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Providing the best care at the lowest price: Outlook for orthopaedics in 2019


It is extraordinary how significantly medicine has evolved in past five years. We’ve gone from a time when private practitioners were combatively competing with hospitals, to hospitals realizing that they’ll struggle if they don’t adapt to the changing medical landscape as private practice groups have been forced to do in recent years. Now, we’re seeing that private practices and hospitals must work together to share resources to ensure the best health outcomes. And as we look at the next five years, there’s a good chance that procedures will move into outpatient settings whenever possible, putting even greater pressure on hospitals.

With healthcare costs consistently rising between five and a half and seven percent each year for the past five years, consolidation has been the standard in the industry. We’ve seen mergers like CVS/Aetna and UnitedHealth/DaVita working to control primary care, and big companies such as Amazon, Berkshire Hathaway and J.P. Morgan entering the space and moving the needle towards self-insurance. What’s been and what will continue to be the driving force behind consolidation and new industry players is robust data that confirms providers are who they say they are – proving that they are the best provider with the highest quality of care at the lowest price. That’s going to be the key factor moving forward, across healthcare and with orthopaedics specifically.

In the next year, I anticipate that orthopaedic physicians will be tasked with looking at total joint care by administering physical therapy more efficiently, decreasing readmissions and better preparing patients for surgery – with the overall goal of improving outcomes. Physicians will also be expected to manage the entire episode of musculoskeletal care – from the time a patient first complains of knee pain to surgery to the end of rehabilitation – while also driving efficiencies in cost.

The biggest question for the orthopaedics market in 2019 is whether a patient’s primary care doctor or orthopaedic specialist will serve as that care manager. That task is appropriately placed in the hands of orthopaedic specialists, but the race to see who will control the course of musculoskeletal care will be affected by several trends that I expect will dominate the orthopaedics market in the coming year.

Advancement of Value-Based Care
In 2018, we heard a lot of talk about value-based care, and I expect that trend will continue – if not exceed the pace — in the new year. However, value-based care will no longer just be about participating in and managing a structured program like bundled payments. Value-based care of the future will require providers to offer the best possible care, at the best price, with the best outcomes. How can you accomplish that? Two decisive factors for orthopaedic providers will be competitive data analytics and taking risks on total cost to control the course of care.

Obesity and The Rise of Bone Disorders
One of the least discussed topics in the orthopaedic market is the increasing incidence of bone disorders in the U.S. as a result of obesity. Two factors destroy knees: genetics, which you can’t control, and lifestyle choices, which you can change. Obesity astronomically raises the complication rate of routine surgery – in fact, it increases the risk of wound problems almost 10 times in obese knee and hip replacement patients. In 2019 and beyond, this will need to be addressed much more seriously by the orthopaedic industry – and we’ll need to spend a lot more time pre-operatively managing patients and not considering joint replacements until the patient can lose weight and demonstrate a healthy lifestyle. Pre-operative patient management will impact and improve outcomes, and lead to happier, healthier patients.

 Spine Management
In the future of orthopaedic medicine, new data on best practices and management of musculoskeletal disease will likely prove what we already believe to be true – that we don’t deliver enough conservative care before we elect to operate. This will be particularly true for spine care. Because spine surgeons are so well-trained, many believe we should operate more often, and consequently there’s an overload of spine surgery in the U.S. – more so than any other country in the world. We don’t conservatively manage spine as well as we should, and as more data emerges, this is an area we’ll be able to improve.

Arthritis Treatment
Arthritis is another area in the orthopaedics market where we can expect to see a change in the coming year. Arthritis is the leading cause of disability in the U.S., and estimates from the Arthritis Foundation say that nearly 54 million adults have doctor-diagnosed arthritis. With such a large number of patients seeking care for this condition, conservative treatment of arthritis is a clinical dilemma facing all orthopaedic specialties. Many new methods of regenerative medicine offer hope for conservatively managing arthritis in the future, and once we’re effective in doing so, we can considerably reduce the cost of musculoskeletal care.

By focusing on improving outcomes – whether that’s through pre-operative management or more conservative care – patients will be better cared for. At The Centers for Advanced Orthopaedics, we believe that will help us prove our value at the best price and with the best outcomes – and that’ll be the “name of the game” for the entire industry in 2019.

Photo: feellife, Getty Images

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