Issue link: https://beckershealthcare.uberflip.com/i/1487345
28 ORTHOPEDICS 2 surgeons under 40 on private equity, the future of orthopedics By Claire Wallace T wo surgeons under the age of 40 discuss where they see the future of orthopedics heading, and the role of private equity in practices moving forward. Question: What are the biggest challenges facing orthopedic surgeons moving forward? Phillip Louie, MD. Virginia Mason Medical Center (Seattle, Wash.): Some of our biggest challenges include upcoming production and volume goals amidst enormous financial losses throughout healthcare, short staffing, burnout and hospital capacity amidst an ongoing pandemic and financial losses that may be generational. With mounting pressures to produce financial and volume targets with limited resources (and temporary resources at many locations), there will be an enormous focus on producing quantity of work. I worry that all the work that we have accomplished in building value-based care pathways, developing quality-based programs and academic pursuits to innovate, will take a back seat to providing the greatest volume of care to "catch up." We are all facing the same pressures, so we must all continue to find opportunities to innovate, invest and collaborate in areas that support quality of care — knowing that best care will also be the one that is in the best interest of all stakeholders: the patients, the providers, the administrators/executives and healthcare as a whole. Jeffrey Mullin, MD. University at Buffalo Neurosurgery (N.Y.): I think barriers preventing surgeons from providing the best care to our patients will continue to be our biggest challenges. is includes insurance denial processes and hospital staffing issues. Q: What are your thoughts on the role of private equity in orthopedics? PL: I see both sides of this issue. e private equity collaboration is likely here to stay, and is part of our new environment. e forces of an ongoing pandemic, hospital/medical center financial crises, insurance companies and the government have significantly altered the healthcare environment in which we work today. In the setting of smaller private practices, private equity ultimately provides an exit strategy for those who have devoted years to building the practice, while also obtaining potential access to the best technology, education and resources to care for patients. In groups with a spectrum of seniority, private equity may present opportunities to reduce the "buy in'' for your partners. But I feel like there is a fundamental lack of mission-agreement between the business models of private equity and healthcare practices. In medical practices, the physician-owners are responsible for the success of the practice, oen by placing the primary focus on patient care, and allowing revenue and profits to follow. Once private equity becomes involved, there becomes a much greater focus on maximizing those revenues/profits. Of primary importance, now becomes the ability to grow the practice's value and EBITDA in the This is why orthopedic groups are dropping out of bundled payments, 1 surgeon says By Carly Behm B undled payments, which were once adopted at many orthopedic groups, wasn't a trend that held long-term. Groups, including Philadelphia-based Rothman Orthopaedics, took them on but eventually dropped them as a payment model. One California surgeon told Becker's why he believes bundled payments don't work for everyone. Editor's note: This response was lightly edited for clarity and length. Question: Why are so many orthopedic groups dropping out of bundles? Hooman Melamed, MD. The Spine Pro (Marina Del Rey, Calif.): To me this is very straightforward. Unfortunately many of these bundle programs were putting profits before patient care. It was about, "How can we save the most amount of money?" which unfortunately ended up resulting in patient care getting compromised. At the end of the day, we as surgeons will be liable for anything happening to our patients. Every patient expects their surgeon to provide the best care at the highest level. And yes this might be a little bit expensive at times, but it delivers high superior care when the right intentions and the right ethics have been utilized. What is also sad is that these bundling programs would punish any surgeon's reimbursements if the care delivered to the patient ended up costing more than anticipated only because the patient required the best care and instead the surgeons' pocketbooks were pinched more. n