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Charles Bush-Joseph, MD discusses the value of belonging to The OrthoForum from The OrthoForum.

Photo courtesy of AAOS

On Friday, May 1, Michael McCaslin, Principal of Somerset CPAs, P.C., and Glenn Sumner, CEO of OrthoTennessee and OrthoForum President, presented at the 2015 National Orthopaedic Leadership Conference on the future of private practice. Aside from their National Annual Meeting, this conference is one of the American Academy of Orthopaedic Surgeons’ largest and most influential gatherings, with representation from leaders from across the country.

As orthopaedics continues to shift to outpatient care (over 70% of all orthopaedic surgery cases are now outpatient), we understand the importance of evaluating how private practices currently operate and how to productively face challenges as we move toward an evolving care delivery model for musculoskeletal services.

McCaslin and Sumner outlined how to address and meet those hurdles by presenting an analysis of five pillars essential to ensure the future of private orthopaedic practices, and by explaining how OrthoTennessee specifically has employed them for the continued success of its orthopaedic group.

• Growth – Growth helps maintain your relevancy and competitiveness- when strong and well-coordinated practice governance structures are put in place. Dictate your role in the care delivery process. Find a management and economic model that works for you and the future of your patients. Size does matter.
• Ancillaries – More efficient use of in-office ancillaries is a way to ensure your recruitment game, revenue streams, and cost per patient, allowing you to stay competitive. Now in bundled payment arrangements they are critical to better patient scheduling/patient flow, more cost effective rehab and improved care coordination through nurse navigators.
• Alignment – Working with hospitals on everything from cost management, staffing efficiencies and process improvement to quality of care, care coordination, outreach and patient satisfaction ensures longevity and strengthens partnerships for an overall more streamlined, successful structure of care.
• Operational Excellence – Analyzing jobs and potentially redesigning workflow can yield tremendous operational improvements. Prepare for greater use of technology by patients and for different types of providers seeing patients, in addition to evaluating resource allocation to various payer categories.
• Quality Initiatives – The continued struggle to agree on a definition of what constitutes true quality hasn’t tempered the need to collect and analyze more relevant outcomes metrics. Going forward we need to be especially sensitive to payers and employers regarding those measures they believe are important, particularly those that also reduce costs.

The overarching theme of change set the stage for the well-received presentation.. For better or worse, we know the payment system is rapidly changing from fee-for-service to fee-for-value. Will we be ready?

“This is an exciting time for the OrthoForum, and orthopaedic practices in general, as we make strides to improve the structure and quality of care with initiatives like BPCI and other value-based payment arrangements. The OrthoForum is establishing itself as a thought leader in orthopaedic practice management and this presentation was further evidence of that fact,” says Sumner. “Embracing industry changes through the power of our collective practice management wisdom will benefit all private practices , helping them prepare for for innovation, quality, and growth needed in an evolving health care landscape.”

We at the OrthoForum are honored to have had the opportunity to speak to such a distinguished group of industry leaders. This is yet another example of how our relationship with the American Academy of Orthopaedic Surgeons continues to strengthen and grow.

To view the full presentation and other presentations, click here.

On Tuesday, April 14, the Senate approved the Medicare and CHIP Reauthorization Act (H.R. 2) in a 92-8 vote, meeting much applause from orthopaedic providers and the American Association for Orthopaedic Surgeons. The bill was then signed by President Obama on Thursday, April 16. The momentous move on behalf of the Senate culminates in the permanent repeal of SGR (Sustainable Growth Rate), signifying a move to ensure better Medicare patient care and the end to what would have been 21-percent Medicare payment cuts to providers. MACRA repealed and replaced the SGR and extended CHIP for two years.

As orthopaedic providers, we at The OrthoForum welcome the end of the SGR formula and the transition to a more functional system based on “quality, value and accountability”. Medicare patients, particularly the vast senior population which rely on orthopaedic care, will now more consistently receive the caliber of care they need at lower costs. This impactful measure will result in a long-awaited, much more streamlined Medicare process, from reporting to payment policies and overall care quality. Providers of all forms have called for an overhaul of the inefficient SGR formula to a value-based system for years, and orthopaedic providers in particular consider this a historic moment in health care legislation.

