facility as long as you mitigate risks and post-op complications, and
manage pain control, PONV and blood loss. In many ways, orthope-
dics is leading the Enhanced Recovery After Surgery (ERAS) move-
ment with surgeons and outpatient facilities teaming up to manage
every aspect of patient care from the moment cases are scheduled
straight through to successful recoveries.
We're placing a greater emphasis on spending time with patients
in the months before procedures in order to prepare their minds
and bodies for the rigors of surgery, and making sure they're
ready both physically and mentally for same-day discharge.
Advances in regional anesthesia and multimodal pain control are
easing the discomfort of notoriously painful procedures with
fewer opioids, presenting a blueprint for opioid-sparing protocols
and practices.
• Value-based care. Under the bundled payment reimburse-
ment model, insurers pay a single payment that covers an entire
episode of care, which begins the day patients schedule surgery
and ends at 90 days post-op. Surgeons and facilities must manage
every aspect of patient care and take on the financial and clinical
risk of doing so, but also stand to profit more than they would
under the traditional fee-for-service payment model if they control
costs and deliver excellent outcomes. The risk-sharing model
incentivizes surgeons and facilities to deliver value-based care,
and continues to control the costs of performing joint replace-
ments without compromising quality.
• Market consolidation. In what's representative of a larger
healthcare trend, we're seeing a consolidation of orthopedic prac-
tices — nationwide, there are 100 groups with 50 or more physi-
cians and 8 groups with 100 or more surgeons — and growing
numbers of orthopedic surgery centers being folded into hospital
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