The pandemic affected orthopedic practices in several ways in the last year, with some centers adapting and others struggling to make ends meet.
Here are five factors that could make or break an orthopedic practice within the next two years, according to six orthopedic leaders:
1. Reimbursements. Orthopedic practices have taken a hit with reimbursement cuts for orthopedic procedures. Both CMS and commercial payers have cut reimbursements with fee-for-service models, which practices will have to adjust to in the next two years.
Andrew Bush, MD, is an independent orthopedic surgeon at his solo practice, Central Carolina Orthopaedics Associates in Pittsboro, N.C. He told Becker's Spine Review that the single biggest roadblock to his practice's survival is surgical reimbursement. He has had to revamp his practice by gaining a pharmacy dispensing license and starting a regenerative medicine program.
Hussein Elkousy, MD, of Houston-based Fondren Orthopedic Group, echoed Dr. Bush's thoughts, saying that orthopedic surgeons will have a hard time sustaining practices on fee-for-service alone.
"This is due to the [American Medical Association] and CMS-driven bundling of services and the reduction in payment for orthopedic procedures that has been occurring since 2010, as well as the more recent shift in payments to non-procedure-based providers," he told Becker's Spine Review. "Orthopedic surgeons and other procedure-based specialties have come out on the short end in many recent CMS policies."
2. New technology. Technology in orthopedics has become increasingly important in the past decade, which has both allowed patients easier access to physicians and physicians easier access to information.
However, Leonard Kibuule, MD, orthopedic surgeon and director of surgical services for Spine Team Texas in Southlake, told Becker's Spine Review that this technology is easier to acquire in facilities that have ample resources and means. And while some facilities are discussing the ways to acquire robotics, other facilities have technology challenges like reliable internet connection for devices.
"Oftentimes facilities with the means to acquire technology are concentrated in more populated areas, and we find that rural clinics may struggle to acquire some of the basic systems that allow us to perform our day-to-day duties," he said. "The systems may merely be high-speed internet connections, reliable computer systems or even equipment within the hospital that allows for basic care."
3. Understanding the landscape. Four orthopedic supergroups of 100-plus physicians have formed since the onset of the pandemic. Some orthopedic surgeons predict consolidation will continue as payers see opportunity for ownership in surgery centers.
Michael Ast, MD, an assistant professor of orthopedic surgery at Weill Cornell Medical College and surgeon at Hospital for Special Surgery, both in New York City, said it's important for orthopedic practices to understand industry shifts to succeed in the next two years.
"It is important for practices to understand the landscape around them and position themselves to be nimble if major market shifts occur locally," he told Becker's Spine Review. "Failure to recognize the landscape as a whole would be a major risk to an orthopedic practice."
4. Patient safety. Lloyd Hey, MD, spinal surgeon and founder of the Raleigh, N.C.-based Hey Clinic for Scoliosis and Spine Care, said that patient safety will always be the biggest factor that could make or break orthopedic practices.
He pointed surgeons to resources like his spine surgery checklist on CareGuard and 3Greens' electronic checklist to enable safer and more efficient teams in clinics and operating rooms.
"Remember, safety and risk management are two sides of the same coin," he told Becker's Spine Review.
5. Partnership adaptability. Orthopedic surgeons need to be flexible when considering relationships with hospitals and ASCs. Cathy Gibson, RN, an orthopedic nurse navigator for Dallas-based Baylor Scott & White, told Becker's Spine Review that this adaptability is particularly important as CMS removes procedures from the inpatient-only list.
"It will be important to identify appropriate patients for same-day discharges and optimize patients in preparation for their procedures," she said. "Hospitals will need to partner with surgeons to make sure patients get the care needed in the most appropriate venue, while also shifting practices to keep up with best care."
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