Issue link: https://beckershealthcare.uberflip.com/i/1456545
23 THOUGHT LEADERSHIP 'Risk' will replace 'value': The future of orthopedic care delivery By Alan Condon A fter some initial success in bundled payment models, many orthopedic providers are dropping out of such Medicare programs as the continuous challenge to reduce costs and maintain high-quality care becomes a "race to the bottom." Recently, more providers are considering shared savings programs — taking on both upside and downside risk — as a start into value-based care. Five surgeons discuss value and risk in orthopedics and how the shift from fee for service will evolve in the coming years. Note: Responses were lightly edited for style and clarity. Andre Blom. CEO of Illinois Bone & Joint Institute (Des Plaines): The "value" buzzword will be replaced by "risk" in the next three to five years. This creates tremendous opportuni- ties for orthopedic surgeons who effectively have a significant portion of control in the management of a multitude of busi- ness verticals tied to their practice. Thus, I follow any changes associated with value-based medicine very carefully. David Jacofsky, MD. CEO of The CORE Institute (Phoenix): Although defining the best model of risk-sharing with pro- viders is an ongoing discussion, there remains little question that there is bipartisan support for this cultural shift to con- tinue. Episodic bundled payments, condition-based bundles and population health are all showing good success in pro- gram performance in most settings. Although some of these programs will need to shift from "race-to-the-bottom" mod- els to more sustainable and longer-term population health models, that shift is now beginning. Nicholas Grosso, MD. President of Centers for Advanced Or- thopaedics (Bethesda, Md.): We will be implementing our first risk-based contract through Maryland's Episode Quality Improvement Program in 2022 and aim to sign one to two more risk-based contracts by the end of next year. In 2022, we will continue to build and invest in the infrastructure needed to succeed with risk-based contracts. This will not happen overnight, but we are prepared for delayed gratifi- cation as we make this exciting transition. Navin Subramanian, MD. Surgeon at Orthopaedic Associates (Houston): The field of orthopedics is vast and encompass- es many pathways. When I take the spectrum of orthopedics in total, I think the biggest game changer will be a move to bundled payment systems to deliver care for surgical pro- cedures. There will be an ongoing larger shift to more out- patient procedures and larger shift to risk-sharing payment systems. This will affect quality of care and may even affect access to care. Risk-sharing models may make surgeons re- consider performing otherwise routine procedures on pa- tients with higher risk stratification. The bundled payment systems may lead payers to either partner with facilities or with physicians; this may influence hospital employment ver- sus private practice models for orthopaedic surgeons. It will be interesting to see how this plays out over the next few years. Adam Bruggeman, MD. Surgeon at Texas Spine Care Center (San Antonio) and CMO of MpowerHealth (Addison, Tex- as): Hospitals have negotiated against surgery centers for decades, leading to a dramatic difference in hospital, hos- pital outpatient department and ASC reimbursement. These practices and policies are driving a significant component of the outpatient migration, in addition to legislation that pre- vents new physician-owned hospitals from being developed de novo. Physicians will be the new drivers of healthcare for the next decade in terms of bundles and at-risk payments. Hospitals will need to find a way to bring their costs into bun- dles that make sense for the physicians who manage these arrangements. n Q: What healthcare trends are you following right now? MG: One thing I'm really interested in and what drew me to e Stead- man Clinic and the Steadman Philippon Research Institute is their dedi- cation to regenerative medicine research. ey are on the cutting edge of really figuring out if there is a way to harness our own tissues to regener- ate. It will be a big trend in the future to customize regeneration with our own stem cells and/or figuring out how to induce our cells to do what we want inside our bodies. From an engineering standpoint, I think we need to more thoroughly understand the spine as a dynamic structure and treat it more like we treat knees, shoulders, wrists and ankles. Spine surgery needs to evolve to consider ligaments, muscles, tendons in addition to the bones and the neural structures, which have traditionally received most of the attention. I think we're missing a large part of the sports medicine part of the spine, where we're not really addressing liga- ment injuries and other cartilage injuries, disc injuries that may be symptomatic for patients. We are just starting to create the right tools to fix those problems. The other big trend is telemedicine. This allows different virtual consultations with patients with imaging reviews and more. Uti- lizing this great technology over the past few years during the pan- demic has been a game changer, really allowing surgeons to coordi- nate care for patients without seeing them in the office. So let's say a patient has a child care issue or is feeling ill and they can't drive in to meet the appointment — that's OK. Through the computer, we can do the appointment right there. We're helping to continue that therapeutic relationship in a remote fashion, which is more focused on patients' needs. n