Michael Chmell, MD, is the medical director of Rockford-based Ortho Illinois Surgery Center. Here, he shares his thoughts on modern challenges facing orthopedic surgeons, bundled payments and opportunities to advance the field.
Question: What are the one or two biggest challenges for you as an orthopedic surgeon today? What keeps you up at night?
Dr. Michael Chmell: I think the biggest challenge in orthopedic surgery is remaining independent, not working at the behest of hospital systems. Part two of this is whether the ongoing trend of "super groups," with dozens or hundreds of members is the correct path to compete with this system or doomed to follow the same path. My view is that independent practices of 10 to 25 surgeons is optimal in terms of providing economical quality care, optimizing the best surgeons performing the correct cases.
Q: How do you see bundled payments, value-based care and other new payment models affecting orthopedics?
MC: Regarding bundled payments, I view this as optimal for providing economically correct care for our patients with the highest quality. No one knows the best way to treat a total hip or knee patient better than their surgeon, who under such a system will direct all care. That being said, an infrastructure is needed to carry out bundled patients: risk assessment nursing pre-op, nurse managers to assist with the bundle post-op, dedicated anesthesiology and physical therapy. Once the system is in place, however, private orthopedic practices and ASCs should hugely outperform any hospital system in terms of profitability.
Q: Where is the best opportunity for orthopedic surgeons to advance the field?
MC: Orthopedic surgeons need to take on a greater role in patient care. We need to play a greater role in such things as BMI reduction, HbA1C reduction and the elimination of unnecessary testing, such as MRIs done for inappropriate patients. Taking such things out of the primary care or educating them more could save more money than bundled payments in my opinion. We should market ourselves as musculoskeletal primary care and take over all such testing, rather than have it originate at a medical primary care office.
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