SGR repeal marks an era of new standards and the significant beginning to the development of delivery and payment models that provide physicians with the flexibility to voluntarily choose options appropriate to their patients and practice. The repeal will improve health care across a broad spectrum, setting the precedent for value-based care in which best practices and quality are rewarded, while allowing patients access to alternative ways to pay for care. This is something we have long fought for, and is certainly seen as a triumph for providers and patients alike.

Read more…

Bipartisan Senate ends flawed Medicare payment formula

BREAKING: President Obama Signs SGR Repeal Legislation, Shifting Medicare Physician Payment Incentives

Good Riddance To One Of Congress’ Dumbest Rituals: The ‘Doc Fix’

 

 

Last month, Aetna announced its proposition to acquire Humana, which would make Aetna the second largest insurer in the country. Because of Humana’s large share of Medicaid Advantage customers, this signifies a landmark health merger, which would bring Aetna’s total Advantage members to approximately 4.4 million.

Bruce D. Broussard, president and CEO of Humana had this to say about the merger:

“Through the use of technology and integrated services to simplify the consumer experience, the combined entity will be even more effective in meeting the health needs of many more people–especially people with chronic conditions, who will benefit from Humana’s home health, pharmacy management and data analytics programs.”

Together, Aetna and Humana hope to make strides in changing healthcare delivery, creating a more consumer-focused marketplace. Following SGR Repeal in April, this news may be an indicator of future stability and growth in the industry overall, in addition to a shift for reduced care costs and efficiency.

“A key thing for larger orthopaedic providers to take away from this merger and several others to follow is leverage. Larger providers will have more leverage in negotiations,” says OrthoTennessee CEO Glenn Sumner. “In this changing healthcare climate, all orthopaedic providers need to continue to evaluate their care models and strategy, while looking for ways to remain competitive and improve quality.”

Read more about the Aetna-Humana merger from Aetna here.

Shortly after Aetna and Humana announced their planned merger, Anthem and Cigna followed suit. On Friday, July 24, Anthem made public its definitive agreement to acquire Cigna Corporation for a total valued transaction of $54.2 billion.

Currently, Anthem is the nation’s second largest health insurer. Merging with Cigna would culminate in the creation of the largest private health insurer (based on membership), serving approximately 53 million members. The Aetna-Humana and Anthem-Cigna mergers will significantly change the health insurance landscape, bringing the country’s amount of large insurers from five to a mere three.

The important difference to note between the Aetna-Humana merger and Anthem-Cigna merger is the membership audience. For Aetna, the acquisition signals an expansion in Medicare Advantage. For Anthem, the most notable affect will be in commercial insurance.

At this time, analysts speculate whether or not this onset of mergers will lead to higher premiums or anti-trust concerns. As large players in the transforming health insurance landscape, both companies will have an advantage in terms of rate negotiation with care providers. With decreased insurer competition, smaller care providers may find themselves at a disadvantage in the realm of payment and coverage negotiation.

Much like the statement from Humana’s president and CEO, Anthem and Cigna leaders addressed the ability to forge a more innovative path in insurance due to the merger, and ultimately, an increase in efficiency and quality.

Anthem president and CEO Joseph Swedish stated in the July 24 announcement:
“We are very pleased to announce an agreement that will deliver meaningful value to consumers and shareholders through expanded provider collaboration, enhanced affordability and cost of care management capabilities, and superior innovations that deliver a high quality health care experience for consumers. We believe that this transaction will allow us to enhance our competitive position and be better positioned to apply the insights and access of a broad network and dedicated local presence to the health care challenges of the increasingly diverse markets, membership, and communities we serve.”

We will continue to update you on developments regarding both mergers and possible regulatory measures.