It’s pretty common advice these days that if you want to understand your customer, you have to understand their pain points. At AAOS, one big pain point for surgeons is accountable care. Well to be more precise, the surgeons are struggling with a system that is unsustainable, and accountable care is a method for dealing with. Accountable care offers, for example an alternative to emphasizing healthcare rather than health, as Kevin Bozic put it. Bozic, who moderated the panel and is also on the AAOS board of directors said that accountable care could be an alternative to defensive medicine and a medical arms race. But that doesn’t mean accountable care in and of itself is simple.
Under accountable care, orthopedic surgeons will have to bear more risk, do more data entry and accounting work, and most importantly, fundamentally change from technicians to holistic caregivers. In the new system, care will shift from focusing on surgeries performed to overall outcome for the patient, including downstream care such as rehabilitation.
Care payments will mostly be bundled as acute care episodes.
The discussion didn’t close in too closely on orthopedic devices except in two particular instances, neither of which were encouraging. Those who think the devices used won’t be part of the calculation are going to be disappointed. In fact, Steven Schutzer, from the Connecticut Joint Replacement Institute, noted that in his hospital’s accountable care program, he told attendees that the single largest expense to one particular example, was the cost of the device. His point was that hospitals will have to emphasize both reimbursement, and clinical effectiveness in choosing devices to work with.
Later on, during the Q&A, a surgeon from North Dakota asked why his hospital was discouraging him from using new technologies. The surgeon specifically asked about computer assisted surgical procedures. Boser, answered that some technologies in orthopedics that have come out in the last 20 years are incremental, and have shown minimal clinical superiority.
First, on that count, Boser is not being entirely fair. I could easily rattle off at least 5 orthopedic innovations that have dramatically improved health outcomes. But he does have a point that some technological advances will need to show the clinical effectiveness that can justify the costs.