Three Award Winners Announced…Diluting the Value of the M.D.…Buying Doctors’ Practices Inevitable?…Urgent Plea to ORIENT Revision Hip Retrievals…Backward Healthcare Rationing on the Ris…and more.
Buying Doctor’s Practices Inevitable?
An observant orthopedic surgeon tells OTW, “The purchasing of doctors’ practices has reached the point where it is almost inevitable. Those of us in private practice are finding it hard to hospitalize a patient, in part because the hospital’s margin of profit on cases is so high. More and more procedures are being done as outpatient procedures in doctor-owned surgery centers—meaning that they can charge a facility fee. This started 10 years ago…many doctors flocked to surgery centers, so the hospital lobby convinced insurance companies to reimburse doctor-owned surgery centers at a lower rate than they reimbursed hospitals for the facility fee. Hospitals are now in the habit of saying, ‘If you work for us we will pay you as much or more than you make now. We will own your surgery center, but we will give you fair market value for what you’re doing.’ If you’re an orthopedic surgeon that has to work in a hospital because you’re doing trauma, spine surgery, or tumors, then you might as well be employed by a hospital. The fear that most of us have is if a hospital hires you to do their inpatient work then they can easily fire you. You’re probably on a yearly contract…and if you leave the hospital then you have to turn your life upside down and leave the area for two years because they have a non-compete clause.”
Urgent Plea to ORIENT Revision Hip Retrievals
Tom Brown, Ph.D. is the chair of orthopaedic biomechanics at the University of Iowa and the director of that institution’s Orthopaedic Biomechanics Laboratory. He tells OTW, “We are doing some new computational modeling of wear in total hips. We now have an algorithm version which is usable for individual patient-specific patterns of damage on femoral heads—we call it a ‘scratch based wear algorithm.’ Our team is running this algorithm on a series of retrieved femoral head specimens (retrieved at the time of revision)—and we are gauging the severity of wear rate acceleration due to patient-specific head damage. We are able to accommodate up to 10, 000 scratch segments, although this process requires microscopic level optical profilometry scanning, which is somewhat time consuming. As for preliminary results, the algorithm successfully matches experimentally measured wear rates for fiducial scratch patterns on femoral heads, to within errors of 4-10%. Retrieval heads from our collection have shown wear rates typically 2-4 times those for pristine femoral heads.”
“A major obstacle to researching in this area is that often, when people are harvesting failed total hips at revision—or when they are doing it for scientific purposes—they tend not to make a notation of the orientation of the head on the trunion. This is really critical, so I’d like to urge that anyone doing retrievals and/or compiling retrieval databases keep track of the orientation of the femoral head on the trunion.”
Multicenter Team Wins Research Award
A team of researchers from Hospital for Special Surgery, Weill Cornell Medical College, the University of Massachusetts Medical School, and Mathematica Policy Research in Princeton, New Jersey, has won recognition and a bit of funding ($1, 000). They have garnered the Team Science Award from the Association for Clinical Research Training, American Federation for Medical Research, Association for Patient Oriented Research and Society for Clinical and Translational Science. The interdisciplinary researchers were recognized for studying the perioperative epidemiology and outcomes of certain orthopedic surgical and anesthetic techniques. The team also received kudos for spurring national dialogue on these issues.
James Hinckley, M.D. Receives Chancellor’s Award
Dr. James Hinckley, an orthopedic surgeon who is a member of the University of Wisconsin-Green Bay Athletics Hall of Fame, has received the university’s Chancellor’s Award. Dr. Hinckley is being recognized for devoting time, medical expertise and philanthropic support to the Green Bay Phoenix since 1978. Dr. Hinckley provided team physicals for the men’s soccer team and was “on the bench” at both home and away games; he then began providing care for the school’s other teams—basketball, in particular—and he continued that volunteer service over three decades as medical consultant, team physician and as a mentor to many of the program’s student trainers. Prior to the opening of the university’s new Kress Events Center in 2007, it was decided to honor him by naming the training and sports medicine area of the facility the James Hinckley Sports Medicine Center. A graduate of the University of Illinois College of Medicine, Dr. Hinckley received training in orthopedics and sports medicine while serving eight years on active duty with the U.S. Navy.
