Episode 23: Evolving Business Options for Orthopedic Surgeons

More orthopedic surgeons and vendors are focusing on alternative forms of treatment such as biologics and laser therapy. Michael, Scott and Jared discuss some of the business implications of these evolving treatment options that were discussed at the Orthopaedic Summit (OSET). Learn how this theme applies not just to orthopedic practices, but broadly across medicine because all specialties are dealing with similar implications for their businesses.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans and many of those humans have unbelievable stories to tell. Here we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together. And here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts here today with co-hosts Jared Johnson and Scott Zeitzer. On today’s episode, we’re beginning a discussion on some of the themes we heard at the Orthopaedic Summit or OSET, the abbreviation of it and how these themes, these changes that are coming, how they apply to ortho practices And also to, you know, larger across the board across medicine. So, it’s not just orthopedics that we’re talking about, but sort of medicine in general.

And, you know, while we were at OSET, this was out in Las Vegas and we had the opportunity to learn just how this field is evolving. And it’s really interesting because it’s not just about here’s the latest way to replace a hip or here’s the latest way to replace a knee, but we started seeing a lot of vendors out there, a lot of discussions that were going on around alternative forms of treatment. These include things like biologics, treatments like laser therapy. And it brought up a couple of interesting points that we’re seeing specifically in ortho, is that doctors and patients, there’s a lot of different treatment pathways that are out there right now, but there’s a lot of effort to still continue to prove this, that these treatment options make sense, that they can be just as reputable as any other form of treatment that’s out there.

There’s some future guests that we’re actually gonna have on the show that actually talk more about this, where they lean into this method and this way of trying to legitimize this. So, there’s just the purely the clinical aspect of it and how different people can go about this. But then there’s also the fact that there’s a lot of business opportunities around this. You know, one of the models that we looked at while we were there is that, hey, not only I hear is this new form of treatment, but also here’s the exact business plan that you can use to add on to your practice and here’s the exact specifications you would use to lay out the runes that you would need to be able to use this type of service. So, it was just really interesting seeing how the business of medicine is also evolving.

Achieving and Maintaining Success in Practice

Michael: And which kind of leads us into Friday night’s session. Dr. Ira Kirschenbaum, former guest on the show, he really leaned into this business angle as a part of this talk called “Achieving and Maintaining Success in Practice: Are You Ready?”  And he had a variety of guests there, including Mr. Zeitzer here. But he kind of walks through the entire thing and said that this was basically like an MBA, a mini MBA for orthopedic surgeons in the crowd. So, Scott, what was your thoughts of the event?

Scott: I shared some similar thoughts. So, from a new technology perspective or emerging technique perspective, I kind of looked at the clinical side for a little bit. I can’t help it, it’s the biomedical engineering degree in me. It was, like you said Michael, a lot of conversation about how do we do a better job of a particular thing that already exists, whether it’s a total hip, total knee or sort of some sort of sports medicine procedure. And there was also a lot of conversation about how to reduce reliance on opioids, like everywhere. We had quite a few conversations with key orthopedic surgeons and practices where they were trying to highlight, and this is how we’re attacking this whole new area of avoiding the need for opioids, which is a lot more than simply saying, “Well, we’re just not going to prescribe them. It’s like, no, we need to update our techniques for that.”

And then Michael, like you were mentioning, there were a lot of alternative treatments out there. I think he used the word “legitimize” and not “legally.” And for everybody listening out there, it’s not “legal,” it’s not…it’s more about the medicine behind it and the proof of the medicine over time. So, most of the time what you’d love to see with a new technique is some sort of, you know, 10-year double blind study.

Pharma does this quite a bit, you know, sugar pill or some other pills or whatever they are working on. With a particular procedure change it’s not as easy. You’ve got to really be very careful about setting your boundary conditions to test the efficacy of a new treatment versus another treatment. And it just takes time, you know, to get enough people, which is really critical for everybody to understand because all these new things, biologicals, etc., will just, you know, honestly, take some time to see how well it pans out. And that’s where the insurance companies in the business side comes in. So, there are a lot of procedures out there that may be very effective at pushing off the knee for a total joint replacement.

