New advanced technology - a step in orthopedic excellence

December 2014
By David O. Navid, D.O

In the history of medical innovation, medical advances in technology is taking us to a unique point in patient care where cutting edge technology allows a surgeon to pave the way for individualized patient care with unbelievable precision and fortitude.

Neil Armstrong’s most famous line – “That’s one small step for man, one giant leap for mankind,” is certainly reflective of how the robotic arm partial knee resurfacing procedure called MAKOplasty® is changing patient’s perception of surgery and improving the quality of life after undergoing joint replacement surgery.

Just like man’s first walk on the moon, this is a first step for countless patients who are looking for solutions to their pain. The results allow a patient to return to a healthy and active lifestyle with a less invasive surgical procedure in a short amount of time. Patients who are candidates for this procedure benefit from smaller incisions, less scarring, and majority qualify for outpatient surgery or overnight hospitalization.

This is a “step for mankind” in orthopedic surgical procedures and an opportunity for the medical community in North Houston.

According to the American Academy of Orthopedic Surgeons, Osteoarthritis (OA) is the most common form of knee arthritis and the leading form of disability worldwide. In an osteoarthritic knee the cartilage covering the ends of the bones in the knee joint eventually wears away, making it more painful to move the joint. The symptoms include pain, stiffness and swelling of the knee joint and sometimes loss of motion.

Historically, traditional knee surgery was extensively invasive and had recovery risks that included infection that could result in additional surgery, blood clots that could lead to stroke or death, and continued knee instability and pain. A total knee replacement also requires an extended rehabilitation program and home planning to accommodate the recovery period.

With the aid of a robotic arm system, the surgeon is able to view a virtual visualization of the patient’s knee based on a CT scan and determine the right size implant to use and can align it in the patient’s knee-all before surgery. The ability to align the implant is critical to achieve optimal implant function and longevity. Patients are showing remarkable recovery rates and the stigma associated with joint replacement surgery is quickly becoming obsolete. Although the standard surgical risks still exist, they are expected to be in much lower rates for qualified patients.

How does robotic-assisted surgery work?

During the surgery, the robotic arm system provides a virtual view inside the knee and that area of the bone where the implant will be placed. By using the robotic arm to prepare the bone for the implant, the system provides a preset safety zone where the cutting tool works and gives an added level of accuracy to bone preparation and implant placement.

Being able to virtually see the bone that is being removed allows for a minimal incision. The surgeon is in complete control of the robotic arm at all times and the system gives him an immediate, tactile, visual and auditory feedback-in essence preventing from going outside the preset area.

Postoperatively, patients have felt little discomfort, are dismissed shortly from the hospital, and in many cases no longer need but oral pain medication just 24 hours after the procedure.

Who is a good candidate for the robotic procedure?

Patients diagnosed with osteoarthritis of the knee that have not progressed to all three compartments are great candidates for this procedure. In addition, the MAKOplasty® procedure can be used for total hip replacement for patient’s diagnosed with hip arthritis.

Younger patients with painful knees where the arthritis involves only a limited portion of the joint, are no longer forced to live with pain until they are candidates for total knee arthroplasty. This limited approach can help return such patients to a more active and enjoyable lifestyle with much shorter time to recovery.

Revenue Reversal

The Affordable Care Act isn’t the only “seismic shift” impacting profitability in the healthcare industry. New research indicates primary care physicians (PCPs) are generating more annual revenue for hospitals than specialists − and it’s a trend that is likely to continue.

A study by the physician staffing and recruitment firm Merritt Hawkins, a subsidiary of AMN Healthcare, showed that PCPs − defined as family physicians, general internists and pediatricians − generated a combined average of $1.57 million in revenue for their affiliated hospitals last year, compared with a combined $1.43 million across 15 specialties.

It’s a big change since 2002 when PCPs accounted for $1.27 million in hospital revenue compared with $1.59 million from specialists. PCP revenues have increased 23 percent in the last decade while specialist revenues have declined by 10 percent.

“Hospitals have a strong interest in recruiting PCPs because they control healthcare,” said Dr. John Peet, co-CEO of Greater Houston Physicians Medical Association. “They have the ability to generate revenue through ancillary services and referrals to specialists.”

As gatekeepers to modern healthcare, PCPs are increasingly important to hospitals because of their power to direct patients to preferred providers, testing labs and treatment facilities. As an employer of physicians, they have greater influence over the flow and direction of treatment.

“Everyone goes to their primary care physician first,” said Fawn Creighton, CEO of Apollo Hospital in The Woodlands. “They are the ones that know what is going on with patients. They put all the pieces of the healthcare puzzle together.”

According to Merritt Hawkins, PCPs are increasingly employed by hospitals in new delivery models, such as accountable care organizations. ACOs reward doctors and hospitals for working together to improve quality and control costs. Physicians are essential to an ACO’s success, because doctors need to direct the use of nurses and other caregivers to manage the medical care of patients.

ACOs are gaining in popularity. In addition to medical care for seniors through Medicare health insurance programs for the elderly, many private health insurance companies are signing on as well − including Aetna, Cigna, Humana, UnitedHealth Group, Wellpoint and Blue Cross, according to Forbes.

Hospitals also face the fact that surgery reimbursements are declining, according to Creighton. Because ACOs and other new approaches to health care delivery emphasize lower cost outpatient care, revenue to hospitals from specialists is dropping. ACOs and patient- centered medical homes are also being paid by Medicare and insurance companies increasingly through bundled payments that emphasize primary care rather than specialized care.

Specialists are still hugely important to hospital revenue streams, however. Orthopedic surgeons and cardiologists can generate significant revenues for hospitals by the nature of their specialty. But the trend is toward shorter hospital stays and more outpatient procedures.

“A lot of specialists have moved out of hospitals,” said Peet. “ Specialty suites and ambulatory surgery centers are increasingly common, taking patients of specialists out of the hospitals.”

That makes successful PCPs even more attractive to hospitals. As hospital employees, physicians are more likely to refer diagnostic tests, therapies, and other services “in-house” to their hospital employer rather than to outside resources such as radiology groups or laboratories, according to the Merritt Hawkins report.

“Primary care physicians have a greater spectrum of normal and specialized treatment needs,” observed Creighton. “Whether it is initiated by an annual physical or a specific concern, the healthcare process starts with the family doctor.”

This evolution in healthcare economics is likely to continue, said Peet. Hospitals will have a vested interest in hiring or establishing working relationships with PCPs because of their ability to impact the hospital’s bottom line. It’s a fact that may help PCPs be in a better bargaining position in future employment agreements.

“Specialists have great skills and are respected members of the medical community,” said Peet. “But hospitals are aware that everything starts with the family doctor in the modern era.”