Lessons in Orthopaedic Leadership: An AOA Podcast

Unlock the future of orthopaedic surgery with our enlightening conversation featuring James L. Cook, DVM, PhD, OTSC, a pioneering expert in regenerative orthopaedics. Learn about the transformative potential of cutting-edge treatments, including the innovative combination of Hyaluronic Acid (HA) and Platelet-Rich Plasma (PRP) for joint health. Dr. Cook sheds light on the importance of evidence-based practices, regulatory challenges with mesenchymal stem cells, and the perils of unverified "stem cell" treatments. We emphasize the need for clear guidelines and insurance coverage to responsibly advance this promising field, ensuring patient safety and efficacy.

Discover the groundbreaking advancements in biologic joint regeneration, from the promising results of PRP and Bone Marrow Aspirate Concentrate (BMAC) to the future of biological grafts and tissue-engineered solutions. Dr. Cook discusses the necessity of standardization for consistent outcomes and highlights the crucial role of comprehensive care centers. We also delve into the financial considerations and insurance hurdles that patients face, stressing the importance of integrating these innovative treatments into mainstream orthopaedic care. Join us for an insightful exploration of how regenerative orthopaedics is poised to revolutionize patient care and the future of orthopaedic surgery.

Discover the transformative changes on the horizon for orthopaedic coding and payment models with our esteemed guest, Dr. Adam Bruggeman. Covered are the new CMS-mandated procedural-based bundles, specifically the "team" bundle affecting 25% of US hospitals. Dr. Bruggeman sheds light on the financial and administrative hurdles these mandates bring and compares them to the cost-saving success of physician-led bundles.

Prepare yourself for an in-depth exploration of the evolving landscape of hospital-based healthcare bundles and their profound implications for orthopaedic surgeons. The conversation reveals how these new regulations might shift financial risks between hospitals and doctors, leading to a rare alignment of interests in opposing mandatory bundles. We also dive into the CMMI's push for value-based care and its potential impact on the sustainability of Medicare, putting a spotlight on the delicate balance of cost and care quality.

Join us as Dr. Bruggeman shares his expert views on the future of medical coding, particularly within the contexts of fee-for-service models and ambulatory surgery centers. From CPT and ICD-10 codes to the Resource-Based Relative Value Scale (RUC), we cover the complexities that define this space. We also discuss the slow shift towards value-based care and the promising, albeit underused, concept of condition-based bundles. This episode is packed with insights and foresight into the future of orthopaedic surgery and healthcare reimbursement models.

Can orthopaedic surgeons balance the demands of their profession while navigating complex healthcare systems? Join us as we explore this and more with our special guest, Felix H. “Buddy” Savoie, III, MD, FAOA. Dr. Savoie pulls back the curtain on the dedication required in orthopedic surgery, the challenges of maintaining high standards in patient care despite restrictive regulations, and how different operational models impact the quality of care provided. This isn't just about bones and joints—it's about the heart and soul surgeons pour into their work.

Learn more about global healthcare systems in Great Britain, South Africa, Canada, Australia, and New Zealand. Discover the strengths and pitfalls of national health services and why New Zealand's system stands out for its efficiency. Dr. Savoie sheds light on the significant delays in care in the UK and Canada, and underscores the critical importance of effective communication between physicians and administrators. His insights into rural healthcare challenges, medical training methodologies, and the role of budget constraints offer a well-rounded perspective on the global state of healthcare.

Looking ahead, we discuss the future landscape of orthopaedic surgery, from the evolution of Medicare reimbursements to the potential for employment models and unionization. Dr. Savoie emphasizes the urgent need for legislative changes to ensure sustainable medical practices, while also highlighting the importance of innovation and member engagement within professional healthcare organizations. Whether you're a medical professional or an enthusiast, this episode offers valuable insights into advocacy, the economics of practice, and the evolving field of orthopaedic surgery. Tune in to gain a comprehensive understanding of the future of healthcare from one of its leading voices.

Curious about how the future of orthopaedic surgery scholarly publications is shaping up? This episode features a deep dive with Marc F. Swiontkowski, MD, FAOA who provides an authoritative look at the challenges and opportunities facing the field. From the unintended consequences of open access mandates leading to a surge in subpar journals and paper mills, to the crucial rise in retracted manuscripts due to poor peer review, Dr. Swiontkowski explores every avenue. Also covered is the role of hybrid open access models and the complexities surrounding preprint servers, especially in the wake of the COVID-19 pandemic. This is an unmissable conversation that underscores the need for rigorous peer review and global cooperation to maintain the integrity of orthopaedic research.
 
In another compelling segment, the pitfalls and limitations of using large clinical databases and registries in medical research is assessed. Learn how missing data and skewed populations can skew your conclusions and why it’s crucial to approach these resources with a critical eye. The misuse of statistical methods by some researchers to chase positive associations without a clear research question, and how this can dilute scientific rigor is also discussed. Finally, how academic journals may inflate their impact factors and the transformative—and sometimes troubling—role of AI in academic publishing is explored. This episode is packed with invaluable insights for anyone vested in the future of orthopaedic surgery research and publications.

Unlock the future of orthopaedic residency training as Dr. Douglas W. Lundy sits down with Dr. J. Lawrence Marsh, a leading voice in the field and chair of the Department of Orthopedic Surgery at the University of Iowa Hospitals and Clinics. Dr. Marsh shares a treasure trove of insights on the paradigm shift from a time-based to a competency-based education system, already gaining momentum in countries like Canada, Australia, and the UK. Listen to Dr. Marsh's firsthand experience and wisdom on what these changes mean for the next generation of orthopaedic residents in the US and how they are set to revolutionize medical training.