So if you are 50 or an active young 60 and you hear that you’ve got joint pain. In the old days it was like, “Well, you know, you’re just going to have to kind of mellow out for a decade or two and then we’ll do the total joint.” Nowadays, it’s, you know, there’s some things that we might be able to do to not only put off the need for total joint, but maybe even forclude the need for total joint. But they’re not tested long enough and they’re not being paid for by the insurance companies yet. And the insurance companies are basically saying, “Hey, man, I just need more data.”

So, out of all that is coming the need for a lot of these orthopedic surgeons to explain themselves better to their patients about where they’re at with these alternative treatments, what they now know, what they’re seeing in their own practice, what they think can and can’t be done. Setting all those appropriate expectations. Also, making sure that the patient realizes that, “Hey, this may not be covered by insurance and may have to be covered out of pocket.” And then as Michael mentioned, because of all that, there are a lot of surgeons, venture capital companies, private equity companies that are basically coming up with ways to fund all of this because medicine is, at its core, trying to take very good care of people but is also a business.

And so, all of these things were playing before my Friday talk. Actually, it wasn’t just my talk, it was I believe, Michael, if I am not mistaken it was 10 or 11 people that joined me for this conversation. It was everything from like what I talked about, which was online marketing all the way to how to recruit, talking to a legal expert on how to protect yourself for contract negotiations, how to recruit better, how to code better. And guys, there is a lot of stuff, for all new people out there who are not in the business of medicine, who are simply just trying to get taken care of, there’s a lot of stuff going on the back end of that office and really is just about like how do we afford to do all this stuff and how do we get better at it?

Because I will tell you everybody, most doctors and surgeons that I talk to are not very good at business. They’re very good at taking care of their patients but boy, there’s some really good basic stuff that was talked about on that Friday talk. All the while, all of these new techniques are coming up. So, it was very interesting time and I thought that the talk, Michael, did you think the talk was well received or you’re just going to be polite because, you know, you work for me?

Scott Zeitzer speaks at OSET 2019
Scott Zeitzer speaks at OSET 2019

Michael: It was really interesting like having, you know, we really had two separate groups of people in there. You basically had all the people that were trying to get in to a practice, right? The residents that were trying to figure out what their career path was going to look like. And so, you know, some of the talks were very much directed towards here’s how to interview, here’s how to deal with, you know, navigating the politics of the practice, navigating getting started and how much it can vary from state to state, what the requirements are, what the insurance requirements are as far as the coding, you know, information’s listed out.

But, and then you had the set of surgeons that, “Hey, you’ve got a career already going. Are you thinking about investing in an ASC? Are you thinking about expanding your service? Are you going to have a PA in there with you more often? Is that how you can kind of help maximize your time and the profit of the practice?”

So, it was really interesting to hear such a variety of viewpoints because I was definitely taking a lot of notes as we were going through all this. This is something that, you know, just having worked with you for about six years now, it’s been so interesting to learn, but just to see how many of these pieces come together. And I love the fact that Ira had a book that everybody could take away from that and everybody at the event was able to walk out of the session with a book so that if they didn’t get through all the talks, if they had to run to something else, they were able to get all of the information in one place.

Scott: Yeah, I agree. And, you know, so many things like if you just think of it from the resident/fellow who’s just trying to figure out where to land, you know, that person right now is trying… In the old days, that person would basically just go find a practice and go through some sort of getting hired and hopefully, become a partner one day if everything worked out. Now, those residents or fellows are coming out there like, “Should I go work for a hospital? Should I go work for a small practice, a large practice? Do I even try to go out on my own?”

With everything that’s changing, I mean so much is changing. Updates in the techniques have been occurring all the time. Thank goodness. So, you know, 20 years ago or 25 years ago when I got into this business, I mean there were always new “cutting edge techniques” that had to be proven out, but it wasn’t all of that happening while the business of medicine, the consumerization of medicine was taking place.

