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ORTHOPEDICS
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TOTAL
JOINTS
How Carilion Clinic's Dr. T.K. Miller plans to grow his
practice & best advice for new surgeons
By Laura Dyrda
T
homas K. Miller, MD, is the sports
medicine section chief at Carilion
Clinic in Roanoke, Va.
In addition to his clinical practice, which
focuses on knee and shoulder reconstruction
as well as nonoperative sports medicine, Dr.
Miller is a professor of orthopedic surgery at
Roanoke-based Virginia Tech Carilion School
of Medicine and an assistant professor of
medical specialties orthopedics at Blacks-
burg-based Virginia College of Osteopathic
Medicine.
Here, Dr. Miller discusses his goals for the
next few years and best advice for young
surgeons entering the field.
Question: What are your top goals
for your practice over the next three
to five years? How do you see it
growing and developing?
Dr. T.K. Miller: e challenge for any
practice and healthcare system is associated
with directing patients and services required
to the most appropriate facility for the entire
"package" of care. e concept of who really
needs a traditional hospital environment
continues to evolve.
Matching and appropriately allocating the
limited resources of time/operating room
access, overhead, materials and staffing to the
patient and procedure needs to be approached
outside the longstanding models of care. is
includes:
• Rigorous [preoperative] screening of
comorbidities and assignment to a site
of care based on anticipated periopera-
tive needs [not just the procedure to be
performed]
• Assessment and optimization of postop-
erative support services
• Patient and family education and training
• Supply of durable goods to enhance
recovery
• Development of efficiencies based on
large volumes and reliably reproducible
protocols and continuous monitoring
of outcomes and adjustment of care
models based on objective evidence
from this monitoring
As more complex procedures are shied to
nontraditional sites of care, we expect to
see a narrower focus of service for sites of
ambulatory care. Just as surgical specialties
have become more subspecialized, we can
expect ambulatory centers to become more
specialized to improve efficiencies and qual-
ity of care. We expect to see not just specialty
specific ASC sites but narrow focus proce-
dure centric facilities.
Q: What advice do you have for new
orthopedic surgeons just entering
the field?
TM: As surgeons, we have traditionally been
shielded or isolated from costs associated
with providing care. is may be even more
of an issue during residency or fellowship
where volumes and complexity of care take
precedence over attention to fiscal issues. I
would encourage any new surgeon to ask
what everything costs. What is the cost of the
implants used, how do they compare to other
alternatives, what do gras, biologics, etc. cost,
is there a primary vendor arrangement usually
associated with volumes and is there a cost
differential when using one-off implants and
systems?
e concept of case costing is essential for
the fiscal viability of any facility, especially in
a freestanding ASC environment so a proac-
tive approach should be taken to determine
how these costs relate to facility and institu-
tional reimbursement. While new provid-
ers are oen hired to bring new techniques
and improve options in patient care, asking
these questions in advance and adjusting to
processes in place smooths the process for
a provider integrating in to the system and
may build a level of acceptance when a new,
expensive system or implant is required.
While training may lead [physicians to form
perceptions] of the best and only implant
or technique, repetitive supply and implant
costs in excess of reimbursement cannot be
viewed as sustainable and some flexibility
and recognition of fiscal realities is required
when working in a new environment.
Be realistic about case posting — both in
regard to time duration and accuracy of the
components of the procedure that should be
noted in the posting order. Training with an
established, high volume, efficient, well sup-
ported mentor does not translate to the real
world as a new provider. Do not expect the
same efficiencies at the start of practice.
New providers who recognize all factors
involved in the time required for "in room to
out" and post accordingly typically find facili-
ties more accommodating to adding cases to
the schedule or allowing for revised case post-
ing than those who routinely under post. A
provider who "posts long and finishes early"
and accurately posts the procedure is usually
accommodated better than one who "always
runs long" or adds "unexpected" additional
procedures to cases. n
Ohio surgery center performs 1K total
joint replacements
By Eric Oliver
N
orth Canton-based Ohio Specialty Surgical Suites and Spectrum
Orthopedics performed its 1,000th total joint replacement surgery,
IndeOnline.com reported.
Here's what you should know:
1. The facility opened in December 2014.
2. This facility is the first freestanding ASC in Northeast Ohio to reach this
case volume.
3. OSS was among the first outpatient ASCs in the U.S. to earn The Joint
Commission's advanced certification in total hip and knee replacements. n
