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A Pragmatic Approach to Healthcare Changes in 2017

Bert R. Mandelbaum, MD, DHL (Hon)


December 22, 2016

In This Article

Motivate Patients to Empower Themselves

But health insurance alone will not protect our patients. As our patients contemplate changes to our healthcare system, we should remind them that they can do more to improve their health than we can.

My years as a sports physician have taught me to think in terms of the tripod: prevention, optimizing performance, and injury or illness care. For each of these aspects of healthcare, our ability to motivate our patients matters more than our skill in reading radiographs or reattaching ligaments.

First, we must motivate our patients to exercise; eat well; get plenty of sleep; and regularly undergo appropriate screening, such as colonoscopy, mammography, prostate-specific antigen measurement, and blood chemistry panels. These steps will prevent many of the most common illnesses.

Second, we must help our patients optimize their performance through fitness. That means adopting an aerobic, resistance, and flexibility routine appropriate to their current fitness and to the activities in which they engage.

I encourage even those people who don't like sports to think of themselves as athletes. Not all our patients are playing soccer or running marathons. For some people, walking across a room or reaching a high shelf is challenge enough. But they still need to optimize their performance for these tasks of daily living. We must empower our patients to improve their physical, emotional, and spiritual lives.

In illness and injury, our role as physicians comes to the fore. Yet patients still play an essential role. They must become informed about their condition, consult with us about their treatment plan, and carefully follow the steps agreed upon for their rehabilitation. Here again, motivation is essential, and we can only truly succeed when we can inspire patients to act in their own best interests.

Embrace the New Medicare Payment Models

Even while working to empower our patients, sports physicians are facing changes in our practices brought about by healthcare reform.

On January 1, we will enter a new system: Under the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA), physicians reimbursed through Medicare will get increases or decreases in payment that are based on quality measures.

The new program takes a step away from the conventional fee-for-service model of healthcare, which rewards physicians for treating patients, to a system that rewards physicians for maintaining patients' health.

This approach empowers the physician as a leader, not only in one-to-one relationships with individual patients, but also of whole populations. And private insurers are following in the path blazed by Medicare. Accountable care organizations, global-fee relationships with hospitals, bundled payments—these are upon us.

The Kerlan-Jobe Orthopaedic Clinic in California, at which I serve as cochair of medical affairs, is an example of a practice well-positioned for these changes. We're an institute of 40 physicians within Cedars-Sinai Medical Center in Los Angeles. We have fully implemented an electronic medical record. We're using this technology to monitor our successes and challenges in pre-, peri- and postoperative situations.

Long before MACRA, we started tracking such outcomes as the Knee injury and Osteoarthritis Outcome Score; Short Form (SF)-36 and SF-12 quality-of-life indices; the Marx Activity Scale; and the International Knee Documentation Committee Subjective Knee Form.

We have participated in the Arthrex Surgical Outcomes System for 5 years. This gives you an optimal dashboard to look at your cases, see how your outcomes have changed over time, and see how you compare with the general population of physicians.

Now we anticipate rewards for this work through MACRA's Merit-Based Incentive Payment System, which pays bonuses or subtracts penalties of up to 4% on the basis of quality standards.

Your practice should be adopting these measures sooner rather than later. They will be necessary to succeed in the new healthcare landscape as it is shaping up.


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