So, for those young people out there trying to figure out where they want it to go, there was one thought process going in and conversation happening. And then like you said, Michael, ASCs, ambulatory surgical centers, PAs, physician assistants, all being discussed and it really was about, “Hey guys, I think we can make more money here, but I know we can take better care of the patient.” And I do think that’s one of the positive outcomes of the consumerization of medicine is that higher-quality will be required and demanded. The days of just doing whatever the doctor said because the doctor said so are over. And I think that’s actually for the better because I think listening is just as important as telling, right? So, you know, Jared, I know this isn’t just happening in orthopedics, right? You know, we focus on ortho, we focus on ortho, spine, and neuro, but you talk to a lot of other people as well.

Jared: Yeah, you’re right, Scott. And I feel like there’s awareness that there are new options out there, but there’s still sometimes a reluctance to dive in and practices might not know exactly where to even start. They hear about them and they might even think there’s some potential to explore, but then they get back to, “Well, but I don’t have time to do that.” And if they’re not staffed correctly, I thought that was a really fascinating point that you and Michael both brought up about whether you bring on a PA for instance, to be able to maximize really how the business, how the clinic is run.

If you haven’t done that and the surgeon or the provider in any case is still the one really doing pretty much everything, then they definitely don’t have time or they don’t feel like they do to go to even explore these other things and just start crunching numbers. They don’t even know where to start. And so, I feel like that’s a challenge across the board regardless of your specialty is understanding where to start. And I think it helps to even put kind of compartmentalize it a little bit and say like what are the pros and cons of each of these new evolving business options for the practice and then for us individually as providers and then as the patient, man, that sounds like three Ps. It’s kind of crazy, you know?

Scott: Yeah, the three P’s. And honestly, and this is the good thing and my advice to all whatever your specialty is, for all doctors, surgeons focus on the patient first. When you took that “Hippocratic Oath” or the “Oath of Maimonides” focus on your patient and if you take great care of your patients, that’s the best way to get started. The secondary stuff about how to maximize your effectiveness / profitability, etc, that’ll all come in. And if you do your job and you take care of your patients well those three Ps do work. Like what kind of patients do I want to see? What kind of procedures and pathologies do I focus on? How do I match that all up?

I mean, those are our basics, right? And you’re right, Jared, it’s swirling out there. And when I talk to the younger people, whether they’re out of fellowship or still in fellowship, it just is the way that it is. So, the “Theory of Relativity” here, right? So, when you’re older you’re going, “I remember in my days…” I’m starting to do that just about everything. And the younger people are basically, it’s more easily accepted. The reluctance is on the people who are closer to retirement or “I’ve been doing this for 20 years and I want to do it for 10 more. Why do I need to change? I liked the way that it was.” And it’s like, “Well, I get it but it’s here.” And I do think anybody listening to this, if you’re on the providing care side, you are going to have to let go of that reluctance and embrace the change.

Exploring Options as Patients

Scott: And if you’re a patient, my best advice about that is know…like be prepared to have a good conversation with your doctor about whatever that problem is that you have that you want to discuss. And don’t be afraid to ask questions. Don’t be afraid to ask why and don’t be afraid to slow down that particular provider, which brings us back to those PAs, those physician assistants out there. They can be really helpful. Most people don’t realize that there are a lot of RNs, PAs, etc, that can be very helpful in terms of just providing standard care. You know, if you have a head cold, you know, I would go to my mom when I was growing up, you know, I have a fever, you know, she just touch my head and then give me some NyQuil or something, right? Well, you know, maybe when it gets worse, you don’t have to be seen by the doctor immediately. You could be seen by somebody else and they’re very good at triaging when that needs to go to the next level, so that’s going to be a big part of future care.

Michael: You know, Scott, thinking through how that happens, like in the clinic, how that happens in the practice, like, there’s a very clear pathway, right? Obviously, a lot of practices have figured this out already. They know how to kind of hand off to the next person to the next person, like as the need gets more severe. Thinking about this from an online perspective, this was something that, you know, as we were kind of looking into some of these different treatment options that are out there, like if you’re a patient, hey, wouldn’t it be great if you didn’t have to get surgery if that wasn’t the first step? And we’ve talked about the fact that surgeons aren’t always trying to push people to get surgery anyway, but it’s that thought, that fear that patients have of, if I go to see the surgeon now I have to get cut on and there’s like an anxiety that kind of arises from that, especially in some people.

