Challenges of orthopedic private practice presents opportunities to adapt, prosper

In the quick medical care scene, orthopedic surgeons in private practice face numerous challenges that threaten their viability, with the decrease in reimbursement rates at the forefront.

During the last 20 years, the Medicare conversion factor, which is essential to determine the payment based on the units of relative value of the work, has decreased from $ 37.90 to $ 32.35. The decrease affects the refund of Medicare and private insurance contracts, which often use Medicare rates as negotiation, significantly eroding the financial value of orthopedic services.

Patients often do not know real compensation for orthopedic procedures. In a 2020 study conducted by Boudreau and colleagues, patients self -informed the reasonable rates of surgeons who will be 11.2 times more than Medicare’s refund for orthopedic procedures. The most significant discrepancy was for the total replacement of the hip, where the perception was real rates more than 20 times greater than the Medicare Rate Program, which underlines the disparity between perception and reality.

Growing costs

Beyond the decrease in reimbursement, the cost of maintaining an orthopedic practice continues to increase. Personnel expenses, advanced practice providers and information technology are significant. Advanced practice suppliers are essential. According to the data of the Medical Group Management Association, compensation for advanced practice providers continues to increase above the annual cost of living rate. Information technology costs increase, especially with respect to income cycle management, which is essential to deal with the growing number of strategies used to delay or deny refund.

The consolidation of the medical care system compounds financial pressures, restricts access to the patient, reduces competition and undermines the principles of free market. While consolidation is often presented as a cost reduction strategy, it generally increases medical care costs. Large systems take advantage of negotiation power over reimbursement rates, which is unattainable for private practices even with their higher results and patient experiences. Despite government efforts to enforce hospital prices, compliance and application are low, further distorting free market competition.

Financial charges extend beyond operations, since the growth of practice requires significant capital. Some surgeons resort to private capital investors, often leading to loss of autonomy, increased exhaustion and reduction in payment to take home. Although there are laws against corporate practice of medicine, private capital companies adjust the budget of the organization of management services (MSO) that operates the practice of the doctor based on the yields of aspirational investors. The leadership of MSO then applies the budget, routinely forcing surgeons to deviate from the previous practice methods that have associated with the best quality and the results of the patients. The influence of investor yields has questioned the sustainability of private capital models to guarantee the long -term success of orthopedic practices that aspire to provide the highest quality of patient care.

Auxiliary services

To navigate these challenges, orthopedic surgeons in private practice must maximize the value and use of auxiliary services, such as ASCs and image services. However, government regulations, such as the moratorium in hospitals owned by a doctor and the archaic law of Stark, suffocate competition and limit growth opportunities.

The Stark Law limits the financial and commercial relations of doctors with designated health services. The hospitals have no restriction that their employee doctors refer to care for their designated health services and often require this behavior, therefore, maximize the income of services and other assistants, such as facilities rates. The disparity in reimbursement rates between hospitals and ASC owned by a doctor for identical procedures further exacerbates the problem and highlights the need for changes in policies to better reflect the free market.

Restrictive agreements

If doctors employed are not satisfied with their work environment, the transition to private practice can be a challenge. Employers want restrictive agreements to protect their commercial interests. The Postiton of the AMA is “agreements, not to compete, restrict competition, can interrupt the continuity of attention and can limit access to attention.”

The current climate suggests a growing interest in eliminating restrictive agreements, but the support of jurisprudence is slow to develop over the State by state. For now, restrictive agreements in labor contracts hinder the mobility of orthopedic surgeons, preventing one from leaving unsatisfactory work environments without significant personal and professional agitation and the loss of continuity of attention. The medical care system will argue that there is no loss of continuity because patients belong to the medical care system, not to the surgeon, and will provide continuity with another surgeon used in their system.

Entrepreneurial spirit

Given these challenges, the future of orthopedic private practice seems uncertain. However, resilience, innovation and business spirit of orthopedic surgeons offer hope to maintain high quality, profitable and value attention. Several measures can be implemented to support this effort. The improvement in the management of the income cycle will probably be positively affected by new companies based on highly precise and effective services. In addition, orthopedic surgeons should strongly not accept contracts that create a deficit by providing adequate patient care. It is likely that policies outside the network, including the possibility of opting for Medicar, increase the practices that can carefully document expenses and income.

It is likely that the most successful challenges for restrictive agreements combined with the political defense of the State reduce or eliminate the impact of the restrictive agreements for surgeons. Raising the moratorium in hospitals owned by a doctor and aligning the Stark law with the same privileges that hospitals have will improve competition and transparency. Government incentives, such as tax exemptions and rewards for practices that demonstrate exceptional satisfaction and results of the patient, could further improve the viability of private practice.

Adapt and prosper

Although the challenges faced by orthopedic surgeons in private practice are substantial, there are opportunities to adapt and prosper. Adopting innovative strategies and advocating policy changes to promote a competitive and equitable market for medical care will allow orthopedic surgeons of private practice that continue to provide the highest quality of patient care.

The collaboration, defense and commitment to preserve the values ​​that define the orthopedic profession will benefit both patients and surgeons.

• References:
• Love. PRINCIPLES OF THE MEDICAL ETHICS OF AMA: III, IV, VI, VII. Available at: https://code-medical-ethics.ama-assn.org/sites/amacoedb/files/2022-08/11.2.3.1.pdf. Consulted: January 30, 0225.
• Boudreau SC, et al. South Med J. 2020; DOI: 10.14423/SMJ.000000000000001081. PMID: 32239232.
• https://public-inspection.federalregister.gov/2024-25382.pdf. Consulted: January 30, 2025.
• https://www.ama-assn.org/system/files/ama-2025-mpfs-summary.pdf. Consulted: January 30, 2025.
• Medical Group Management Association. Compensation and production of suppliers 2024 mgma. Available at: https://www.mgma.com/data-report-provider-comp-2024. Consulted: January 30, 2025.

• For more information:
• Anthony A. Romeo, MD, It is Healio’s main medical editor | Orthopedics today. You can contact Healio, 6900 Grove Road, Thorofare, NJ 08086; Email: [email protected].

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Fountain: Presentation of experts

Dissemination: Romeo reports that they received royalties from, at the Office of speakers and a consultant, and conducted an investigation contracted for Arthrex.

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