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A Different Perspective: Current Healthcare Trends as Seen By a Trauma Surgeon

Current, well-publicized trends in healthcare delivery look different through the eyes of a trauma surgeon. Payment mechanisms, physician engagement, and patient satisfaction are seen through a very different lens.

Pre-authorizations, Payment for Services, and the Affordable Care Act

Dr. Patrick Leach succinctly expresses how trauma surgery is different, “When you have a poly-trauma case and immediate surgery is needed, you don’t call for pre-authorization. There isn’t time. We have to do what we can to treat that patient.”

In his practice, the type of cases he sees and the most prevalent payment sources are:

Poly-trauma cases – 40% of cases – Insurance pays Auto accidents with other vehicles; drunk-driving, drugs, distracted driving like texting. These are frequently people making bad life decisions or people with bad impulse control. Among this population, if they survive an accident it is not atypical to see recidivism if they continue to make the same bad decisions. This injury pattern also occurs for the innocent person who may be the “other party” in a traffic accident.

Elderly demographic – 40% of cases – Medicare pays because falls tend to be single-system involvement, (i.e., hip, shoulder, or elbow), the cost of care may rise due to demographics (e.g., aging of the baby-boomer generation). But the procedure costs themselves are not likely to increase.

Workers Compensation accidents – 20% of cases – Workers Compensation pays Work-related accidents and injuries are typically covered by Worker’s Compensation programs. This injuries often include falls from ladders, roofs, or scaffolds, or accidents with heavy or power equipment.

The Affordable Care Act, for example, has no direct effect on orthopedic trauma surgery. Due to the nature of the treatment, orthopedic trauma surgeons typically experience a minimum of hassle related to non-clinical demands and politics of practicing medicine.

Physician-to-Physician Communication

Physician-to-physician communication is less frequent today. There are fewer opportunities for personal, one-to-one interactions or consults between physicians. The proliferation of hospitalists and other hospital-based specialties, the infrequency of primary care doctors actually coming to the hospital, and the advent of the electronic medical record— among other things—have all combined to alter traditional, physician-to-physician communication channels.

However, the physician one-to-one consult has never been as relevant to trauma surgeons as it might be in other physicians in other specialties. Often there is not time for dialogue. Getting to the necessary work at hand is the most important thing.

“In some cases, I will take a consult but often I have what I need in the electronic medical record and can get right to work. I may talk with another physician, but there typically isn’t much time to talk, or the need. In the majority of the cases I have what I need to get to work.”

Patient Satisfaction

Another well-publicized element of today’s healthcare system is the increased emphasis on increasing and maintaining patient satisfaction, or a positive patient experience.

Again, trauma surgery being a bottom-line situation that can involve life or death circumstances, the level of customer service a patient experiences fades in importance. Having their lives saved is the ultimate positive patient experience.

On the other hand, a negative patient experience can be created when, for example, a medical device manufacturer “promises” Florida retirees a hip replacement will put them back on the golf course in two weeks. But, after surgery, when the patient realizes that is not possible, the surgeon may take the blame.

This blog post excerpts an article in the Q1 2017 Provider Advisor, where we interviewed Dr. Patrick Leach, trauma surgeon, for his perspective on some of the trends prevalent in healthcare.

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