Re: Surgeon Hospital Payment Malalignment

Dear CSS Colleagues:


Here are a few interesting facts. Of the children now being born in the USA, about 50% will live longer than their 100th year and over the next 30 years the number of people > 90yo will more than triple….(Source: 60 minutes, Neuroscientist researcher: https://www.cbsnews.com/video/long-life-retirement-community-60-minutes-video-2021-05-30/ ).


These statistics lead me to consider a sobering reality for healthcare. Healthcare in general will not be able to shoulder the economic burden that will come through caring for this number of aging people. Orthopedics in particular will buckle under the weight of


the burden of musculoskeletal care. It is a given that the downward pressure on costs of this incredible weight of patient care will lead to reduced payments for service, and strain a system already incapable of lean management and rife with waste. Moreover, an over-inflated impression of its own worth is a contributing factor. There are only two models available in the future and neither is fee-for-service, soon to go the way of the Dodo Birth and the Dinosaur. (Sooner for some than others.)


First is the “Employment Model” like Mayo, Cleveland Clinic and Kaiser. This will become even more of a top-down model where administrators hold all the power and physicians are commodities with less leverage on their daily life and choices. That’s before Amazon or some other third party decides to invade the healthcare supply chain and drive down prices and along with that choices of physicians for what they use to teach patients.


The second is an “Alignment or Collaboration model. Such models exist, with prime examples being Rothman Institute in Philadelphia and The HOAG healthcare network in Southern California (Physician Hospital ownership was outlawed in several administrations ago); and more contemporary examples might be Rush in Chicago and HSS in NYC. Each manages to achieve some form of symbiotic relationship with their hospital system.


Enclosed is an article entitled “Surgeon Charges and Reimbursements are declining compared with hospital payments for shoulder arthroplasty”. The title speaks for itself. In my opinion, the only way to maintain some control on what we do as surgeons, is to measure costs and outcomes. The authors state “These results encourage the need for future studies with detailed cost analysis to identify the reasons for hospital and surgeon malalignment.”


Please share your thoughts and comments via our WhatsApp group.


Kind Regards,


“JP” Warner MD

Founder, The CSS


Surgeon Charges and Reimbursements are declining compared with hospital payments for shoul
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