JAAOS Wins Gold
The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) was recently awarded a Gold Award for the Best Peer Reviewed Journal by the American Society of Healthcare Publication Editors (ASHPE). JAAOS is the flagship publication of the American Academy of Orthopaedic Surgeons (AAOS) and presents comprehensive, authoritative, well-written peer-reviewed articles that disseminate knowledge to improve the care of patients with musculoskeletal disorders to 30, 000 Academy reader-members, as well as to 20, 000 additional readers worldwide.
Diluting the Value of the M.D.?
An orthopedic surgeon involved in legislative affairs tells OTW, “Most orthopedic surgeons don’t know this, but people in the allied health sciences (nurses, nurse practitioners, physical therapists, etc.) are on a nationwide mission to convert their degrees to doctorates. The national organizations that represent these individuals are going to universities and saying, ‘You will make your PT/nurse practitioner, etc., program a doctorate level program…if you don’t we will not accredit your program anymore.’ All of the nurse practitioners will be ‘DNP’—literally, ‘Dr. Nurse.’ All of the nurse anesthetists in my state will also be doctors within four years.”
“When everybody is a doctor it means less to be a doctor. From a practical standpoint what happens is that once these groups get everyone converted to doctorates, then they go to each state and try to expand their scope of practice by addressing each state’s practice act. Sometime this year nurses in my state will be coming to the statehouse and saying, ‘We are doctors and we want to write scripts and work alone.’ Medicine is not what it used to be and I will not be encouraging my children to go into healthcare.”
Victoria Hughes—New VP, Quality Systems at Millstone
An 18 year veteran of the quality arena has joined Millstone Medical Outsourcing as the Vice President of Quality Systems. Hughes will be responsible for managing the quality systems for all of Millstone Medical’s facilities, directing all quality associates, and working closely with customers to ensure the highest quality standards. Before joining Millstone in April, Hughes was Senior Manager of Quality Assurance at Olympus Biotech Corporation. She also served in senior quality management positions at Alexion Pharmaceuticals, Inc., Amgen, Dow Biopharmaceutical Contract Manufacturing Services, and Copley Pharmaceuticals, Inc. Hughes began her career in quality assurance at Springborn Laboratories, Inc.
Backward Healthcare Rationing Raises Its Ugly Head
There is a backwards rationing of medical care going on, says Don Johnson, M.D., medical director at the Southeastern Spine Institute in Mount Pleasant, South Carolina. He tells OTW, “What is hard for surgeons is that there are not consistent themes among different—or even the same—insurance companies. Dealing with insurers has become like that old game whack-a-mole where you think you’ve addressed an issue only to have it pop up again in a different place. This is nowhere more apparent than in spine fusion. There is one insurer that demands that patients do ‘active’ physical therapy before they can be considered for fusion. How can people in pain do active PT?”
“I appealed to the medical reviewer, but to no avail. We canceled the surgery and the patient is trying to get some relief with gentle PT. She may end up doing what the insurance company wants, that is, saying, ‘Forget surgery…I will lead a life that is less full because of the pain.’ Now this medical reviewer was a board certified orthopedic surgeon, but that seems rare. I’ve had to deal with a pediatrician and a chiropractor…and we’re obviously not speaking the same language. If you come upon this situation with a patient, you should insist that the medical reviewer be a board certified orthopedic surgeon or neurosurgeon.”
“The patient? She will probably end up with permanent nerve injury. At the end of the day these issues are symptomatic of a bigger problem—we just don’t know what we want healthcare to look like in this country. We will probably end up with a national health service, so we should just go ahead and get there. Many groups will opt out of it and there will be a thriving private practice healthcare delivery service working in tandem with the national health service.”
