Private Practice as the Future of Orthopaedic Surgery

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By Dr. Nicholas Grosso

Some may believe that private practice is a way of the past and that hospital and health systems are the future of medicine. And if you simply looked at the 2018 Survey of America’s Physicians from The Physicians Foundation, which found that nearly 50 percent of physicians identified as a hospital or medical group employee, it might seem like this is a good assumption. But as the president of the largest private orthopaedic group in the country, I’m here to tell you it’s quite the opposite. Private practice is the future – particularly in orthopaedic surgery – and for good reason.

It all starts with the cost of care. A recent study published in Orthopaedic Reviews found that orthopaedic surgeries cost an average of $3,225 more when performed in a hospital setting compared to an outpatient ambulatory care center. Hospital treatment is more expensive for a variety of reasons, including site of service fees and reimbursement structures. So, simply put, the care being provided in this setting is always going to be more expensive. And we know the cost of healthcare is rising, and that musculoskeletal is the second most expensive specialty, according to The Burden of Musculoskeletal Diseases in the United States, so there is a significant amount money on the line.

That’s where a private practice’s unique ability to implement alternative payment models comes in. Alternative payment models are an approach to paying for medical care that incentivizes high-quality and cost-efficient care. The CORE Institute is an example of an organization that has pioneered this tactic in which it takes on the risk of being accountable for the entire diagnosis-based spend annually. Contrary to popular belief, hospitals and payors are not the organizations best equipped to leverage alternative payment models to their full capacity. Private practices are nimble and flexible enough to adopt new processes more quickly, and can drive cost savings and best possible patient outcomes. 

Additionally, at The Centers for Advanced Orthopaedics (CAO), and at most private practices for that matter, physicians are the ones providing the care and making decisions. This means we have the autonomy to determine both how care is delivered and how it is coordinated, making it as efficient as possible. For example, we as care managers decide how long a patient is kept under our supervision before being sent to an outpatient facility after surgery, or what their specific course of treatment is if surgery is not required. We can also use our own physical therapy centers to monitor the frequency of a patient’s visits and keep track of their progress. Equally important, we provide our patients with access to a nurse care manager who follows the patient from day one to 90 days post-op. This gives patients a resource who is familiar with their case regardless of where they are in their care journey, as opposed to going into the ER if they have any concerns about their recovery. This control puts us in an excellent position to achieve the ultimate goal – the highest-quality care at a lower cost, and therefore, increased patient satisfaction.

Diving headfirst into alternative payment models without the proper foundation in place is not the answer, though, and is why I say private practice is the future of orthopaedics. Establishing alternative payment models creates both a challenge and an opportunity, which we are seeing firsthand at CAO. For alternative payment models to be a long-term solution, we need the right data to make informed decisions on what actions to take as we care for our patients. As all physicians know, collecting and making sense of patient data takes time.

We have learned firsthand that having all patient information integrated into a single EMR system is key because it positions us to have the data analytics necessary to offer alternative payment models at the best possible price. Further integration, data collection and analysis are also vital before any organization can go about taking on the risk necessary to keep costs down. Our goal is to determine what an actuary anticipates and where we can cut costs without jeopardizing patient care. Making these changes will not only save the patient money, but it will satisfy insures and providers. That’s why the data to make informed decisions is so critical. From my perspective as a private practice leader, we are perfectly positioned to mine this data and make efficient clinical changes that lower the cost of care while exceeding patient expectations. 

In the coming years, I anticipate this will come to fruition and it is my belief that private practice will be a leader in implementing alternative payment models. The highest quality care at the lowest possible price, what could be better!

Dr. Nicholas Grosso is president of The Centers for Advanced Orthopaedics. 

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