Innovative ideas for orthopedists to consider: Key thoughts from Somerset CPAs' Mike McCaslin

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Orthopedic-driven ASCs are thriving and offering surgeons promising futures in private practice.

Indianapolis-based Somerset CPAs Principal Mike McCaslin spoke about exciting developments in ideas related to orthopedics today.

Mr. McCaslin is speaking on a panel titled “The Best Ideas for Orthopedics Now” at the Becker’s 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine, June 22 to 24, 2017 in Chicago. Click here to learn more and register.

Q: Which orthopedic developments offer the most promise for today’s surgeons?

Mike McCaslin: There are a number of developments that offer promise for today’s surgeons. Commercial bundled payments offer surgeons the opportunity to manage the care delivery process from beginning to end taking some risk but creating the opportunity for improvements in care at a lower cost of care. The surgeon takes the entire bundled payment and then out of this amount pays for the balance of care required. For those physicians whose groups own most of the care deliver assets required (ASC, PT, MRI, DME, etc.) then the risk in managing the bundle is mitigated substantially. For those who do not own the cadre of assets required they will need to sharpen their negotiating skills with outside entities to arrive at an acceptable rate to pay for the care needed by their patients.

The rapid transition of care from inpatient settings to outpatient settings obviously favors those surgeons and groups who own their own surgery centers. This transition will continue and certainly we all need to keep an eye on CMS to see when they loosen the strings on Medicare patients.

The use of extenders (physician assistants and nurse practitioners) to create more access for patients through walk-in clinics and extended hour/urgent care clinics has enabled the orthopedic surgeon and group to capture more patient volume and using a lower cost setting of care for this patient capture.  The extended-hour/urgent care clinics keep the patient out of the emergency room and have the patient gaining immediate access to orthopedic specialty care so the right test and right diagnosis are received immediately.

 
Q: How can independent orthopedic surgeons remain in private practice?

MM: I think they need to be able to do the items noted above. In addition good partnerships with the local hospital (two-way partnerships and not one-sided partnerships) for those surgeons who cannot own the assets noted above will be important for both the surgeon and the hospital. An intense focus on the right care by the right provider in the right facility at the right cost is essential for sustainable success.

Q: What are the smartest orthopedic surgeons doing today to set themselves up for success in the future?

MM: In addition to the items noted in No. 1 above (which is the primary focus) many surgeons and groups are discussing destination orthopedic hospitals to manage the volume that will continue to require inpatient settings. Attached to this inpatient facility is the outpatient ASC, the physicians’ medical office building housing the group and the cadre of freestanding services (PT, MRI, DME, skilled nursing) to create the comprehensive campus and destination facilities. In today’s environment, these can only be owned by an existing hospital but there are opportunities available to the surgeon to manage the operations, own the real estate and lease to the hospital and to negotiate a purchase option for the inpatient operations if the prohibition on physician ownership is ever repealed.

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