Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Aligning Physician and Hospital Incentives 16 articles


The Orthopaedist’s Role in Healthcare System Governance

Robert A. Probe MD

Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders.

Evolution of Physician-Hospital Alignment Models: A Case Study of Comanagement

Kevin W. Sowers MSN, RN, Paul R. Newman MHA, Jeffrey C. Langdon MHA

Recently, quality, financial, and regulatory demands have driven physicians to seek alignment opportunities with hospitals. The motivation for alignment on the part of physicians and hospitals is now accelerating because the new paradigm under healthcare reform requires an increased focus on improving quality, cost, and efficiency.

Orthopaedic Surgeon-hospital Alignment at Geisinger Health System

Daniel S. Horwitz MD

There is broad recognition that the healthcare crisis in the United States is going to require a response and change in clinical practice. The management structure of Geisinger Health System is unique, and this has the potential to change the dynamics of surgeon-administration alignment.

The Evolution of Advocacy and Orthopaedic Surgery

Manish K. Sethi MD, Allie Obremskey, Vasanth Sathiyakumar BA, John T. Gill MD, Richard C. Mather MD

The future direction of American health care has become increasingly controversial during the last decade. As healthcare costs, quality, and delivery have come under intense scrutiny, physicians play evolving roles as “advocates” for both their profession and patients via healthcare policy. Hospital-physician alignment is critical to the future success of advocacy among orthopaedic surgeons, as both hospitals and physicians are key stakeholders in health care and can work together to influence major health policy decisions.

Healthcare Technology: Physician Collaboration in Reducing the Surgical Cost

Steven A. Olson MD, William T. Obremskey MD, MPH, Kevin J. Bozic MD, MBA

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care.

Orthopaedist-Hospital Alignment in a Community Setting

Justin R. Kauk MD, Timothy J. Bray MD

Physician-hospital alignments are becoming more common in today’s healthcare environment. In the community setting, these relationships can impact quality of care as well as physician and hospital bottom lines. Alignment strategies take many different forms and can be advantageous to both the community orthopaedist and the community hospital, but certain key factors must be present to prevent a failed effort. Both the physician and hospital must be clear about their goals and expectations to overcome barriers and ensure success.

Aligning Incentives in Health Care: Physician Practice and Health System Partnership

L. Scott Levin MD, Lori Gustave MBA, MHA

The key to successfully aligning hospitals and physicians is financial integration and joint incentives for academic, quality, and clinical productivity. Many physician practices and health systems are moving toward closer integration, but mainly through consolidation and employment strategies.

Understanding How Orthopaedic Surgery Practices Generate Value for Healthcare Systems

Steven A. Olson MD, Richard C. Mather MD

Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems.

Orthopaedic Surgeons Frequently Underestimate the Cost of Orthopaedic Implants

Jonathan J. Streit MD, Ashraf Youssef MD, Robert M. Coale MD, James E. Carpenter MD, Randall E. Marcus MD

A poor understanding of cost among healthcare providers may contribute to high healthcare expenditures. Currently, it is unclear whether and how much surgeons know about the costs of implantable medical devices (IMDs).

Factors Driving Physician-Hospital Alignment in Orthopaedic Surgery

Alexandra E. Page MD, Craig A. Butler MD, MBA, Kevin J. Bozic MD, MBA

The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging.

Critical Roles of Orthopaedic Surgeon Leadership in Healthcare Systems to Improve Orthopaedic Surgical Patient Safety

Calvin C. Kuo MD, William J. Robb MD

The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited.

Developing a High-efficiency Operating Room for Total Joint Arthroplasty in an Academic Setting

David E. Attarian MD, FACS, Jennie E. Wahl PT, MBA, Samuel S. Wellman MD, Michael P. Bolognesi MD

Developing a high-efficiency operating room (OR) for total joint arthroplasty (TJA) in an academic setting is challenging given the preexisting work cultures, bureaucratic road blocks, and departmental silo mentalities. Also, academic institutions and aligned surgeons must have strategies to become more efficient and productive in the rapidly changing healthcare marketplace to ensure future financial viability.

Factors That Influence Provider Selection for Elective Total Joint Arthroplasty

Kevin J. Bozic MD, MBA, David Kaufman MD, Vanessa C. Chan MPH, Stephanie Caminiti APRN, Courtland Lewis MD

The growth of consumer-directed health plans has sparked increased demand for information regarding the cost and quality of healthcare services, including total joint arthroplasty (TJA). However, the factors that influence patients’ choice of provider when pursuing elective orthopaedic care, such as TJA, are poorly understood.