Texas Back Institute Co-Founder Stephen Hochschuler, MD, discusses key trends in the independent practice of medicine for orthopedic and spine surgeons and how to prepare for the future.
Dr. Hochschuler will be speaking at the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference. To learn more and register, click here. Contact Maura Jodoin at mjodoin@beckershealthcare.com or Kristelle Khazzaka at Kkhazzaka@beckershealthcare.com for further information about sponsorship and exhibitor opportunities.
Question: Do you think spine surgeons and ASCs will be able to maintain independence over the next decade? How can they prepare and what factors should they monitor closely?
Dr. Stephen Hochschuler: Unfortunately, around 50 percent of orthopedic surgeons and 70 percent of neurosurgeons are employed by hospitals. Everyone is scared right now; insurance companies are scared as well. If you look at what UnitedHealth has done, purchasing Optum and SCA, they are able to deliver informatics and predictive analytics to surgery centers. Many of these surgery centers have physician owners who partnered with hospitals or another entity to own and operate the center.
The second trend is physicians congregating in large groups, including Midwest Orthopaedics at Rush, Rothman Institute, Hospital for Special Surgery, Texas Back Institute and The CORE Institute. Young surgeons could affiliate with one of those groups; you wouldn't have total independence, because the group runs the practice, but at least you could have ownership of the practice.
The third model for independent physicians is to become an expert in the field and survive based on recognition in the market. These physicians can also affiliate with other groups, including outpatient surgery centers, rehab facilities and short-stay hospitals. They'll have to figure out whether global fees and bundled payments are taking hold in their market to get out front of this trend without taking on too much risk.
Q: How do you see physician groups succeeding in the future?
SH: I've always believed you have to watch what the competition is doing. That doesn't mean it regulates what you do, but be aware of it. If the hospitals are consolidating, figure out what hospital you'll do deformity procedures in and whether they'll give you credentials. Additionally, surgeons need to go to national conferences. They don't like to go, but that's where you make contacts and gain recognition in the field.
Look at your situation: What is happening to your numbers? Do you have the same referrals as you did a few years ago? Are you achieving the same payment per case? Look at those trends and from there you can predict what will happen in three to five years.
Q: Where do you see the biggest opportunities for independent physicians to build their businesses?
SH: Becker's Healthcare is a great resource. Surgeons can get their name published and thoughts out there proactively. When I started working with Becker's, I didn't know the publication's reputation. But I contributed. The leader always takes arrows in their back, but then everyone wonders what they are doing and tries to get involved. Spine Health and SpineUniverse are also great resources, especially if you're looking to grow on nickels rather than $100 bills.
Telehealth is another expandable area that allows you to cover your patients more efficiently. All the rules of telehealth are changing, so you have to learn what they are. Another area I'm looking at is pain management for spine surgeons; you need a multimodal approach to prepare the patient for pre-op and then what to expect without opioids. Finally, I'm looking at regenerative medicine for spinal procedures to address anti-inflammatory issues, which all spine surgeons should be interested in.