Issue link: https://beckershealthcare.uberflip.com/i/1504986
15 ORTHOPEDICS Q: Rothman has had some recent changes in its top leadership and in its corporate structure. To what extent has that affected physician operations? AV: Recent cost restructuring moves have had no effect on patient care. We have 1,800 employees, and we recently downsized 18 corporate positions to right size our back office. We are restructuring the business to be more consistent with economic times. Our business needs to respond to the economic realities of the times. We have to bend the cost curve. I think all surviving businesses have done this across the entire spectrum of businesses. Everyone has downsized during these inflationary periods. When staffing costs increase, you have to sometimes downsize so spending in that particular area doesn't outweigh the margins necessary to provide quality care. Q: What other healthcare trends have you been watching? AV: We are all watching the trend among insurance companies and healthcare centers to get bigger through mergers and acquisitions. is will only be successful if it decreases the cost of care and provides an improved quality of care. If the cost of care eventually increases due to these trends, what will the federal government's response be to that? At the end of the day, every move we make has to make it less expensive for families to access healthcare. If that does not occur, then we will see the regulators intervene on behalf of the patient. Q: What do you predict the government would do if cost care rises? Does it match up with what you want it to do? AV: Well, the FTC hopefully will not allow these mergers and acquisitions to decrease competition. So, number one, we have to strive to preserve the autonomy of the private practice physician. All physicians, given their autonomy, will follow their oath and place patients care centric to all care decisions. e cost of care at this time is so excessive that any margin is best shared on those that provide the care rather than third parties, unless their involvement directly improves the quality of care or improves access. So I think that we have to always preserve the private practice model in this country. When you socialize or corporatize healthcare, you risk not placing the patient first. is in my opinion is at less of a risk in a large single or multispecialty physician-run group. A large private group has the ability to be nimbler and is able to respond quickly to trends in the market. A large corporation with shareholders and multiple boards makes the ability to pivot or modify health decisions more difficult. n Orthopedic ASC rejects 'sexy, exciting, crazy technology' in favor of new growth model By Laura Dyrda A ndrew Lovewell joined the Becker's Ambulatory Surgery Centers podcast to talk about the future of orthopedics in ASCs and his practice's unique approach to growth. An excerpt from the conversation is below. Note: Responses have been slightly edited for clarity. Question: How do you anticipate orthopedics and spine will evolve in the next few years? Andrew Lovewell: I think we're going to see a continued shift of appropriate cases to the outpatient arena. A lot of that is dictated by the federal government. We run a very large private practice orthopedic group and I still have 25 percent of my volume inpatient I cannot move outpatient due to patient appropriateness. Some of that comes down to Medicare not covering outpatient shoulder surgeries yet, which is ridiculous and unreasonable when we do every other joint [in the ASC]. We use an internal metric to determine the right place, right patient and right time. As we get really far down the road, how much do we move to robotics and augmented reality or any type of adjunctive technologies? I would love to say we'll do as much as we can with technology or robotics with digital integration into the operating room. But that all comes with a cost, and there isn't increased reimbursement. Technology can't just create a spiral of zero. Zero is not a good multiplier. We're going to continue down this path of trying to increase our technology-driven surgery and there's no increased reimbursement for us, so that's going to be a challenge for a lot of small ASCs. But it's also a challenge when it comes to actually providing good care. We have to ask ourselves, what's right and what's appropriate? How are you compensated for what's right? That's the conversation that needs to happen. Q: Where are you seeing the best opportunities for growth? AL: Our practice is a little different. Our model is very heavily in nonoperative orthopedic care. Unlike most surgical practices, we're trying to avoid surgery. We're trying to get people healthier, faster and better. We've invested heavily in weight management clinics, osteoporosis clinics and we have a virtual therapy platform that we've rolled out to patients for nonoperative care to give them access to more therapy than just in person. We're hitting a crisis point when it comes to staffing and we're trying to make sure our patients aren't lost in the shuffle. From an ASC standpoint, that doesn't do anything to bolster the bottom line. But what it does do is guarantee patients aren't on an island and they have somebody to talk to and access to care. It eventually does create momentum from patients to say, these guys really care about value. They care about giving me stuff that is added to my care, not subtractive to my care. That to me is the big selling point; how do we create an intelligent and digital front door, and widen the funnel to get more patients access to our services. If it's a surgical patient, how do we get them through the pre-cert and pre-approval or predetermination process with the insurance companies as quickly as possible, and as reasonably as possible to get them to surgery and back doing what they want to do. That's how we plan to grow. It's not going to be the sexy, exciting, crazy technology companies, but it's continuing to deliver value at every step of the care continuum in the musculoskeletal and orthopedic space for our patients. n