DOCTOR LED BUSINESS MODELS PROVEN SUPERIOR (Orthopedics This Week)
Doctor-Led Models Superior!
A certain in-the-know health policy expert is predicting a pendulum shift—back towards orthopedic surgeons having more say in the care of their patients. Chad Mather, M.D. is an attending orthopedic surgeon at Duke University. Dr. Mather, an AAOS (American Academy of Orthopaedic Surgeons) Washington Health Policy Fellow, tells OTW, “Right now, orthopedic surgeons are mobilizing toward adapting to different payment models, much of which requires more integrated care for episodic payments. What we’re starting to see is that physician-led models deliver more cost efficient and convenient care. My health policy colleagues and I were just in Washington, D.C. discussing how to protect access to in-office ancillary services, and we are convinced from examining the evidence that doctor-led initiatives will soon emerge as the most successful models of care. In episodic payment models, reimbursement could go to the orthopedic surgeon, the hospital, or a primary care doctor. We believe that the orthopedic surgeon is the best equipped provider to manage the pathway of care. For example, the facility where a procedure is performed a major driver of the cost of care. Orthopedic surgeons can get patients to the least expensive facility that is safe for them.
“It’s early, but one reason we know that this is imminent is because market conditions favor physician led models—most hospital-based services cost significantly more than office-based services. Perhaps the most important piece of this is that orthopedic surgeons are in a unique position of knowing more about both primary and specialty musculoskeletal care than any other provider. The musculoskeletal system is widely known to be underrepresented in medical school—as opposed to the cardiopulmonay system, for example—yet one out of every five presenting complaints to primary care physicians in this country is musculoskeletal. Primary care doctors are just not as well equipped to manage orthopedic issues as they are equipped to handle, for example, cardiology or GI problems. I think it will become increasingly clear to payers as they scrutinize different care models that orthopedic surgeons are best equipped to deliver high value musculoskeletal care.”