While trends such as private equity investment and same-day surgery excite some orthopedic surgeons, others are concerned about them.
Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.
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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Wednesday, March 30, 2022.
Editor's note: Responses were edited for style.
Question: What’s the most dangerous trend in orthopedics today?
John Corsetti, MD. New England Orthopedic Surgeons (Springfield, Mass.): The most dangerous current trend in orthopedic surgery is the insinuation of private equity into our business. Over the past five years, we have seen a rapid increase in the number of groups coming under the control of private equity. These companies place a premium on profitability, seeking to maximize profit and flip the practice to the next highest paying suitor in a relatively short time frame. They are, in general, impervious to quality of care issues, instead focusing entirely on maximizing revenue while minimizing cost/overhead. The physician owners lose a substantial degree of control and autonomy once the acquisition occurs, often leading to problems with recruitment and retention of future hires. I've watched a number of groups, many of which have existed and thrived for over 20 years, sell out to private equity, trading their legacy for a quick payout. This trend, in my opinion, is the most pressing threat to orthopedic practices nationally.
Anthony Melillo, MD. Bay Oaks Orthopaedics and Sports Medicine (Houston): The most dangerous trend in orthopedics today is the push for same-day surgery for joint replacements.
Efficiencies are wonderful and cost-saving. However, a joint replacement is a big procedure with very serious potential complications. Most patients need perioperative observation, care and reassurance. This is best provided by a qualified nurse, not a family member.
The only benefit for same-day surgery in joint replacements is cost-saving for insurance companies and additional profits for the facility.
Jason Weisstein, MD. Yavapai Regional Medical Center. (Prescott, Ariz.): One of the most dangerous trends is the skyrocketing use of biologic agents and accompanying high cash costs passed on to patients to treat musculoskeletal conditions without data to support their clinic use.
Alexander van der Ven, MD. Miami Orthopedics & Sports Medicine Institute: My biggest concern is going to be access for arthritis care. With the baby boomers reaching the ages of needing interventions, and the lack of expansion in providers, there will be a significant backlog of care over the next two decades. Limited access will create frustrations among patients and providers. As surgeons become "volume"-based, it will become more difficult to establish a trust-based relationship. This likely will increase burnout and further aggravate the access issue.