In August, Anthony Romeo, MD, returned to the Chicago area to lead DuPage Medical Group's effort to develop a Musculoskeletal Institute.
Dr. Romeo spent two decades as an orthopedic surgeon at Midwest Orthopaedics at Rush (MOR) in Chicago before heading to New York to develop Philadelphia-based Rothman Orthopaedics' New York division. Now, he is excited about his new role as an orthopedic leader within the larger multispecialty medical group. Here, Dr. Romeo discusses what excites him about his new role and where he sees orthopedics headed.
Question: Why did you choose to join DuPage Medical Group? What was attractive about the opportunity?
Dr. Anthony Romeo: When I was part of Midwest Orthopaedics, we developed an amazing program of highly specialized orthopedic care. Over the past decade, mergers and acquisitions as well as coalescence of healthcare systems have led to an increasing number of patients captured inside narrow referral networks. Because of our collective pursuit of top-level orthopaedic care and the reputation we developed within the Chicago metro area, we were insulated from that process. But what was clear is that younger surgeons coming in had fewer patients referred from primary care outside of our health system. We were interested in the DMG model a few years ago and had some discussions about a relationship with them because they had experienced success in western Chicago suburbs located in DuPage County — and they have a large and diverse primary care system for their patients.
The relationship between MOR and DMG never formalized, so when I was looking for an opportunity to make a difference in terms of the delivery of orthopedic and musculoskeletal care within a broader healthcare delivery system, DMG was on the top of the list and we initiated discussions. It was clear they had all the ingredients of a vibrant and progressive medical system, with more than 400 primary care providers, excellent relationships with payers and hospitals, an innovative private practice setting, and high-quality physicians in the areas that focus on musculoskeletal care.
I thought this would be a great opportunity to create an integrated program comprised of orthopedics, spine care, physiatry, pain management, rheumatology, and rehabilitation. The goal is to have the services and expertise that manage all aspects of musculoskeletal care under one roof, initially with a virtual integration and alignment of resources and subspecialized providers. It so happened the leadership at DMG had been planning a musculoskeletal institute and I was fortunate enough to be selected to help spearhead it. I see this as a great opportunity to provide next-level care to the patients already in the system and to become a true destination for musculoskeletal care around the region. Ultimately, we want DMG to be the medical home for our patients where they can receive high-quality care in all aspects related to their health, with a strong primary care base to manage the entire spectrum of their healthcare needs, and for the Musculoskeletal Institute to deliver the most up-to-date, comprehensive, and highest quality of care regarding all problems related to their bones, joints, spine, muscles, tendons, and ligaments.
DMG was also attractive to me because they’ve cultivated a great reputation for high-quality overall medical care. Their team did a great job in the early months of the pandemic—rising to the occasion to help the community in a number of ways. They are very patient-focused, and that’s evident in the way they deliver care and the outcomes they produce.
Q: What is your vision for the DMG Musculoskeletal Institute?
AR: I've been fortunate enough during my career to develop and work with some of the top orthopedic surgeons and programs in the country. I expect nothing less from the DMG Musculoskeletal Institute. We have the resources, physicians and providers to do that. Our plan using the DMG model is to be highly patient focused in the way we deliver care. By leveraging integrated technologies, we can make vast improvements to the patient experience from start to finish.
We are going to ensure physicians are practicing with the best evidence-based information because of our technological capabilities. We will track outcomes, using that data to improve the care we provide and help inform care decisions for other patients. We have an incredible informatics team and the cutting-edge technology that allows us to deliver that care now and in the future. And because we are part of a comprehensive healthcare team, we will be able to better understand and address more complex challenges that affect our results such as the social determinants of health and the overall health status of our patients, especially before we provide procedural interventions including surgery. I believe we'll become a model to other organizations.
Q: Why did you want to be in a multispecialty group now instead of a single-specialty orthopedics group, like you've been part of in the past?
AR: The advantage of being here instead of a single-specialty group is that we have the ability to be part of a medical home for the patient. Patients are frequently dealing with more than just a musculoskeletal issue, especially our older patients—and often it's those other issues that have a profound effect on our orthopedic care. The advantage of our integrated system is that we'll have all those components working together so we can look at the patient as a whole for both those that need surgical care and those who don't. It will help us avoid complications and problems beyond orthopedics.
We know smoking, obesity, nutrition, transportation, social issues, and the inability to get medications can all play a role in the success of orthopedic care. At DMG, we can participate in a process and care for those things while providing a high-level of musculoskeletal care, whether that requires the expertise of a rheumatologist to determine the best medication, a physical therapist to determine the best exercise, or an orthopaedic surgeon to provide the safest procedure associated with the best outcome. This is value-based care delivery in action. We will also work to create opportunities with insurance industry partners and other payers, employers, and hospitals to provide access to care for the greatest number of patients. We want to make sure that when patients need care, they can get it.
Q: The concept of value-based care has been around for a long time; what is different about what you'll do at DMG?
AR: There are many definitions for what value-based care means, but at the core of this process, physicians need to be able to carefully measure and consistently reassess the outcomes of the care they provide while they are defining the total cost of that care to achieve those best-in-class outcomes. At DMG we will strive to reach value by moving away from incentives that encourage expensive interventions reimbursed based solely on the volume, and work towards incentives that focus on the total cost of care for a population of patients with similar problems. We continue to have significant fee-for-service care throughout healthcare, which does not provide the best environment to encourage value-based care. We have move to some alternative payment models such as bundled payments, but this method typically lacks sustainable incentives. Bundled payments can have the effect of reducing a specific episode of care, but they are not built to eliminate less successful surgeries and it doesn't necessarily reduce overall cost of care. These methods have been interesting efforts to try to improve care and reduce costs, but often the only thing that happens is that a single episode of care has a reduced overall cost, without much impact on the total cost of care for a population of patients. While there have certainly been some reports of significant savings and increased financial benefit to some groups, the inevitable conclusion has been that when the efficiencies are maximized, physician reimbursement is driven to levels below a sustainable business model.
