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The Business Case for Hospitalist & Orthopedic Co-management

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Orthopedic surgeons are vital assets to any hospital — delivering essential patient care and serving as significant drivers of revenue. Unfortunately, many hospitals find it increasingly difficult to maintain adequate emergency department and inpatient services from orthopedic surgeons practicing in the community. As a result, those hospital leaders face challenges such as long wait times and lengths of stay, which lead to unhappy patients, physicians and nurses. In many instances hospitals simply lose orthopedic cases (and revenue) when patients must be transferred to other facilities to receive orthopedic care.


Traditionally, hospitals forged relationships with orthopedic surgeons practicing in the community to cover emergency cases on an on-call basis. Hospitals paid little or nothing for this “community service” and surgeons used it as a way to build their practices and generate revenue. In addition, those surgeons relied on hospital surgical facilities when patients from their office-based practices required non-emergent, scheduled procedures.

In total, one full-time orthopedic surgeon can generate an average of $2.7 million in revenue for their affiliated hospital – approximately 5.5 times their annual salary, according to Merritt Hawkins. That’s more than any other specialty, including general surgery ($2.2 million), internal medicine ($1.8 million) and neurosurgery ($2.4 million).


Changes in the healthcare industry are altering the relationships between hospitals and community orthopedic surgeons. In a one-two punch, there are both fewer orthopedic surgeons available to cover emergency department and inpatient services, and the available surgeons are less likely to enter an on-call relationship with their local hospital – making it tough for hospitals to provide essential patient care and depleting or removing a significant source of revenue.

Today, the average orthopedic surgeon is 57 years old, and retirements are outpacing the recruitment of new physicians into the specialty. Only 670 new orthopedic surgeons enter the workforce each year. Of new recruits, approximately 90 percent enter sub-specialty training that is likely to steer them away from general call and trauma responsibilities.

Even some private practice orthopedic surgeons who used to provide emergency department and inpatient coverage have stopped making themselves available to local hospitals. They no longer see an “upside” to taking call: Today it is poorly reimbursed compared to elective practice, burdensome on their practice and lifestyle, and administratively frustrating. Currently, about half of practicing orthopedic surgeons did not take any emergency department call.

As a result, some facilities simply cannot fulfill their orthopedic care needs, forcing them to transfer cases to other facilities for care – essentially sending revenue to their competitors. And not only emergency department revenue – additional consult services, radiographic workup, inpatient pharmacy charges, et cetera. All of that is lost when a case must be transferred.


To ensure timely orthopedic care is available to all patients, hospitals that are facing a decline in reliable community coverage must look to new models. The most effective strategy for hospitals to achieve guaranteed orthopedic services — and added value throughout the facility — is partnering with an experienced, third-party provider of orthopedic hospitalists to create an integrated, hospital-based orthopedic surgical service.

In this model, the hospital’s partner recruits and employs a small team of orthopedic surgeons who share hospital coverage responsibility on a rotating basis. The benefits of this model include:

  • Guaranteed surgeon availability – 24-hours a day, every day of the year
  • No hospital responsibility for orthopedic surgeon recruitment, management or scheduling
  • Increased clinician and patient satisfaction
  • Improved revenue opportunities throughout the hospital


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