January 1996 Bulletin

How to start the New Year

George Conomikes urges orthopaedic surgeons to update their database with the new RBRVS schedule. "They should do a complete fee review in the first 90 days of the year," said Conomikes, who heads a Los Angeles-based practice management consulting firm bearing his name.

"The orthopaedic surgeons also should take a longer-term look at their entire practice to see where they can make cost reductions. As fees are ratcheted down and practice costs go up, physicians are caught in a squeeze."

There's another reason for taking this view. "Orthopaedic surgeons should realize that when a managed care organization comes into their area, the physician with the highest practice cost may not be able to take on a contract or will take a beating on it," Conomikes said.

"One of the reasons why doctors are grouping is to reduce costs. I've worked on more mergers in the last three years than in the previous 22 years.

"Their agenda is to look attractive to managed care organizations and to reduce the costs of personnel and to better utilize physical facilities."

One more piece of New Year advice: recognize that the gatekeeper is a referring doctor, said Conomikes. Orthopaedic surgeons may believe that their practices get most of their referrals from patients, but in the new marketplace that might not be the case.

He advises physicians to visit the primary care doctors in their practices and "build bridges." Orthopaedic surgeons should "tell the primary physicians how they can perform routine musculoskeletal care, like treating sprains, and avoid some referrals," Conomikes said. "That builds good will."


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