightest, the most diverse and the most interested group."
4. Phasing out fee-for-service compensation models. Dr. Mandell says that while the push towards pay-for-performance and away from fee-for-service "looks good on paper," AAOS is concerned from a specialist perspective that the change may severely impact access to high-quality specialty care. "We do procedures like total hip replacement, total knee replacement and arthroscopy, that add a lot to quality of life but aren't inexpensive procedures," he says.
He says AAOS wants more expensive orthopedic procedures to be performed on those patients who need them and not rationed because of an unfeasible expense. "The models being proposed — ACOs, episodes of care and bundling services together — are looking pretty good right now, but the long-term results are [still unclear]," he says.
Learn more about the American Academy of Orthopaedic Surgeons.
1. The development of appropriate use criteria. According to Dr. Mandell, AAOS is currently developing "appropriate use criteria" to phase out procedures that are no longer as useful or appropriate as previously thought. "Cardiologists have had appropriate use criteria for a long time, and they've found that one way to save money is to do procedures that work and phase out those that looked promising years ago but might not work anymore," he says. Over the next few years, AAOS will gather data to determine which procedures are most appropriate for each patient population and which should be discontinued by the specialty as a whole.
For example, he says total joint replacement in younger adults has become more popular over the last decade, raising a discussion over whether the procedure is appropriate for people in their 40s. "As a general rule, you're implanting a piece of metal and plastic that won't last 30 or 40 years in most people," Dr. Mandell says. "If you shift those resources to older people who don't have access because of insurance and other medical problems, you may not save money, but you're going to be using the money more appropriately."
2. Medical liability reform. According to Dr. Mandell, the practice of "defensive medicine," or procedures and tests ordered to offset the likelihood of being sued, costs the United States over $50 billion every year. He says physicians should focus on using resources to treat patients appropriately rather than fend off lawyers.
In order to reduce the use of defensive medicine, AAOS is developing guidelines to protect physicians from lawsuits. For example, AAOS has published a guideline instructing surgeons on how to prevent symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty, emphasizing the importance of assessing the patient's risk for bleeding. While physicians can currently only use the guidelines to argue a malpractice case, AAOS hopes the guidelines will eventually be "enshrined in law" so that physicians who follow the guidelines will not be sued in the first place.
"It's a tragedy [when a patient dies or is harmed during surgery], and the individuals or family should be appropriately compensated, but if you've done everything right and follow the guidelines and it was just bad luck, you shouldn't have to worry about getting sued," he says.
3. Influx of newly insured patients. Dr. Mandell says that over the next few years, orthopedic surgeons, like all physicians, will be tasked with handling a large influx of newly insured Americans, some of whom have lacked medical care for many years.
He says orthopedic surgeons will have to increase their focus on preventive care and patient responsibility by managing patient expectations about where and how often patients should receive care. As providers are stretched thin by the influx of new patients, he says many people will no longer be able to go to the emergency room for non-emergency situations because the waits will simply be too long. "They're going to have to take care of themselves more by watching their weight and taking responsibility for their health," he says. "A lot of problems, such as knee arthritis and hip arthritis, are caused by carrying that extra weight." He says orthopedic surgeons can help by encouraging their patients to lead healthy lifestyles and directing them to resources that will help them lose weight and stay active.
While the impending provider shortage is a problem for orthopedics as well as other specialties, Dr. Mandell says the specialty is still gaining quality orthopedic physicians every year. "We are getting very high quality folks coming into orthopedic surgery," he says. "We're working hard to have the best and the brightest, the most diverse and the most interested group."
4. Phasing out fee-for-service compensation models. Dr. Mandell says that while the push towards pay-for-performance and away from fee-for-service "looks good on paper," AAOS is concerned from a specialist perspective that the change may severely impact access to high-quality specialty care. "We do procedures like total hip replacement, total knee replacement and arthroscopy, that add a lot to quality of life but aren't inexpensive procedures," he says.
He says AAOS wants more expensive orthopedic procedures to be performed on those patients who need them and not rationed because of an unfeasible expense. "The models being proposed — ACOs, episodes of care and bundling services together — are looking pretty good right now, but the long-term results are [still unclear]," he says.
Learn more about the American Academy of Orthopaedic Surgeons.