Today, more than one-third (37 percent) of the U.S. population is 45 years of age or older. In a little more than 10 years that percentage is projected to increase from 37 percent to 42 percent, and account for more than 118 million people. By 2017, the leading edge of the baby boom will be entering their early 70's. This generation will seek healthcare services that promote good health and longevity, as well as support an active lifestyle. Chief among their needs will be musculoskeletal and orthopedic services.
Combine an aging population with technological advances in orthopedic care and devices, and the stage is set for unprecedented demand and increased opportunities for healthcare providers.
Key trends to watch
There are five key trends that hospitals and health systems need to aggressively plan for:
Consumerism: Patients are increasingly taking charge of their healthcare. Our musculoskeletal health research shows that, lacking comprehensive information from their primary care physicians, consumers are developing their own continuums of care to maintain health and vitality. Services in their continuums include physical and occupational therapy, exercise and weight reduction, aqua therapy, chiropractic, yoga, integrative medicine and acupuncture. Consumers are willing to invest time and money to educate themselves about treatment options and create a personalized care pathway that will enable them to reduce pain and maintain an active lifestyle.
Physician specialization: The percentage of sub specialty (fellowship) trained orthopedic physicians has increased from 20 percent in 1990 to almost 40 percent in 2005. Increasingly, orthopedic physicians are specializing in sports medicine, hand, spine and joint replacement. Our research confirms that consumers seek fellowship trained, high volume surgeons when considering surgery. To be considered the preferred provider of care musculoskeletal centers will require a cadre of these specialists.
Rapidly changing technology: Two inpatient areas undergoing significant changes are spine and total joint surgery. In spine surgery, interspinous spacers, dynamic stabilization systems, facet arthroplasty and minimally invasive fusion techniques loom on the horizon. Total joint replacement surgery faces competition from new techniques and new modes of delivery including resurfacing arthroplasty, minimally invasive surgery, computer-assisted surgery, increasingly differentiated joint implants and the movement to outpatient surgical centers. In most cases technological improvements come with increased costs placing increased pressure on procedure margins. With direct to consumer advertising by implant and technology vendors, consumers are seeking the latest implants and equipment.
Market structure and competition: In some markets, hospitals are losing volume to specialty hospitals and ambulatory surgical centers. It is estimated that there are approximately 30 hospitals in the U.S. that specialize in orthopedics. Physician offices are also capturing market share through the development of focused ambulatory surgical centers, the acquisition of imaging equipment-CT and MRI's, therapeutic equipment, and the provision of outpatient rehabilitation. A by-product of this increased competition is that as patients are treated in ASCs and physician offices, the acuity of hospital patients increases.
Quality and cost transparency: CMS and The Joint Commission have targeted the next round of quality measurement on orthopedic procedures. Public reporting of basic measures of volume, length of stay, infection rates, return to surgery, pain management, patient satisfaction and DVT/PE events will evolve to range of motion (pre and post), percent discharged to home, time required for return to work or quality of life, unrestricted activity, and years between implant procedures. The focus of costs will be on the total cost of care between pre-surgery and return to work or quality of life.
These five trends demand that musculoskeletal services be designed and implemented to meet the multifaceted needs of an increasingly savvy consumer, but also for physicians and hospitals facing limited increases in procedure payments.
Creating a musculoskeletal medicine program
Implementing a Musculoskeletal Medicine Program or Service Line can create significant bottom-line results. It can equip and position your hospital or health system to:
Strategies for success
Hospitals and health systems seeking competitive advantage with a musculoskeletal medicine service line must implement an integrated process of care to facilitate patients' diagnosis, intervention, recovery and wellness.
Implementing key strategies can establish a long-term platform for growth and profitability of your Musculoskeletal Medicine program: