Medicine / Orthopaedics
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Orthopaedic measurement of healthcare.

March 9th, 2012

Michael Flaherty, MD


Albany Medical Center - Albany Medical College, Division of Orthopaedic Surgery

The front page of the New York Times exclaims in large old english lettering that healthcare reform has died with Senator Ted Kennedy. President Barack Obama pleads desperately with Congress during the State of the Union address to keep working on healthcare despite the ominous cloud which is the American economy. American's celebrate en mass as Scott Brown, a Republican, takes the senate seat in liberal Massachusetts. Healthcare reform in America has become the top priority in this country and yet throughout the media circus which follows this heated debate, the physician has been all but left out. Those who take the well-being and health of America's people into their own hands are left to watch idley as decisions are made for them.

As the battle over reform in America continues, orthopaedic procedures such as total hip and total knee arthroplasty remain in the heat of discussion. Total joint replacement, of which the majority of cases are elective, improve quality of life for many patients and allow our aging population to remain more active and healthy. Total joint arthroplasty is not an emergent procedure, like coronary artery bypass surgery or ischemic bowel resection, however the procedure likely has a larger effect on every American than these other procedures. Total joint replacement can cure the debilitating disease, arthritis and allow patients to live happier and healthier lives. In countries with socialized medicine, quality of care is often measured by improving the wait times for these procedures. In a recent recruiting pamphlet from the Health Force Ontario, the advertising and selling point for physicians to work in Canada was a reduction in wait times for five procedures. Of these procedures three were orthopaedic: total hip replacement, total knee replacement and carpal tunnel release.

Elective orthopaedic procedures have become a measuring tool for quality of life and also for quality of healthcare. Although these procedures have become so very important to our patient population in America, there is a risk of losing such an important treatment because of decreased reimbursements. As Medicare and private insurers continue to decrease overall reimbursement for total joint replacement and the prices of implants, hospital stay and post-operative rehabilitation continue to rise, physician compensation dwindles. With physician compensation decreasing, the number of orthopaedic surgeons specializing in joint replacement has already decreased and the number of cases each surgeon undertakes increased. The ultimate result will be very few joint replacement surgeons and excessive number of cases, a formula which will decrease overall quality of care. As this occurs there will slowly be a trend toward increasing wait times in America, which has rarely ever been a problem, but as Canada has proven, is a measurement of quality of care.

Healthcare in our country does not live and die with the total joint replacement. But the joint replacement does represent an important treatment which can improve quality of life and overall patient care. With many orthopaedic procedures being used as the measuring stick with which quality healthcare and poor healthcare are graded it is imperative that orthopaedic surgeons serve a large role in healthcare reform.

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