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Emerging Market Opportunity: Musculoskeletal Services (Part II)

John Kessler, for HealthLeaders Media, February 26, 2008
Editor's note: This is the second in a two-part series on the emerging market opportunity in musculoskeletal services. Last week's article focused on the factors driving the developing market. This week's article discusses how to prepare for key trends in the market and develop a program that will contribute to your bottom line.

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:

  • Provide a service that creates a tangible, positive difference in patients' lives
  • Increase your top line revenue and net operating income
  • Increase your case mix index
  • Increase volume and revenue to your onsite and off-site ancillary services (PT, OT, Lab)
  • Develop alignment opportunities with your medical staff
  • Develop partnerships with other community agencies (VNA, DME)
  • Improve the esprit de corps of the service line clinical staff, and help reduce employee turnover
It is important to acknowledge that musculoskeletal medicine is more than orthopedic surgery. Today's older adult and baby boomers are interested in exploring all options prior to pursuing surgery. Customer-centric, comprehensive musculoskeletal centers will need to offer the following spectrum of services including:
  • Prevention and Health Promotion: Outreach, Educational Program, Online Information, Weight loss and fitness information
  • Diagnosis: Primary Care, Radiology, Laboratory
  • Treatment: Rheumatology, Physiatry, Rx Consultation, PT and OT, Pain Management, Weight Loss, Complementary Medicine, Care Management, Surgery
  • Rehabilitation: Inpatient PT/OT, Home PT, Outpatient PT/OT, Fitness Programs
  • Habilitation: durable medical equipment

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:

  • Identifying and assigning responsibility to a service line leader and physician champion
  • Focusing on those areas where the institution and the medical staff are strong
  • Providing comprehensive and integrated patient-focused care to manage the entire course of care from beginning to end
  • Proactively managing all costs, especially implant costs, and capital expenditures for new technology
  • Streamlining all consumer and physician office staff interactions/processes with the hospital
  • Aggressively marketing the program to both referring physicians and consumers
  • Publishing clinical results
It is the masterful, thorough execution of the entire process from health promotion through clinical intervention by the hospital, physicians and ancillary clinical staff that will drive volume and market share. In these days of continuous revenue and margin challenges, musculoskeletal medicine can be--for those institutions with the will, fortitude and quality medical staff--the next big growth opportunity.
John Kessler is vice president of The Strategy Group in Norfolk, VA. He is a consultant, speaker and author. He may be reached at kessler@thestrategygroup.com.
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