For several years, the AAOS has offered a variety of symposia on practice management, including two during the Annual Meeting—one directed to orthopaedic residents and the other to practicing orthopaedic surgeons. I’ve been to most of them, and in my opinion, the best one is the AAOS Practice Forward: Managing Your Practice in an Era of Health Care Transformation, which I attended last year.
One of the most valuable aspects of this course is the opportunity to hear from those who are currently involved in areas and programs likely to shape the future of orthopaedic practices. The concrete information and advice they provided gave me and other attendees new perspectives on the issues.
In last year’s session on electronic health records (EHR) and meaningful use, for example, Louis McIntyre, MD, of Westchester Orthopedic Associates, presented a comprehensive approach to meeting Stage 1 meaningful use criteria. Dr. McIntyre reviewed the entire core set of measures, explaining what each covers, whether any exemptions applied, and how to report them. Attendees who implemented his advice about establishing a secure patient portal function to communicate electronically with patients are now a step closer to meeting the recently proposed Stage 2 requirements. (See “EHR Implementation: Meaningful Use Stage 2” on page 33 for more information.)
The discussion on “The Accountable Care Organization (ACO) and the Specialist” was a real eye-opener for me. Although seen as a way to manage a patient population and achieve better care, improved health, and lower costs, ACOs are still not well understood. Because specialists are key components of any comprehensive care network, orthopaedic surgeons need to be involved, work collaboratively, and ensure that physicians—not hospitals—are directing the efforts.
In 2013, Medicare will begin a nationwide pilot program on episode-based payments—a single payment to cover all related services for an episode of care (defined as a hospital stay, plus 3 days prior to admission and the first 30 days following discharge). The primary targets of this program are reducing the number of hospital readmissions within the first 30 days following discharge and controlling spending on postacute care.
Although several details must still be defined, conditions such as total joint replacement are prime candidates for episode-based payments. Similar initiatives are already being implemented in more than a dozen states, by both private payers and Medicare. The program developed between CaroMont Health and Carolina Orthopaedic and Sports Medicine on bundled payments for routine total knee replacements was used to show how the payments were decided and what the downside risks might be.
Preparing for change
Each year, elements of healthcare reform are changing the medical care paradigm. We, as orthopaedic surgeons, need to understand how the legislation and regulation will play out, affect our businesses, and change how we practice orthopaedics. This course provides attendees with the planning tools to make the right decisions at the right time.
I’m not the only one who thinks this course is a must. According to Frank Noyes, MD, a well-known orthopaedist and leader in the sports medicine community who attended last year’s program, “The AAOS Practice Forward: Managing Your Practice in an Era of Health Care Transformation is superb, expertly crafted, and an absolute must for orthopaedic surgeons contemplating an expanded relationship with hospitals, business entities, and insurance carriers.”
Frederick N. Meyer, MD, is a member of the AAOS Practice Management Committee and the codirector of the AAOS Practice Forward: Managing Your Practice in an Era of Health Care Transformation course.