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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 pre-
ferred employment. ose under age 40 were twice as likely to be em-
ployed than self-employed, while those over 40 had only a slight prefer-
ence 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 declining reimbursements
and less favorable renewal terms of their initial contracts, there is likely to be
a loss of enthusiasm for hospital employment," 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 stay-
ing 'private' within larger orthopedic group practices."
2. Outpatient procedures. Keith Berend, MD, an orthopedic surgeon
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 procedures, 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 outpa-
tient joint replacement is becoming the norm," Dr. Berend said in an in-
terview with Becker's Spine Review. Recent research has acknowledged 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 Center for
Medicare and Medicaid Innovation. Although the model is meant to be
a cost-saving and quality-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 coming
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 payments,
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 U.S. Department of Health and Hu-
man Services.
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 bac-
terial infection is a two-stage procedure, which takes about three months
and two more surgeries." is two-staged surgical treatment is well-es-
tablished; however, ongoing research may help to shorten a patient's ep-
isode of care aer infection. At OrthoCarolina, researchers are studying
the efficacy of a single-stage approach, in which a joint infection is treat-
ed by removing the original joint, sterilizing the infected area and then
implanting a new joint in one operation. n
