Working with Orthopedic Surgeons

Daniel Herman MD, PhD, CAQSMAsst. Professor, UF Department of Orthopaedics and RehabilitationUF Running Medicine Clinic (352-265-RUNR)UF Human Dynamics Laboratory

2015 AAPMR Annual Meeting

Disclosures

• None

Outline

• Describe ways in which your practice may differ in working in an Orthopedic Practice vs. a Physiatric Practice

• Tips on creating a successful relationship and working environment

• How to market yourself to Orthopedic Practices

Your Role in an Orthopedic Practice

• The surgeons are the engine of the machine– Practice leaders– High billing and reimbursement

• May have access to great levels of resources

• You need to support the mission!– Implications for your practice patterns– Implications for your billing and patient volume

Your Role in an Orthopedic Practice

• Your role: Triage and Support

– Discern Operative vs. Non-operative cases

– Complete non-operative management

– “Support” Services• Ultrasound guided injections• Fluoroscopy• Electrodiagnostics

Your Role: Practice Implications• Adapt your style to the needs of the surgeon

– Impression: “Right upper extremity median sensory and motor latencies are elevated relative to laboratory norms and compared to that of the contralateral limb, indicative of a potential mononeuritis. Chronic neurogenic potentials in the thenar muscles are supportive of this diagnosis, but no acute neurogenic changes were observed.”

– Moderate right carpal tunnel syndrome

– Surgeon: “Do I cut on this guy or not?!?”

Your Role: Practice Implications

• Clinical Decision-Making Protocols– How does the surgeon want the patient tee’ed up?

• Knee Osteoarthritis– Surgeon: “They must have at least KL stage 3 OA on Xray,

complete at least 6 weeks of physical therapy, have used NSAIDS, and have at least partial response to an injection.”

– Restrictions on BMI, co-morbidities

• Carpal Tunnel Syndrome– Surgeon: “EMG of moderate CTS, failed injection, and have

tried wrist splints for at least 3 months.”– Restrictions on radiculopathy

Your Role: Practice Implications• Example Area of Conflict: ACL Injury

– Data not very supportive of reconstruction• No change in risk of osteoarthritis• “Copers” exist, may be discerned with clinical testing• Frobell RTC: same activity, function, meniscal injuries

• Surgeons: CUT!!!

• My role: – Start PT for ROM/Quads– Confirm injury with MRI– Send to surgeons

Your Role: Practice Implications• Example Area of Conflict: FAST and HA

– Fasciotomy and Surgical Tenotomy• Focused ultrasound debridement of degenerative tissue• Performed under ultrasound guidance by non-surgeons

– Surgeons may perceive this as a threat

– Hyluronic Acid Injections• ACR: feasible option for knee OA• AAOS: recommends against use

– Surgeons may use this to cease offering

Your Role: Practice Implications• Accessibility

– How many patients you see

– EMGs within 2 weeks, not 6 months

– Same-day ultrasound guided injections

– Push timing of advanced imaging

Enhance the patient experience through

expedited care (retain surgical cases)

Maintaining a Good Relationship• Communication

– Patients• Ex. Tricky findings from EMG• Don’t box the surgeon into a

corner when discussing surgery

– Protocols• Are you packaging patients to the surgeon’s liking?

– Education• What services can you offer? Considering? DON’T offer?

Maintaining a Good Relationship• New procedures

– May be perceived as a threat to surgical volume– Education and communication

• Evidence, Risk, Benefit to patients• Marketing potential

– New revenue stream– Differentiates the practice– Drives surgical volume

“They come for the viscosupplementation and stay for the arthroplasty.”

Maintaining a Good Relationship

• Develop allies with the practice– Good service for your core surgeons

– Excellence in patient treatment

– May find allies in unusual places• Administration• Surgeons outside of sports medicine• Younger surgeons

Marketing Yourself to Orthopods• Education is key

– Be persistent• Identify the correct

point of contact– Practice Manager– Medical Director

• Make take a few timesof reaching out

– Identify needs of the practice• Personnel in practice, surgeon mix

Marketing Yourself to Orthopods• Be explicit about what you can offer

– Differentiate yourself from other PCSM providers• Fluoroscopy and electrodiagnostics

– Are you willing to go outside your comfort zone?• Fracture care• Scoliosis• Club foot

• Be explicit about what revenue you can bring in– Pro forma analysis

Marketing Yourself to Orthopods• Pro Forma Analysis

– Analyze referral patterns• Outside procedures including

injections and electrodiagnostics

– Insurance mix for the practice• Billing and collections

– Anticipated practice growth• New procedures and programs

– Insurance, personnel, and start-up costs– Use your department financial officer as a resource

Thank You

Contact: hermadc@ortho.ufl.edu