Michael Redler, MD, is a partner at Fairfield, Conn.-based Orthopedic & Sports Medicine Center, an orthopedic surgeon at Connecticut Orthopedics, an assistant clinical professor at North Haven, Conn.-based Frank H. Netter School of Medicine at Quinnipiac University, and a visiting assistant clinical professor at the Charlottesville-based University of Virginia Department of Orthopaedics.
Dr. Redler will serve on the panels “Payer Trends for Orthopedics and Spine” and “ASC Management and Transactions: Big Trends for 2023” at Becker’s 19th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference. As part of an ongoing series, Becker’s is talking to healthcare leaders who plan to speak at the conference, which will take place in Chicago from June 16-18.
To learn more and register, click here.
Question: What issues are you spending most of your time on today?
Dr. Michael Redler: The time I’m spending is directly related to maintaining the excellence of patient care while dealing with some of the challenges that have been created by healthcare payers. We all get into our work in medicine and in orthopedic surgery to take good care of patients and get good outcomes. However, I think some of the challenges being created is that as time has gone on, payers have made it more and more difficult to provide the care that you feel is indicated. There seem to be more denials and a need for peer-to-peer discussions before you can proceed with care. The number of hours that our office and our practice, Connecticut Orthopedics, now go through to get a clean claim is increased. I believe the payers think that if they deny it or say you’ve got to do an appeal or a peer-to-peer, you’ll say never mind. We must continue to be our patient’s advocates despite having these roadblocks placed in front of us.
Q: What are your top challenges and how will they change over the next 12 months?
MR: The challenges aren’t all bad regarding what’s moving forward because we’re in basic agreement with the payers and most often with the patients to move these higher-acuity cases to an ambulatory surgical center. Our challenge is to ensure that patients are properly selected, that they will still receive excellence in care, and that we have the wherewithal. We need to do just as good a job in an ambulatory setting as in the hospital. Some of the things we have done now at Connecticut Orthopedics is creating bundle packages for both joints and even the spine. Also, we have a hospital or post-op hotel where patients stay overnight. Under the guidance of Susan Bader, our CEO, we’ve included that in our bundle payments for some of these high-acuity cases, and the patients love it.
It drives more volume to these centers and I think it provides better care because these patients are getting up and being cared for, and we know that recovery completely at home during the first 24 hours can be variable. So I think that’s been a win-win situation. I think that the thing that we look for now is that we want to partner with these payers so that if we’re doing these higher acuity cases on an outpatient basis where they’re saving a lot of money, we’d like to see an increase in the professional fees to help encourage orthopedic surgeons to do more of these cases in an outpatient setting.
Q: How are you thinking about investments and growth in the next two years?
MR: The investments that we need to make are ones to help streamline our care. We know between electronic medical records and hours spent dealing with the payers, our ideal thing would be to create a streamlined situation so we can be spending more time with direct patient care. So the integration of our ability to know patients’ medical history, even if they’ve come from several different healthcare systems. In Connecticut, a new system called Connie is up and running. It is in its infancy, whereby we can now get medical record information even if it’s across several healthcare systems. We want to invest in basic systems that will allow us to decrease the amount of time we’re either spending in front of a computer or talking to a payer and more time with patients.
Q: What are you most excited about right now?
MR: Since my specialty is sports medicine and upper extremity surgery, I’m most excited about us continuing to push the envelope with biological alternatives for repair, lubrication and augmentation of some of our procedures. Also, I continue to be excited about the more different alternatives regarding treating our patients postoperatively to minimize opioid use. I believe that’s one of the things I’ve always felt is so important, and we’re getting better and better at it.