At DMG, working within the value-based care model also means that look at the whole patient. We look for opportunities to share the risk of patient care by managing the entire patient—being responsible for all of the medical problems and social determinants of health, which will allow us to better manage the overall cost of care and achieve better outcomes. Of course, our role will be focused on the challenges related to the musculoskeletal system. Within the context of the whole organization and the high level of informatics that we have, as well as protocols and technology, we want to work towards a model of what healthcare should be in the future.
Q: How does the informatics side of things evolve?
AR: We have developed unique expertise in medical informatics and data analysis. Understanding the informatics from all aspects of healthcare allows us to create a truly comprehensive model. The electronic healthcare record (EHR) is one small piece of it. There is tremendous data beyond the EHR that gives us the ability to analyze the information what is truly valuable and how we can improve the way we deliver care. The systems we have working allow us to deliver truly patient-centered care. For instance, we know patients want to schedule their own appointments, identify which physician they want to work with and own their own medical record. And we’re prepared to provide that type of experience –– giving patients a single point of access to their complete care, from any digital access device, including their phones.
We are getting the patient involved and making sure they participate and are engaged with their healthcare. We have the ability to analyze the field of orthopedic surgery and look at the indications for surgery and the potential outcomes of surgery, as well as examine the potential complications and readmissions rates to identify where there may be a problem to remedy.
Then we use our best practices among physicians to make sure we are creating the highest level of care to detect, almost in real time, when there are problems. If we see a complication or issue, we can see whether it's related to the patient or failure to sterilize and we can get very precise to make sure we can remedy the problems. We are also able to capture outcomes, correlate that to comorbidities and their social determinants of health.
The ability to make it to the physician's office, afford medication and overcome comorbidities is important, and because we have the complete picture of the patient, we can use the information to select the right patient diagnosis and treatment that could include nonsurgical care in orthopedics.
Q: How do you see orthopedics evolving over the next 12-24 months?
AR: Orthopedics was exposed during the COVID-19 pandemic. We are heavily determined by elective surgical care. If elective surgical care is taken away, orthopedics practices will fail. When it was taken away for just two or three months, some practices were close to failing and some were trying to figure out how to get out of a hole. This is even true at higher level institutions. Hospitals lost millions of dollars per month due to no elective orthopedic surgeries. When the pandemic has subsided, isolating or focusing on a single specialty can be an effective way to manage healthcare. But if you want a sustainable program to get through the highs and lows and provide value to the organization, you want to be part of a system that has more than just musculoskeletal care.
Practices are creating an M&A philosophy to get bigger in orthopedics. The problem is they are going to struggle to be able to understand the total picture of caring for their patients; they will focus just on their own episode of care and not the overall healthcare of the patient. I think we will see a number of practices continuing to diversify and create affiliations with other healthcare groups. Some will think they are bigger and will have enough leverage to build within their subspecialty. Some will be successful, but the trend in orthopedics is one of the least diverse medical specialties in terms of the way we care for patients and get reimbursed for care.
In the future, we will have more groupings, mergers and acquisitions of orthopedic groups with non-orthopedic entities. Some will be purchased or partner with private equity to have enough capital to keep up with the other organizations that are building programs on a broader base healthcare model and we will see the opportunity for significant change in the way healthcare is delivered.
I also think virtual care delivery is here to stay and there is an opportunity to incorporate telehealth into the treatment model in a way that can be valuable to patients. That would be an expansion of the role physicians have had in the past and I think we'll see more significant innovations in nonoperative treatment for arthritis, back pain and other musculoskeletal issues, and that will reduce elective surgery needed for those conditions.
Q: What will be essential investments for orthopedic surgeons as they look to grow their practices?
AR: In orthopedic surgery, there’s currently a lot of buzz around robotics as a way to help us perform procedures with better precision and outcomes. Robotics are extremely expensive and we're struggling to prove they have better outcomes. In some cases, it’s actually taking longer to perform surgery with them. That doesn't mean robotics won't be great in the future, but it's a narrow approach to growth and currently more of a sensational marketing tactic rather than a concrete strategy to achieve greater outcomes. The public will see through these things.
Orthobiologics and stem cells will see the same fate. There are some aspects that are worthwhile, but the hype and marketing has far surpassed the evidence of overall value. When you are talking about essential investments, it relies on technology. We need to be able to acquire and manage the data and have astute data analytics to provide the best level of care to patients in front of us and provide care to patients in the future. We will not be able to practice orthopedic surgery the same way we did five years ago or when we finished our training; it's a dynamic field. We have tremendous amounts of insights provided to us on a daily basis and it's important for practices to invest in technology to manage data for patient care and run the business.
We see tremendous pressure to reduce healthcare costs. Payers are in the insurance industry now and employers will find a way to reduce expenses but still receive the best care possible. We know that orthopedic care in general is very expensive. We are at the forefront of elective surgical procedures and total joints for bundled care to reduce costs and provide better outcomes. You can't do that with a pen and paper. You need sophisticated informatics and software programs and applications that allow you to make real time decisions and manage the care you provide. Those are the investments that make a difference if a group survives and thrives in the future.