So, as people are trying to think through and as they’re trying to get informed around what their options are, if they’re just looking at these different therapies, it’s not always clear if this is right for them, if this is…there’s just so much information out there that’s not always organized in a way that leads patients down that pathway, right? Like, I can’t self-diagnose, right? Like I can’t self-diagnose as a patient, but at least I can get some sort of feel for like what are the things that even matter and that may help me.

Scott: Yeah. You know, that’s where we have these conversations with a lot of our customers where they will have on their existing website something like this is what a total knee is, you know, to be very silly and that’s great. And for patients who are wondering what a total knee is or whether they might need one or not. That’s good I guess and there’s quite a bit of information online out there where you could learn about a particular procedure. What we tend to coach a lot of our customers on and what we talked a little bit about Friday night, that last Friday night was, “Hey, you got to get more specific. What is this?”

If we are talking about a particular procedure, just to use that as an example, like, well, how experienced are you with that particular procedure? What should patients expect when you perform that particular procedure? That’s the kind of things that I think help a lot of patients because, you know, some patients are just starting to wonder like, “Well, you know my knee kind of hurts. I wonder what that means.”

I self-diagnosed at 2:00 in the morning, not a good plan. But, with that being said, as you start to try to figure that out, at least it’ll prepare you for a conversation with your doctor or if you need to go to an orthopedic surgeon, your surgeon about a total knee, excuse me, about a knee problem. And then when they start talking about potential options, that’s when you can read more about it, see what’s on their own website about it because it’s one thing to talk about the use of a new type of procedure, it’s another thing to kind of walk the patient through some of the frequently asked questions, what they’re going to expect. And I think that’s where the value of online comes in. It’s trying to have these good conversations.

You know, the pediatrician that we spoke to that was Justin Smith, he actually figured this out. You know, he has the same conversations over and over with every two-month wellness visit hopefully, right? If you really want it to be just like, “Well, your baby’s two months, here’s what we’re gonna talk about.” Because there are no curve balls and that’s what everybody wants. And he prepares his patients before they walk in the door with, “Hey, this is what we’re going to talk about.” That’s we do on a lot of websites. When you’ve got good content marketing, you’re going to come in and talk to me about a particular procedure or a particular pathology, “Here’s what I’m going to be discussing with you.” You know, so ask them questions accordingly because I’ve got some good information. Very critical not only to helping you get new patients if you’re a doctor out there, but also to making sure your patients are better prepared and better taken care of. So, it’s a real win across the board.

The Business Side of Medicine

Jared: So, Scott, I think when we think about what practices should keep in mind when they start going down these roads and start exploring some of these alternative treatments, they do have to keep the business side of it in mind. I guess, where do they start? Where does the practice…what are the considerations for practice as they start exploring all these alternative procedures? Like, I’ll turn it on treatments.

Scott: As I mentioned before, the absolute most important thing is does the doctor, do the group of providers feel that whatever this new or alternative treatment is, is it helpful to the patient? Now, I will tell you, again, never been in a meeting with any provider who, you know, sounded like Mr. Burns saying, “We’re gonna make millions out of these,” if anybody watches “The Simpsons.” And I think a lot of people do. Most of the time it really is like, “Man, I really think this can help people. Now, how do I get more people to find out about that?” So, the next step, if you really believe this is helpful, and they normally do, the next step is going to be like, “Well, how do I explain myself? What is this procedure? How can it help them? What kind of candidates are best for that procedure?”

You know, Michael, you mentioned that there’s Dr. Scott Sigman who does a lot of laser therapy for pain and swelling and just general orthopedic treatment care and he’s found it to be an extremely effective tool for a lot of scenarios. And Dr. Sigman saw it working very well for his patients and then said, you know, “I want to get this particular type of procedure,  type of treatment, excuse me, in the hands of more orthopods.” And he’s actually created almost like a franchise setup for orthopedic surgeons. Will Dr. Sigman make more money because of that decision? I hope so, for his sake. But just as important and I think more importantly, when I talked to Dr. Sigman, it was really about, “Hey, this works and I want to get this in the hands of more surgeons to take better care of their patients.” He is avid, and has always been avid for quite some time about trying to avoid opioids. It’s been his thing. He’s been on it well before it was popular to say that. And he found the use of this laser therapy to be very efficacious. He’s very confident that it’s a very helpful procedure.

