The U.S. orthopedic industry is undergoing major transitions that are expected to continue. Consolidation among orthopedic group practices continues both regionally and nationally, greater surgeon accountability in tracking outcomes, implementation of Affordable Care Act and as of April 1, 2016, the Comprehensive Care for Joint Replacement (CCJR) are all placing increasing demands on surgeons in justifying clinical direction and documenting outcomes. We will focus on the last two trends and will discuss implications of these initiatives. We will also discuss how a new technology can help orthopedic surgeons maintain control of their clinical direction from 3rd party payers and government agencies.
Let’s first look at the Affordable Care Act. Penalties are applied to healthcare institutions for hospital readmissions. This places greater accountability on surgeons in managing patient’s clinical care both pre-op and post-op. Orthopedic surgeons have lots at stake including: greater scrutiny from third party payers, jeopardized relationship with hospital and potential negativity to their private practice as outcomes data becomes more visible to stakeholders.
Now let’s look at the CCJR. There are various aspects to this new regulation but we will only touch on a couple. First is the bundled payments. A pool of dollars is allocated pre/post-surgery plus costs associated with the surgery itself. Costs beyond the bundled payments are the risk of the hospital and surgeons. Furthermore, outcome results, most of which are based on subjective data received from patients, place surgeons in a potentially vulnerable position in the absence of measurable and quantifiable data to support clinical improvement.
