Enhancing Your Practice's Revenue - California Orthopaedic ...

• The physicians (particularly non-operative orthopaedists;see below) represent an excellent way to “test thewaters” when consideration is being given to adding toorthopaedic surgeon complement.• The physicians generate direct revenue for the practice.They also free up practice principals to perform surgery,which typically reimburses at a higher rate than work inthe office.• They allow for the generation of ancillary revenue,including (a) x-ray, (b) the sale of supplies, and possiblyeven (c) office procedures.• They can potentially expand subspecialty practice withnew products or services (such as pain management, andpre-surgical medical clearances) that may be in demandwithin the community.Note: non-physician extenders such as Nurse Practitioners(NPs), Physician Assistants (PAs), OrthopaedicPhysician Assistants (OPAs) and Athletic Trainers (ATs/ATCs) have been incorporated into orthopaedic practicesfor a number of years to enhance surgeons’ efficiency inthe clinic and operating room. However, requirements forsupervision may limit their use and reimbursement undernew models of health care delivery. See Chapter 1: NonphysicianExtenders.DownsidesThe recruitment of non-surgical physicians also has certaindownsides.• Tension can arise if the physician wants to become apractice principal. Issues such as income distribution,on-call, and governance are sufficiently complicated evenin “homogenous” practices.• Care must be taken to be certain that there is a realneed in the community for the kind of physician whois recruited. Otherwise the practice will pay out asignificant amount of money and generate little netincome in return.• Physicians in the practice will need to agree on the scopeof practice for each non-surgical physician and utilizehim or her accordingly.• Unless employment agreements are constructed with anenforceable non-compete clause, employed doctors couldleave at the end of their contract and take patients withthem.• The practice must exercise care in developing marketingand promotion material (and in educating office staff)so that patients can make informed decisions regardingwhom they wish to see.Types of Non-operative Physiciansin Orthopaedic PracticesThere are several options for the addition of non-surgicalphysicians into a practice.Non-operative orthopaedic surgeons: Orthopaedic surgeonsmay choose to engage in non-operative practice fora variety of reasons. These include the decision to cut backas retirement age approaches; partial physical disability;personal/family commitments; or simply the decision tolive life with less stress and pressure. There are several advantagesof adding one or even more non-operative orthopaedicsurgeons to a subspecialty surgical practice. Sincethey do not perform surgery, they have a greater immediateavailability for new patient visits and consults. Because theyhave had previous experience in providing M/S surgicalcare, they are skilled in the assessment of patients who mayneed surgery and/or people who need to be seen on shortnotice for post-surgical concerns.Further, referring PCPs can be assured that their patientswill receive the same high quality of musculoskeletal careas they would receive from an operating orthopaedist.Finally, they provide timely initial fracture management forpatients referred from an emergency department or urgentcare clinic. Practices may choose to employ non-operativeorthopaedists during traditional office hours, or use them“after hours; e.g., early mornings, evenings and/or weekends.Physical medicine and rehabilitation physicians (Physiatrists):Physical medicine and rehabilitation physicians treatindividuals suffering from both minor and serious physicalinjuries and conditions. The core of a physiatrist’s trainingfocuses primarily on nerve, muscle and bone injuries as wellas illnesses that can affect these areas. Many physiatriststreat a broad range of conditions but some choose to focuson specific areas such as sports medicine, the spine or thepelvis. They can read and interpret MRI scans as well asperform epidurals and nerve tests (EMG’s). Physiatrists cantherefore generate several revenue streams for orthopaedicoffices and at the same time, allow practice principals to focuson surgery. The practice also benefits from an “image”standpoint because patients view the office as place to go toreceive care for a wide range of musculoskeletal conditions.Rheumatologists: Rheumatologists treat more than 200diseases and conditions, including rheumatoid arthritis,osteoarthritis, gout, lupus, back pain, osteoporosis andtendinitis. They also treat soft tissue problems related tomusculoskeletal system sports-related soft tissue disorders.The specialty is interrelated with the physical medicineand rehabilitation of disabled patients (see above) andphysiotherapy. As is the case with physiatrists, orthopaedicpractices employing rheumatologists benefit becausethese doctors generate revenue directly and allow practiceprincipals to focus on surgery. And again, the practice also12© 2011 American Academy of Orthopaedic Surgeons