And so, you look across the board, Jared, and part one, make sure you feel this is effective, make sure your patients feel the same way. You know, after you provide the treatment and then how do you attack that business model. It could be as simple as like just tell people about it and it could be as complex as what Dr. Sigman is doing, which is like, wow, this is working so well. I need some help on how I get the word out as well like going down the whole franchise pathway. Fascinating to see that. And I’m hoping to actually do a podcast, we are all hoping to do a podcast With Dr. Sigman because I think he’d be a very valuable person to talk to in terms of his insight on how he takes better care of his patients, the results of treatments and his whole concept behind franchising this particular type of treatment.

Michael: Scott, jumping on that conversation we had with Dr. Sigman, one of the things that really stood out to me, and it’s something that we haven’t discussed a lot on the show, maybe some was the conversation that we’ve had with the practice administrator, but it’s that whole how do you pay for healthcare, right? Like, this is a big, big hard topic and there’s lots of different, you know, moving pieces to all of that kind of stuff, but one of the things that he specifically brought up was the patient that’s like a contract worker for construction. That person can’t necessarily just take off eight weeks for a knee replacement or, you know, some other kind of like major procedure that’s going to put that person out of work for a long period of time. That is also a factor in terms of paying for healthcare.  It’s not just can I pay for this particular procedure? But also what does it cost me in missed time on the job, all of that kind of stuff.

So, it’s interesting to hear that patient angle as well. And also from a business perspective around the practice, because there are different ways that the Dr. Sigman in particular is structuring a payment model for patients to be able to handle this. You know, we talked about this not necessarily being something that insurance is covering right now. And here’s ways that they can…

Scott: You know, there’s quite a few doctors out there who believe in a particular type of treatment and avoiding surgery. I mean, a lot of this is about avoiding surgery and so part of it is, hey, I really…and these are surgeons, everybody, so surgeons, you know, got into surgery because they don’t like performing surgery but they really do believe that taking better care of their patients. Like, I promise you that. And as was the case with Dr. Sigman and a few other people that we’ve talked over there, it’s like, man, I really believe that we can avoid surgery and of course we want to avoid surgery and it will be less costly over time, not just for the particular procedure but to the patient from just health perspective as well as just, like you mentioned, time off.

It’s expensive not to be working and so it may not be a total knee, it might be ACL repair or some other type of arthroscopic procedure. Hey, that’s why arthroscopic procedures became such a big deal. It was less time to be out of commission and that’s important. Just like you mentioned, if you’re a construction worker and, you know, you can figure out a way to just be out for a couple of days rather than a couple of weeks or six to eight weeks, that’s a big deal. It really is. And so, again, it’s fascinating to need all of these potential changes and help that can be out there for patients all occurring with the backdrop of, “Wow, medicine is changing.”

Final Thoughts

Michael: There’s a lot of change and a lot of topics that we’ve discussed here that require the practice to have that time to step back and say, what’s the strategy that we’re going to use here? What’s the approach that we’re going to use? And so, we’re recording this right at the end of the year coming up on the beginning of the year. So, this is a time when a lot of people are kind of thinking through strategy, what’s next for career, what’s next for your practice? So, this is a good time to think about these kinds of matters. There’s a lot of opportunities out there for individual surgeons as well as for practices as a whole.

I’d say the other side of this would be that patients have more and more opportunity to direct the type of care that they’re looking for. And I think that’s a really great opportunity. And we as communicators, as marketers, whatever that role may be, we can help guide that process. There are things that we can do on our side to enable that process and make them aware of what’s coming up. So, it’s an exciting time. It’s an exciting year that’s coming up for just as medicine continues to develop, as the orthopedic skills continue to develop, there’s a lot of opportunity here. So, really looking forward to seeing what 2020 brings, and thank you for listening today and have a great week.

Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts