Issue: January 2021
Disclosures: Romeo reports he receives royalties from, is on the speakers bureau, is a consultant and does contracted research for Arthrex.
January 15, 2021
3 min read
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We need to improve ability to work as team members, leaders

Issue: January 2021
Disclosures: Romeo reports he receives royalties from, is on the speakers bureau, is a consultant and does contracted research for Arthrex.
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The arrival of 2021 brings mixed emotions for many people.

The COVID-19 pandemic has affected all aspects of life and it remains a daily concern as the virus has yet to be contained.

Anthony A. Romeo

Vaccines provide hope for a return later this year to the lifestyles we remember. A new administration enters the White House. It is poised for a significant response and to provide federal support to establish a “new normal” based on sound scientific advice.

We are essentially embarking on a new era for our society, which will be affected by the leadership in Washington. The continued impact of the pandemic on every sector of the economy and the realization that health care must evolve toward a population-based model includes efforts to improve care for all citizens of our nation. There is speculation about the development of an affordable public option similar to Medicare. However, major health care issues will need to be directed through the slow and divisive Congress. “Medicare for all” is gone from any reasonable agenda, but there will be emphasis on establishing health insurance for Americans who are uninsured.

Population-based care

Fundamental change in health care is underway even without Congressional approval in areas critical to orthopedics and musculoskeletal care, much of which has been accelerated by the pandemic. The migration to population-based care, with an emphasis on value, has led to the realization that one cannot compete at this level without state-of-the-art data caollection, analysis and reporting, as well as high-level revenue-cycle management as a fundamental part of practice and strategy development.

There has been a steady increase in individual surgeon employment in health care systems, practice merger and acquisitions, sale of practices to hospitals and health care systems, unique affiliations and the infusion of private equity ownership to accomplish these expensive goals. The impact is there will be ever-increasing third-party monitoring and management of individual practices focused on indications, techniques, outcomes, patient satisfaction scores, and cost per episode of care or diagnoses. It is critical that we take an active, participatory role in the process to help others not lose sight of a patient- and provider-centric approach to health care.

We will continue to see a dramatic shift of surgical cases and procedures out of the hospital and into lower cost-of-care sites, including ASCs and offices. Payers have started financial incentives by lowering reimbursement for cases performed in a hospital that were indicated for an ASC, while increasing reimbursement for cases performed in an ASC that were previously done in a hospital, such as joint replacement. Without question, patient and surgeon satisfaction is increased in this environment when the facility is primarily owned and operated by the physicians.

Hospital ownership is now considered an advantage to reimbursement fee schedules, which is likely to change and become unrelated to site of care in the future. The same inefficiencies and lack of critical processes seen in many hospital ORs can be frustrating to accept in an ASC. Progressive administrators are working closely with the surgeons or partnering with ASC management companies to improve the challenges.

Adapt and learn

As fundamental changes continue to affect our professional lives, the ability to adapt and learn new leadership and communication styles will be valuable. The emphasis has been changing from predominately an authoritative culture to one that is affiliative, democratic and seeks the best environment for all involved in patient care.

Surgeons may have become accustomed to being “captain of the ship” and having executive power to make decisions based on personal experiences and goals. However, the future will be led by the agile thinker and communicator who can adapt and flourish in a diverse, multifaceted, and group-centric culture. This concept is fundamental to the successful management of population health.

As we work toward agreement in clinical care pathways, reduce variability in care, rely more on advanced practice providers and staff, move cases to the best site of care based on value and have more effective relationships with administrators, we need to improve our ability to work as a team member, even as the leader, if we want to be truly successful in 2021 and long-term.