Becker's ASC Review

8 THOUGHT LEADERSHIP 'They have become fearful': How physicians have lost autonomy By Patsy Newitt K enneth Candido, MD, CEO and president of Chicago Anesthesia Associates:joined Becker's to discuss why physicians are leaving medicine. Editor's note: This response was edited lightly for clarity and length. Question: Only 40% of physicians would recommend a career in medicine, according to a 2023 survey. What reforms are needed to abate this? Dr. Kenneth Candido: This is based upon the recent trend of a total lack of autonomy as physicians become employed at an exponential rate. In the past, physicians had the ability to select their optimal work environment and the parameters upon which they saw patients. In the employment model, their schedules are determined by forces outside of their control and their referrals are made at the behest of an institution without regard to their preferences. Income is also not contingent upon effort but is predetermined by the corporation. Sanctions are made against independent thinking, including referring their patients to trusted outside consultants, which are punitive and demeaning. The corporation has its ultimate goal of maintaining control over all professional functions; the physician has lost decision making abilities. The corporation feeds itself from monopolizing the local markets. Even where superior outside consultants would better serve patients, the corporation prohibits it. The corporation does not care about patients besides what type of health insurance they may have. There is no attempt to maximize the best options for patients, rather the goal is to maintain exclusive control of the patient's entire health universe. The so-called "population health" model does not serve patients, it serves institutions and corporations. Physicians sit by and watch all this unfold and are helpless and impotent to address the fundamental flaws in this system, since in the end they have become fearful and have been forced into a dependent role. This dependent role is not what medicine was intended to be, and is not the medicine of our forefathers in any capacity. n 'Like peering through fog without a compass': Value-based care's future in orthopedics By Riz Hatton Valued-based care has become a household name in healthcare. Philip Louie, MD, a spine surgeon at Virginia Mason Franciscan Health in Tacoma, Wash., connected with Becker's to answer, "What is the future like for value-based care in orthopedics?" Note: This response has been lightly edited for length and clarity. Dr. Philip Louie: Very complicated, like peering through fog without a compass. Value-based care, in its most basic form, is founded on a simple equation [value = quality/cost], with value being the highest priority of orthopedic care. The initial wave was full of momentum and fanfare supporting the transition from the long-standing model of fee-for services to a value- based care model, in which reimbursements would follow outcomes, rather than volume. Ultimately, this value-based care model aims to bring all the stakeholders into alignment, centering around the four important elements of access, cost, quality and the patient experience. This lies in conflict with a fee-for-service model. The conflict has always been between the health plan or payer, insurance company, or employer government agency who want to lower costs as much as possible, thus encouraging a drive toward volume to reach a reasonable financial performance. Aside from the enormous administrative burden that these goals have presented with, we still poorly understand both parts of the equation in orthopedics. Outcomes: Which ones are the most meaningful? How many should we obtain? Which ones are most centers collecting? Are patients tired of filling out surveys? How do we promote transparency? Costs: How do we best calculate them? Which costs are most important? What are the main drivers? Traditional cost-accounting methods miss significant variables; can time-driven activity based costing capture the meaningful costs? The rise of digital health tools will drive the advanced data analytics, which will help with everything from patient engagement to population health management. I still believe in the overarching goal of value-based care in which we aim to align our interests (the healthcare providers) with the health and wellness of the patients. While there are challenges in implementing this model, including the need for significant infrastructure and data capabilities, the potential benefits of ensuring that patients get the right care at the right time in a sustainable fashion keeps us pushing forward. n

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