Given the complexity of payment realities, the burden of quality initiatives, and the uncertain nature of future regulations, it may be a slight overstatement to say, "The future is bright for orthopaedic surgeons." However, orthopaedics has a silver lining. Demand for services will increase over the next decade due to an aging and obese patient population and improvements in technology. Expanded insurance opportunities, made possible by the Affordable Care Act, may also increase demand by individuals who can now afford elective surgeries, including orthopaedic procedures.
In many markets, orthopaedics continues to be a very competitive service. Practices must ask "How can we capture this volume?" Successful entrepreneurs will recognize that traditional referrals from other practitioners are important but insufficient.
As employers shift financial responsibility for health insurance coverage to their employees, consumers are taking a more active role in their health care choices—and becoming increasingly savvy. They are doing their research; turning to friends, family, and work colleagues for advice; searching the Internet for outcomes data; and seeking to understand how much of the overall treatment costs they will personally have to pay.
Websites such as HealthGrades, Yelp, and even the Centers for Medicare & Medicaid Services (CMS) provide information on perceived quality. More recently, consumers can evaluate the value of providers and programs based on cost data. In South Carolina, a website (www.scpricepoint.org) sponsored by the state hospital association enables consumers to evaluate costs for a wide array of inpatient and outpatient procedures across 51 hospital organizations in the state.
Patient expectations are at an unprecedented high. Consumers are looking for convenient care in their neighborhood or workplace, expedited access to services, and a clear understanding of their care path and alternatives—all with a smile, please.
What does that mean for orthopaedic surgeons? The following key considerations will help AAOS members meet the needs of an increasingly "retail" health consumer.
Create consumer awareness
Today, consumer awareness goes beyond a website presence, billboards, or other forms of advertising. It involves educating patients about their share of the cost for the entire episode of care surrounding a procedure. It also means proactively providing outcomes data to patients in language they can understand and executing strategic partnerships within—and even outside—the orthopaedic community. For example, with bundled payments for joint replacement, orthopaedic practices may need to establish strategic partnerships with local rehabilitation and skilled nursing facilities.
Embrace varying access channels
How do patients find you? How do they want to access your services? Although some consumers are content with a referral from their primary care provider, copies of black-and-white information sheets, and a postcard follow-up, others want more contemporary responses and engagement. Access to virtual health care—through video chats, smartphone apps, and "e-visits"—is increasing in popularity; even CMS is finally recognizing the need to reimburse physicians for telehealth services.
Care navigation—Retail-driven consumers will not only access orthopaedic services through new channels, they will also want to be engaged in their care processes. Ignore them at your own risk; if they cannot interact with your practice on their terms, they may seek care elsewhere. Virtual platforms such as VOX telehealth, SwiftPath, and Wellbe, in addition to home-grown solutions, can minimize that risk.
Sports performance offerings—Even before the consumer becomes a patient, orthopaedic practices can position themselves as the preferred provider of specific services—as well as the best choice for orthopaedic care in general. For example, instead of waiting for patients to sustain an injury, practices can increase awareness via sports performance programs tied to comprehensive orthopaedic offerings. These can be in collaboration with a hospital or other community partnerships.
Physical therapy—Aligning with the right independent physical therapy practice or providing physical therapy services as part of the practice can be a great access channel. All but three states currently permit some type of direct access to physical therapy without a physician referral, ranging from evaluation only to a limited number of visits to unlimited access. As a result, consumers may contact these providers before turning to an orthopaedist. Patients who have already been through conservative management may also be more ready for surgical interventions.
Payer/employer linkages—Payers and employers are aggressively seeking not just healthcare providers, but healthcare solutions to their most pressing employee and member health issues. Partnerships with hospitals and other providers, often as part of a clinically integrated network, are valuable to the sustainability of physician practices.
Understand new realities
Shifting costs of care, a stronger emphasis on value, and increasing use of virtual health solutions are all part of the new consumer reality. Orthopaedic surgeons must understand and take advantage of the opportunities presented by these new realities.
Recognize the savvy consumer—Average annual health insurance premiums have increased 69 percent during the past decade, and worker contributions have increased 81 percent. The annual deductible for individual coverage increased from $584 in 2006 to $1,217 in 2014. In addition to the increases in premiums and deductibles, 72 percent of covered workers also have copayments when they see a specialist physician. Consumers with more "skin in the game" will carefully evaluate their options.
Define and broaden your value proposition—Partnering with hospitals, postacute providers, and physician colleagues to provide an episode of care price is valuable to reach this market.
Assess virtual health solutions—Although evaluation and management visits for orthopaedics and spine care will not shift to virtual settings as rapidly as other service lines, virtual services offer substantial opportunities to improve the patient experience. Tactics such as online scheduling, patient navigation platforms, on-line apps, and virtual visits in appropriate situations will ensure coordinated, convenient care and a well-educated patient with clear expectations.
Today's consumers are making more critical decisions about their own healthcare than ever before. They—not their primary care physicians—are making decisions about providers, sites of care, and timing of elective procedures.
Orthopaedic providers would be well-served by enthusiastically meeting patients under these new terms and conditions. Comprehensive programs that best meet the needs of the musculoskeletal patient will succeed. However, these programs will require surgeons to explore varying access and referral channels, work collaboratively with other providers within the care continuum (often through more formal partnership models), and demonstrate value in terms that consumers can understand.
Kristi Crowe, MPT, is an associate vice president with Sg2, a provider of market data and information for the healthcare industry. She can be reached at email@example.com
Sources: Impact of Change® v15.0; NIS; PharMetrics; CMS; Sg2 Analysis, 2015; Kaiser/HRET Survey of Employer Health Benefits, 2014