1. Working with Orthopedic Surgeons Daniel Herman MD, PhD, CAQSM Asst. Professor, UF Department of Orthopaedics and Rehabilitation UF Running Medicine Clinic (352-265-RUNR) UF Human Dynamics Laboratory 2015 AAPMR Annual Meeting

2. Disclosures None

3. Outline Describe ways in which your practice may differ in working in an Orthopedic Practice vs. a Physiatric Practice Tips on creating a successful relationship and working environment How to market yourself to Orthopedic Practices

4. Your Role in an Orthopedic Practice The surgeons are the engine of the machine – Practice leaders – High billing and reimbursement May have access to great levels of resources You need to support the mission! – Implications for your practice patterns – Implications for your billing and patient volume

5. Your Role in an Orthopedic Practice Your role: Triage and Support – Discern Operative vs. Non-operative cases – Complete non-operative management – “Support” Services Ultrasound guided injections Fluoroscopy Electrodiagnostics

6. Your Role: Practice Implications Adapt your style to the needs of the surgeon – Impression: “Right upper extremity median sensory and motor latencies are elevated relative to laboratory norms and compared to that of the contralateral limb, indicative of a potential mononeuritis. Chronic neurogenic potentials in the thenar muscles are supportive of this diagnosis, but no acute neurogenic changes were observed.” – Moderate right carpal tunnel syndrome – Surgeon: “Do I cut on this guy or not?!?”

7. Your Role: Practice Implications Clinical Decision-Making Protocols – How does the surgeon want the patient tee’ed up? Knee Osteoarthritis – Surgeon: “They must have at least KL stage 3 OA on Xray, complete at least 6 weeks of physical therapy, have used NSAIDS, and have at least partial response to an injection.” – Restrictions on BMI, co-morbidities Carpal Tunnel Syndrome – Surgeon: “EMG of moderate CTS, failed injection, and have tried wrist splints for at least 3 months.” – Restrictions on radiculopathy

8. Your Role: Practice Implications Example Area of Conflict: ACL Injury – Data not very supportive of reconstruction No change in risk of osteoarthritis “Copers” exist, may be discerned with clinical testing Frobell RTC: same activity, function, meniscal injuries Surgeons: CUT!!! My role: – Start PT for ROM/Quads – Confirm injury with MRI – Send to surgeons

9. Your Role: Practice Implications Example Area of Conflict: FAST and HA – Fasciotomy and Surgical Tenotomy Focused ultrasound debridement of degenerative tissue Performed under ultrasound guidance by non-surgeons – Surgeons may perceive this as a threat – Hyluronic Acid Injections ACR: feasible option for knee OA AAOS: recommends against use – Surgeons may use this to cease offering

10. Your Role: Practice Implications Accessibility – How many patients you see – EMGs within 2 weeks, not 6 months – Same-day ultrasound guided injections – Push timing of advanced imaging Enhance the patient experience through expedited care (retain surgical cases)

11. Maintaining a Good Relationship Communication – Patients Ex. Tricky findings from EMG Don’t box the surgeon into a corner when discussing surgery – Protocols Are you packaging patients to the surgeon’s liking? – Education What services can you offer? Considering? DON’T offer?

12. Maintaining a Good Relationship New procedures – May be perceived as a threat to surgical volume – Education and communication Evidence, Risk, Benefit to patients Marketing potential – New revenue stream – Differentiates the practice – Drives surgical volume “They come for the viscosupplementation and stay for the arthroplasty.”

13. Maintaining a Good Relationship Develop allies with the practice – Good service for your core surgeons – Excellence in patient treatment – May find allies in unusual places Administration Surgeons outside of sports medicine Younger surgeons

14. Marketing Yourself to Orthopods Education is key – Be persistent Identify the correct point of contact – Practice Manager – Medical Director Make take a few times of reaching out – Identify needs of the practice Personnel in practice, surgeon mix

15. Marketing Yourself to Orthopods Be explicit about what you can offer – Differentiate yourself from other PCSM providers Fluoroscopy and electrodiagnostics – Are you willing to go outside your comfort zone? Fracture care Scoliosis Club foot Be explicit about what revenue you can bring in – Pro forma analysis

16. Marketing Yourself to Orthopods Pro Forma Analysis – Analyze referral patterns Outside procedures including injections and electrodiagnostics – Insurance mix for the practice Billing and collections – Anticipated practice growth New procedures and programs – Insurance, personnel, and start-up costs – Use your department financial officer as a resource

17. Thank You Contact: hermadc@ortho.ufl.edu