The shrinking pool of independent physicians is contributing to rising costs in care for patients, while low reimbursement from CMS is placing an increasing burden on providers, according to Alex Vaccaro, MD, PhD.
Dr. Vaccaro is president of Philadelphia-based Rothman Orthopaedic Institute. He spoke with Becker's on a number of topics in orthopedics, including the top challenges for independent practices, the biggest opportunities for growth, and skills healthcare leaders need to know.
Editor's note: Responses have been lightly edited for style and clarity.
Question: What do you see as the most pressing issue facing independent orthopedic practices?
Dr. Alex Vaccaro: The biggest threat that independent orthopedic practices face today is the exponential migration of graduates as hired employees into large healthcare systems. Over 70 percent of new orthopedic graduates are now forgoing private practice and signing up as full-time employees into health systems throughout the country. Outside stakeholders, including payers and the government, are concerned that this will dramatically increase the cost of care while at the same time minimize physician autonomy with regards to best patient care business practices and quality of life in the long run. The question is: Will patients benefit from the loss of independent physician leadership on best practices and site of care when a nonphysician administrator is now in charge of directing resource utilization and location of care? It is imperative that physicians have the autonomy to determine what is in the best interest of patients while making sure that care is delivered in safe, low-cost facilities which may not be available or desirable to a large healthcare facility.
Independent physicians who are patient-facing are motivated to do things that are in the best interest of patients in terms of efficiencies, point-of-care access, and advocating in a scarce resource environment. These liberties will most likely be curtailed in an employed model.
Q: What are the top three healthcare trends you're following?
AV: My first concern is maintaining physician autonomy by advocating appropriate Medicare reimbursement to physician practices that are faced with the escalating cost of maintaining a practice. Physicians have staff who are facing the reality of cost-of-living increases which has resulted in the "Great Resignation" of the labor force in the last three months. We have to advocate against proposed Medicare cuts to have an ample workforce available for our aging patient population.
My second concern is the viability and growth of telemedicine. We need Congress to support reimbursement for telemedicine to safeguard at-risk patients disadvantaged by social determinants of health and to afford equity through equal access, regardless of geography. This includes audio-only telemedicine for those without access to the internet or the know-how in the case of the elderly. Congress should also support across-state telemedicine access for patient care and continuity of care, especially for access for specialists where it would be cost- prohibitive for a patient to access that care, regardless of the state license of a doctor.
The last trend is that we have to continue to make sure that there is equity in medicine. We have to make sure that all populations, no matter how adversely they are affected by social determinants of health, will have equal access to quality healthcare.
Q: Where are the biggest opportunities for growth in orthopedics?
AV: The growth of large single-specialty groups that understand the breadth of musculoskeletal ailments, creating independent practice units that focus on bringing care to the patient rather than requiring patients to navigate the complicated gauntlet of fragmented care. This would be the birthplace of managing healthcare from a population healthcare perspective — that's the greatest opportunity.
Q: What skills are critical for healthcare leaders to thrive in today's environment?
AV: Starting in medical school, students should be provided the opportunity to learn basic business skills ranging from healthcare microeconomics, macroeconomics, GAAP accounting, leadership, motivation, and population health. Healthcare is the largest business in the world — 18.5 percent of our GDP is dedicated to healthcare, and no one takes care of patients better than physicians. So we have to have an understanding of how to do this in a value-based healthcare paradigm. This can be efficiently administered through physician leadership and know-how. Physicians understand what it's like to take care of a patient in the middle of the night with limited resources to get the best care for that patient. So I think that's what we need to do. We need basic business skills for every physician, not just physician MBA leaders.
Q: What are your practice's goals for 2022?
AV: We're going to continue to expand our brand nationally. We plan to be up and running in the West Coast by next year and further expand in the North and Southeast. We're also focusing on maintaining excellent relationships with our healthcare partners, as together we can bend the cost curve to make healthcare affordable to all.