Working with Orthopedic Surgeons Daniel Herman MD, PhD, CAQSM Asst. Professor, UF Department of Orthopaedics and Rehabilitation UF Running Medicine Clinic (352-265-RUNR) UF Human Dynamics Laboratory 2015 AAPMR Annual Meeting
Dec 14, 2015
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
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