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5 Trends for Orthopedic Surgeons to Watch in 2017
By Jessica Kim Cohen
O
rthopedic surgery is a continuously evolving field. Here are
five of the major trends surgeons hypothesize will have an
impact on the industry in the coming year:
1. Hospital employment vs. private practice. Over the past
few years, there has been substantial discussion regarding physician
employment by hospitals. A recent Medscape report, titled "Employed
Doctors Report 2016: Who's Happier—Employed or Self-employed
Doctors?" found that, unlike older physicians, younger physicians
preferred employment. ose under age 40 were twice as likely to be
employed than self-employed, while those over 40 had only a slight
preference for self-employment.
However, not all think this trend toward hospital employment will
continue. "In my opinion, as many hospital-employed physicians find
themselves on the receiving end of cuts to their pay because of declin-
ing reimbursements and less favorable renewal terms of their initial
contracts, there is likely to be a loss of enthusiasm for hospital employ-
ment," says Alan S. Hilibrand, MD, an orthopedic surgeon specializing
in spinal care at the Rothman Institute, an orthopedic group with office
locations throughout Pennsylvania and New Jersey. "ere will likely
be much more interest in private practitioners staying 'private' within
larger orthopedic group practices."
2. Outpatient procedures. Keith Berend, MD, an orthopedic sur-
geon specializing in hip and knee care at New Albany, Ohio-based Joint
Implant Surgeons, said that frequent rapid recovery developments,
which lead to short lengths of stay and eventually outpatient proce-
dures, is "certainly the most profound" trend he's noticed throughout
his career.
"It's very remarkable to me how we've moved into an era where out-
patient joint replacement is becoming the norm," Dr. Berend said
in an interview with Becker's Spine Review. Recent research has ac-
knowledged the short-term benefits of same-day procedures, as
well; a study published last December in Orthopedic Reviews found
outpatient orthopedic surgeries are not only cost-effective, but also
have improved rates of patient satisfaction. However, there is still more
research to be done in the coming year.
"We need to continue to let results bore out in the data, to see what is
best for patient care overall," says Keith A. Fehring, MD, an orthopedic
surgeon specializing in hip and knee care at OrthoCarolina's Hip &
Knee Center in Charlotte, N.C.
3. Payment models. e CMS-mandated bundled payment model
for hip and knee replacements, called the "Comprehensive Care for
Joint Replacement model," began this past April. e CJR model is the
first-ever mandatory bundled payment program issued by the CMS
Innovation. Although the model is meant to be a cost-saving and qual-
ity-improvement program, orthopedic surgeons have raised concerns
about the lack of data on similar programs.
"With this push toward bundled payments for total joints in the com-
ing year, people don't know exactly what to expect," Dr. Fehring says.
"at's something we need to keep an eye on." Outside of bundled pay-
ments, MACRA is reforming how providers are reimbursed through
Medicare — and many physicians are skeptical of the changes.
"MIPS and MACRA are going to begin affecting downstream reim-
bursement, and there are likely to be more losers than winners, despite
the purported budget neutrality," Dr. Hilibrand says.
4. Pain management. "ere will be significant popular support
for alternative strategies for pain management, both in response to the
opioid epidemic, as well as the move towards more outpatient surgery,"
Dr. Hilibrand says.
In recent years, stakeholders spanning individual healthcare facilities
to federal agencies have voiced concerns about growing rates of opioid
dependence — on a typical day in the United States, more than 650,000
opioid prescriptions are dispensed and 78 people die from opioid-
related overdose, according to the HHS.
Alternative, multimodal pain management approaches have
been shown to provide effective analgesia, while also discouraging
opioid reliance, by encompassing a range of non-opioid techniques
like regional nerve blocks, intraoperative methods, oral medications
and intramuscular injections.
5. Infection control. About one in 100 patients that undergo hip
or knee replacement surgery may develop a postoperative infection,
according to the American Academy of Orthopaedic Surgeons.
"Infection is rare, but when it does occur, it's a big deal — and it's very
difficult to treat," Dr. Fehring says. "e traditional treatment for a
bacterial infection is a two-stage procedure, which takes about three
months and two more surgeries." is two-staged surgical treatment
is well-established; however, ongoing research may help to shorten a
patient's episode of care aer infection.
At OrthoCarolina, researchers are studying the efficacy of a single-
stage approach, in which a joint infection is treated by removing the
original joint, sterilizing the infected area and then implanting a new
joint in one operation.
n
Dr. Alan HIlibrand Dr. Keith Berend Dr. Keith Fehring
"There will likely be much more
interest in private practicioners
staying 'private' within larger
orthopedic group practices."
— Dr. Alan S. Hilibrand, Rothman Institute
