Author Interviews, Cost of Health Care, Orthopedics / 26.10.2016
Patients Greatly Underestimate Reimbursement For Orthopedic Procedures
MedicalResearch.com Interview with:
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Dr. Kelechi Okoroha[/caption]
Kelechi Okoroha, M.D.
Orthopaedic Surgery House Officer
Henry Ford Health System
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training.
• Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut.
• 61 percent of patients say a surgeon’s salary should not be tied to outcomes.
• 79 percent of patients say reimbursement to drug and device companies should be reduced.
Dr. Kelechi Okoroha[/caption]
Kelechi Okoroha, M.D.
Orthopaedic Surgery House Officer
Henry Ford Health System
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training.
• Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut.
• 61 percent of patients say a surgeon’s salary should not be tied to outcomes.
• 79 percent of patients say reimbursement to drug and device companies should be reduced.
Dr. Robert Keller[/caption]
Robert Keller, M.D., Chief resident
Department of Orthopedic Surgery
Henry Ford Hospital Detroit
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Keller: Injuries to the medial ulnar collateral ligament (the ligament torn in pitchers requiring tommy john surgery) are common in overhead-throwing athletes. Recent data supports that the number of MLB pitchers requiring tommy john surgery continues to increase, with estimates near 25% of all MLB pitchers undergoing tommy john surgery. Recent investigations have attempted to analyze factors that contribute to UCL injuries with the aim to decrease the rate of injury. Studies have suggested that possible risk factors include pitching mechanics, pitch type (curve ball, fastball, etc), g, pitching fatigue, chronic overuse, and pitch velocity, among other factors.
Specifically, increased pitch velocity has been implicated as a risk factor for UCL injury. However, no study has exclusively attempted to assess whether MLB pitchers who required Tommy John surgery pitch at a higher velocity than those that do not. Pitch type (fastball, curveball, slider, etc) is another significant factor that has been investigated as a contributor to UCL injuries. Various biomechanical studies have attempted to correlate pitch types with torque across the throwing elbow, with contrasting results: some suggest fastballs create more torque, whereas others found off-speed pitches produce increased stresses. Beyond not evaluating MLB pitchers, these previous studies also failed to evaluate the volume or amount of a specific pitch type thrown by these pitchers that may contribute to UCL injuries.
Dr. Margaret Gourlay[/caption]
MedicalResearch.com Interview with:
Margaret L. Gourlay, MD, MPH
Assistant Professor
UNC Department of Family Medicine
Chapel Hill, NC 27599-7595
Medical Research: What is the background for this study? What are the main findings?
Dr. Gourlay: While clinical practice guidelines universally recommend bone density screening for fracture prevention in women aged 65 years and older, minimal data exist to guide bone density screening in older men. We studied how often bone density screening tests should be ordered in men, using data from the Osteoporotic Fractures in Men (MrOS) Study. MrOS is the largest and longest-running (since 2000) US study of bone density and fracture in men aged 65 and older.
After peak bone mass is reached in young adulthood, both men and women lose bone density as they get older. Based on our earlier findings in older women, we expected that men aged 65 and older with higher bone density T-score measurements (T-score >-1.50) on a first (baseline) bone density test would have a substantially longer estimated time to develop the lowest level of bone density (osteoporosis) than men with better baseline measurements. Clinicians want to know the time to osteoporosis because they prescribe osteoporosis treatments to prevent future fractures in elderly patients.
As expected, we found that the men with higher baseline bone density had a much slower transition to osteoporosis compared to men with lower bone density. In fact, only nine out of 4203 (0.2%) of men with higher baseline bone density developed osteoporosis after an average of 8.7 years of bone density follow-up. That was much lower than we expected and is good news for men who have favorable scores on their first bone density test. Men who had lower baseline bone density measurements developed osteoporosis faster.
Unfortunately, maintaining bone density above the osteoporosis range did not guarantee that men remained fracture-free. Most of the major osteoporotic fractures (broken hip, spine, wrist or upper arm/shoulder) occurred in men who did not have osteoporosis. This might be because they had accidents or injuries that broke their bones despite their bone density being above the thinnest range.
MedicalResearch.com Interview with:
Daniel Steffens, Ph.D.
The George Institute for Global Health
The University of Sydney
Medical Research: What is the background for this study?
Dr. Steffens: Back pain is a leading cause of disease burden globally. At present, a variety of interventions, such as getting a 
Dr. Zachary Kerr[/caption]
MedicalResearch.com Interview with:
Zachary Y. Kerr, PhD, MPH
Sports Injury Epidemiologist
Director, NCAA Injury Surveillance Program
Datalys Center for Sports Injury Research and Prevention
Indianapolis, IN 46202
Medical Research: What is the background for this study? What are the main findings?
Dr. Kerr: The NCAA Injury Surveillance Program has been ongoing since 1982, but the Datalys Center for Sports Injury Research and Prevention began management in 2009. We provide the NCAA sports and medical committees with evidence-based data they can use to make rule and policy decisions aimed at student-athlete health and safety. However, among the research community, there lacks current injury incidence data across the collegiate student-athlete population.
The main findings of this study is that the rate of injury was higher in competitions than in practices. However, the total number of 
Dr. Schütz[/caption]
MedicalResearch.com Interview with:
Uwe Schütz, M.D.
Radiologist and specialist in orthopedics and trauma surgery
Department of Diagnostic and Interventional Radiology
University Hospital of Ulm
Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Schütz: In this study, which is a small part of the Trans Europe Foot Race (TEFR) TEFR-project, we investigated the question, what happens to the joints, in detail to the joint cartilage of the lower extremities, when running 4500 km without any day rest for nearly 10 weeks. Is there really a risk for developing an arthrosis when doing this, like some researches and many physicians postulate?
Well, what we find when accompanying 44 ultra-athletes with a modern 1.5Tesla MRI mounted on a custom made 38tonnes truck trailer day by day over 64 days on their way throughout whole Europe is, that the joint cartilage is initially altered by this running burden: It shows signals of cartilage matrix degradation beneath the first 1000 to 1500 km of running. But then the situation changes. When further running occurs, then the cartilage shows the ability to partially regenerate under ongoing running burden. This is a pretty new and astonishing finding, first time measured and observed in human joint in vivo. But knowledge of Scandinavian animal studies show the same behavior in dog cartilage.
