Authors:
Susanne M. Roberts, MDa – [email protected]
Dana Jacoby, MBAb – [email protected]
Marney F. Reid, BSc – [email protected]
Over the years, orthopedic surgeons, especially hand specialists, have had to adapt to a shifting healthcare landscape. The push toward value-based care has changed how medicine is delivered, with bundled payments beginning to replace traditional fee-for-service (FFS) models. While these changes were designed to lower costs and improve outcomes, they’ve also introduced new hurdles: declining FFS reimbursement, increased administrative burdens, and greater insurance interference through prior authorization and claims denials.
For hand surgeons, the impact is particularly challenging. Clinic visits remain under-reimbursed despite being critical to patient education and preventative care. Meanwhile, rising patient volumes, time-consuming documentation, and the need for meticulous coding are piling up, making it harder for surgeons to maintain financial viability while providing high-quality care.
To put it simply: the modern hand surgeon is expected to do more with less, less time, less money, and fewer resources.
Patients Are More Informed Which Can Be a Double-Edged Sword
Today’s patient arrives at their surgeon’s office, armed with information from Google, WebMD, and other various social media outlets. While patient education is a good thing, misinformation or information used out of context without proper medical training and experience can make consultations more time-consuming for the providers and their staff. Instead of a straightforward discussion about treatment options, surgeons often find themselves debunking myths, correcting misconceptions, and reframing expectations and care pathway options for each patient’s unique pathology and situation.
This extra effort is critical, especially in the era of physician reviews and reimbursement somewhat tied to patient satisfaction scores, but often goes unrecognized and more importantly, undercompensated. Surgeons are left juggling higher patient volumes with increasingly in-depth conversations. Some have turned to digital platforms, educational handouts, or even social media to streamline patient education, but these solutions require time and financial investment outside of direct patient care.
The Productivity Squeeze
On top of patient education challenges, hand surgeons are also feeling the pressure to increase productivity. Hospitals and private practices alike push for higher office-based procedure and surgical volumes, which means more new patient visits to identify these candidates. But ramping up volume isn’t as simple as opening the doors to more patients. Referral patterns, insurance constraints, and administrative roadblocks all play a role in determining patient flow.
Adding to the complexity, patient satisfaction scores now influence both hospital metrics and reimbursement rates. The less face-to-face time a surgeon has with a patient, the harder it is to foster strong relationships and positive outcomes.
It’s no surprise that burnout among orthopedic surgeons is on the rise. But what if there was a better way to balance efficiency, financial sustainability, and patient-centered care?
A New Approach: The Longitudinal Patient Experience (LPE)
We propose a new concept to help combat the above challenges faced by Orthopedic hand surgeons, which is the concept of the Longitudinal Patient Experience (LPE). This is a specialist-led approach that prioritizes efficiency, patient education, and streamlined workflows.
Instead of a fragmented patient journey, the LPE model provides structured pathways for care. From the moment a patient schedules an appointment, they are triaged to the right provider, whether that’s a surgeon, an advanced practice provider (APP), or a specialized clinic tailored to their condition.
How the LPE model works:
Optimized Triage: Patients are guided to the most appropriate provider based on their diagnosis, preventing unnecessary visits and delays.
Disease-Specific Clinics: Specialized clinics, such as an injection clinic or a preoperative counseling clinic to reduce inefficiencies and improve throughput, led by the specialist (orthopedic hand surgeon).
Standardized Workflows: Educational materials, informed consent, and preoperative preparations are managed to ensure a smooth patient experience.
Efficient Follow-Ups: Patients on non-surgical treatment plans (e.g., injections) are scheduled for dedicated follow-ups, while surgical candidates receive detailed guidance on next steps.
By structuring care in this way, surgeons can increase efficiency without sacrificing quality, and potentially improve patient outcomes and satisfaction.
A Real-World Example: Dupuytren’s Contracture
Take Dupuytren’s Contracture as an example. Traditionally, a hand specialist might spend significant time explaining the condition and history, discussing pharmaceutical and surgical options, and answering patient questions.
Under an LPE model, this process becomes far more streamlined. Physicians and APPs share the workload, maximizing efficiency without compromising care.
The Bigger Picture: A Call for Specialist-Led Care
Hand surgeons and other orthopedic specialists are at a crossroads. The current system is placing unsustainable demands on surgeons while failing to address the root causes of inefficiency in patient care. Instead of letting administrative forces dictate practice models, specialists must take the lead in shaping the future of orthopedic care.
The U.S. spend on healthcare continues to grow, currently 17.4% of its GDP, yet cost-cutting efforts have primarily targeted surgical reimbursement rather than systemic inefficiencies. A specialist-led LPE model could help address this issue by:
- Enhancing patient care through efficient workflows
- Reducing burnout by create specialist-led care models
- Improving financial sustainability without compromising quality
The challenge is clear, but so is the opportunity. The question now is: Will orthopedic specialists step up and lead the charge?
Institutional Affiliation:
Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th St, New York, NY USA 10032
Vector Medical Group, 951 20th Street #1378, Denver, CO 80202
Marney Reid Consulting, LLC, 191939 Juanita Ln., Cornelius, NC 28031
Acknowledgements:
We thank Ian S. Hong, BMSc and Samuel Rosas, MD, PhD, MBA for assistance in formatting and editing of this manuscript for journal submission.
Senior Author: Marney F. Reid, BS
Corresponding Author: Susanne M. Roberts, MD
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https://emedicine.medscape.com/article/329414-overview?form=fpf