Specialist
Former C-level Executive at Proliance Surgeons LLC
Agenda
- US orthopaedic sector overview
- Benefits of sector consolidation
- Major KPIs and reimbursement trends
- Outlook for year-end and early 2020
Questions
1.
What key themes and trends are you following in the orthopaedic sector?
2.
What growth do you expect for orthopaedics over the next 3-5 years?
3.
You mentioned that Optum hasn’t moved into the orthopaedics sector yet. Do you foresee it and the other large international players moving in eventually?
4.
Are there any recent or upcoming regulations you foresee having a significant impact on orthopaedics?
5.
How should we evaluate the green lighting of orthopaedics procedures to the outpatient setting? Is there anything about total joint that is different from the procedures that were previously approved? Do you foresee orthopaedics generally moving towards the outpatient setting?
6.
Could you give us your financial perspective on the various service offerings of orthopaedic clinics? What are the volumes and margins for transplants, urgent care, ambulatory services, etc?
7.
How do the unit economics for orthopaedics compare to other specialties with heavy PE investment such as gastro, neuro, etc?
8.
You mentioned that the reimbursement environment in orthopaedics is relatively favourable. Do you think there’s room for a pricing increase from the clinical side, or is it relatively inelastic?
9.
Are there any outsourcing trends starting to gain momentum, such as revenue cycle management [RCM] or international outsourcing?
10.
Could you outline the importance of various KPIs for orthopaedic clinics, such as labour costs, patient demographics, geography, EBITDA, etc? How would you rank their importance?
11.
How significant is the focus on value-based care and service for orthopaedics? Is the sector making a greater effort to bundle services that way?
12.
Do you think the fee-for-service model will remain, or will orthopaedics follow the broader trend in healthcare towards value-based objectives? Are patient outcomes being more closely measured, and what metrics are being used?
13.
Do you think orthopaedic practices want to affiliate with hospital systems or independent ambulatory care centres, or remain completely independent of both?
14.
What do you think of three-way joint ventures with hospitals vs two-way joint ventures between ambulatory surgery centres and doctors? How do you think staffing ability differs between those two models?
15.
How do the economics compare between three-way joint ventures and two-way independent practices working with hospitals? Are there any other economics to consider in the various settings and how they might differ from each other?
16.
How do you think orthopaedic practices view de novo ambulatory surgery centres [ASC] builds vs affiliating with hospitals and adding on? Do practices favour joining a larger group which already has a network, due to the reduced upfront cost and effort, or are there still practices doing de novo ASC builds?
17.
Do you think the total joint approval and migration of hip and knee replacements to outpatient settings will help accelerate PE investment and interest in orthopaedics? Is it a significant factor, or one of many?
18.
What is your view of the breakdown of Medicare-Medicaid vs commercial in the orthopaedic sector? Do you foresee any shift in the reimbursement dynamic, or do you think it will remain relatively favourable for orthopaedics?
19.
From a physician’s standpoint, is there any benefit to consolidation in terms of back office services and cost efficiencies? Are there any other factors that influence a physician’s decision to consolidate their practice?
20.
Do you think consolidation will dominate orthopaedics like it has obstetrics, gynaecology and a number of other specialities?
21.
What is your 12-24-month outlook for orthopaedics? Is there anything you want to highlight?
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