Discover the intriguing challenges of granting more independence to exceptionally skilled surgical residents and how this can widen the competency gap between them and their peers. We explore the logistical and operational hurdles in transitioning to a competency-based training system and why a well-defined curriculum is critical. Organizations like the ACGME and orthopaedic boards are taking significant steps to implement this new framework, and we discuss the delicate balance needed to integrate competency-based attributes within the traditional time-based structure.

Stay ahead of the curve with the latest advancements in residency training, particularly through practice-based assessments and real-time evaluations using mobile technology. These innovations promise to significantly enhance skill acquisition and feedback, generating vast amounts of data to improve training standards. From basic models to cutting-edge VR simulations, we delve into the essential role of technology in preparing residents for complex surgical tasks. Finally, we contemplate the external forces driving rapid transformation in medical education, emphasizing the urgency for change within the next three years. Join us for an enlightening conversation that promises to reshape the future of orthopaedic education.

How is artificial intelligence revolutionizing orthopaedic surgery, and what can big data teach us about improving patient outcomes across different healthcare systems? In our latest episode, we feature insights from Dr. Wayne Sebastianelli, a leading expert in orthopaedics, as he discusses the transformative role of AI and big data in advancing orthopaedic care. Dr. Sebastianelli provides a comparative analysis of international big data registries, highlighting the differences between systems in the United Kingdom, New Zealand, and the United States, and the impact these systems have on patient care. We also explore the challenges of managing extensive data and the implications of different healthcare models on orthopaedic practices.
 
Leadership development and emotional intelligence are pivotal in ensuring the future success of orthopaedists. Listen as Dr. Sebastianelli shares his vision on balancing manpower and honing leadership skills within the field of orthopaedics. We dive into the collaborative efforts of the AOA, AAOS, and ABOS in addressing key issues like compensation and advocacy while emphasizing the critical role of AI in reducing administrative burdens. Dr. Sebastianelli's rich experiences and leadership roles offer valuable perspectives on preparing the next generation of practitioners. Join us for an enlightening conversation that celebrates Dr. Sebastianelli's contributions and looks ahead to the evolving landscape of orthopedic surgery.

Douglas W. Lundy, MD, MBA, FAOA, interviewed Jim Barber, MD who is an accomplished orthopaedic surgeon who practices in Douglas, Georgia. Dr. Barber shares his compelling journey, the various leadership roles he has embraced, and his experiences enriching a close-knit community despite the geographical limitations of a small town. His story illuminates the challenges and rewards of rural healthcare, showing how one dedicated individual can make a significant impact both locally and nationally.
 
Drs. Lundy and Barber tackle the evolving landscape of rural solo private practice, touching on the mounting pressures from insurance companies, the complexities of electronic medical records, and the growing need for larger teams. Dr. Barber offers his thoughts on state support programs, value-based care, and the pressures of consolidation, while reflecting on the changing dynamics of physician collegiality and scope of practice. Through innovative collaboration with local hospitals and Medicare shared savings programs, various pathways are explored for sustainability and the importance of staying positive and proactive in this challenging environment.

Aaron Brandt, MD, spoke with Anthony Catanzano, MD, a Pediatric Spine and Neuromuscular Surgeon at Duke University, and Erin Honcharuk, MD, a Pediatric Deformity Surgeon at Johns Hopkins University, to discuss the Board Certification Process and their methods for preparation.

While the boards can be a stressful process, all three orthopaedic surgeons emphasized that the examiners want to make sure that you are practicing safe medicine. Drs. Brandt, Honcharuk, and Catanzano highlighted the importance of using proper documentation, redacting all identifying data, and thoroughly reviewing the ABOS guidelines. Using proper documentation will set you and your patient up for future success. Throughout the conversation, they share valuable insights and personal stories about how mentors and colleagues played pivotal roles in their board preparation. Tune in for essential tips and advice to help you navigate this challenging process with confidence. 

Douglas W. Lundy, MD, MBA, FAOA, interviewed Karl Koenig, MD, FAOA, Executive Director and Adult Reconstruction Surgeon at Musculoskeletal Institute for the University of Texas at Austin, to discuss Shifts in Medicare. 

Dr. Koenig touched on the different views for Medicare shifting payment systems and managing budget issues. While America has spent large amounts of money on healthcare, Dr. Koenig believes the payment system needs to be adjusted to improve patient outcomes. It is discussed how Medicare is trying to move in a different direction by creating relationships between the specialists and Accountable Care Organizations (ACOs), so they can work together and achieve the same goals. Drs. Lundy and Koenig transitioned to a discussion on bundle payments; and explained the pros and cons for both physicians and patients. Overall, Dr. Koenig stated there are different views on Medicare, but the goal is to have the surgeons’ incentives be more aligned with the patients, to give them the best care possible.  

Alexander Aleem, MD, FAOA, interviewed Dr. Danny P. Goel, CEO of PrecisionOS, who currently practices in Vancouver, B.C. and is a Clinical Professor in the Department of Orthopedic Surgery at the University of British Columbia, to discuss the role of virtual reality training and surgical simulation in orthopaedics.

Virtual Reality (VR) training is impacting orthopaedics for both residents and educators. The ease of access and affordability of virtual reality education allows residents to practice and be better prepared in the OR, while also allowing the educators to assess the resident’s performance and teach them the best habits and actions to operate at the highest level. While typical training methods give haptic feedback to residents, virtual reality allows both haptic and real data feedback to assess competency. In addition to the different types of feedback that VR provides, it also can help foster mentorship both live or on demand, which helps promote a synchronous learning experience for the mentor and mentee. Dr. Goel expresses his excitement and optimism about the future role that VR and AI will play in the world of orthopaedics to provide the best training to future orthopaedic surgeons.