#DOCSF18 – Mark Froimson MD is President of the American Association of Hip and Knee Surgeons (AAHKS) and past Chief Clinical Officer and Executive Vice President of Trinity Health. Dr. Froimson talks to Breanna Cunningham, Founder and CEO of CODE Technology, about the role of AAHKS in leading innovation and championing physician causes.
Bre Cunningham: Hello, hello.
Dr. Froimson: We’ve already started this conversation, and off we go.
Bre Cunningham: Well, hello there. Bre Cunningham here with Code Technology. And I have the pleasure of interviewing Dr Froimson, current president-
Dr. Froimson: It’s my pleasure.
Bre Cunningham: Thank you. Current president of AAKHS, with an amazing background in innovation, and just a real thought leader. And this conference is always fantastic.
Dr. Froimson: I look forward to it now two years in a row. I’d say, every year, but this is the second year. And it’s such a great-
Bre Cunningham: It feels like it’s gone on forever, right?
Dr. Froimson: Yeah. I think what you find is, there’s such an energy here, that has continued from last year. And people have been engaged. The conversations that I had last year with companies, with colleagues here, about how we’re gonna try to improve healthcare for our patients, have been ongoing all year. And we’ve all been looking forward to getting back together to check up on our progress, and to get re-energized about what we’re gonna do differently, and how we’re gonna move the ball forward. So it’s really fun to be here.
Bre Cunningham: The amount of productivity from those startups was incredible, so that was exciting to get their stories.
Dr. Froimson: Yeah. I think it’s a testament to this model, which is to get companies, innovators, entrepreneurs together with end-users, clinicians and decision-makers, and really accelerate, not only the development of good products … And we know that the innovators are out there, developing products like crazy, and there’s no shortage of innovation. The key has been to accelerate the implementation and adoption of some of these best-in-class solutions. And that’s what this is all about, is ensuring that we’re having the right conversation, so that these great innovations can be made available to our patients …
Bre Cunningham: Make it to market. Yeah.
Dr. Froimson: … and to the caregivers who are charged with the responsibility of taking care of our patients.
Bre Cunningham: So in the last presentation there was a comment about providers being at the table. And there was a great quote that he said, “If you’re not at the table, you’re on the menu.” Is that right?
Dr. Froimson: If you’re not at the table, you’re [crosstalk 00:02:07] …
Bre Cunningham: You’re on the menu.
Dr. Froimson: … you’re on the menu.
Bre Cunningham: And with providers at AAKHS, you really do a great job of working with the payers to not be eaten. Can you tell me a little bit about that in the work that you guys do?
Dr. Froimson: I like the imaginary. So what I think you’re really getting at, is that we have decided not to bemoan the changes that are going on in healthcare, but to rather embrace the opportunity to provide leadership. So hip and knee surgeons have been in the cross hairs of payers, of the government. Because what we do is growing in volume, is growing in what they would refer to as cost. I mean, a lot of people want what we have to offer. They need joint replacements. They have bad hips, bad knees, bad shoulders. And we can fix them.
And what happens when you have an increasing volume of procedures is, somebody has to pay for it. It’s a cost to society. What we have found however is, as we get to have conversations with payers, with the industry, with government … we can have a meaningful conversation that says, look, this is not a cost center. This is actually providing value to patients. And let us show you how. Let us show you what the outcomes look like. Let us show you the improved independence of our patients after we’ve taken care of them, the patient satisfaction.
So we know that change has to occur. We have to become more efficient. We have to remain patient-centric. And our job at AAKHS, our job as professionals, is to own the challenge, and to provide leadership to industry. To provide leadership to our profession, and say, it is our job not to stay status-quo, not to be static, but to be dynamic, to embrace the changes. And I’ve been very fortunate to lead an organization that has a long history of leadership, of innovation, of embracing challenges. Of embracing the opportunity to have great conversations with people, and translate what we know and what we do, so that others can understand it. And it’s been a real pleasure. But back to your point, we know … I don’t like the imagery of being on the table or being on the menu.
Bre Cunningham: It was a [crosstalk 00:04:28].
Dr. Froimson: The point is that we know that we have, as professionals, a responsibility to be leaders. We know that if this field is gonna move forward, we need to collaborate with other interested parties. And around this conference you see those other interested parties are entrepreneurs, innovators, industry, the financial sector. Each of whom has their own perspective, has some value to bring to the table. And to the extent that we can share our stories, share our perspectives, listen to one another, I think our patients are gonna benefit.
Bre Cunningham: You know, there is a lot of talk about physician burnouts. Do you see that a lot with being at the table, giving a surgeon one more task, right? They want to take care of their patients. They’re in the OR. They’re documenting two hours for every one hour they’re in clinic. And now they need to go to more meetings? How does AAKHS address that, or what do you guys do?
Dr. Froimson: I think the physicians’ stress issue is real. I mean, let’s be honest, I don’t think it’s any surprise that when a patient comes to you with their challenging problems and they’re looking to you with the trust that they have, you’re taking on a significant amount of responsibility. And there’s an inherent stress to being a physician, to being a surgeon. You own with the patient that problem. So what we want to do is ensure that that natural stress, that we all are energized by … we embrace the opportunity to help our patients, and help solve their problems. We want to remove the obstacles that can get in the way of that physician/patient relationship.
And I think what you’re hearing from physicians is not about burnout so much, or about anything to do with … anything other than, they want to embrace the opportunity to take care of their patients. What they’re telling you is, often times well-intended parties, whether it’s the government, whether it’s industry, whether it’s innovators, are putting obstacles in the way. And that the technology that’s been introduced isn’t always a facilitator of the physician/patient conversation. Sometimes it feels like it’s an impediment. Sometimes it feels like an obstacle.
So our job collectively is to try to identify, when something is introduced into the workflow that is an impediment to a good conversation between a physician and a patient … when it seems like, and you’ve heard this reference, that the physician is just looking at a computer screen, right, instead of looking at the patient …
Bre Cunningham: Absolutely.
Dr. Froimson: … when they’re encumbered by excess documentation requirements. When they have to check too many boxes, that don’t feel like they’re adding value to that patient in front of them, those are the things that add to physicians’ stress, that don’t provide benefit to the patient. And our job in a leadership role, and our job collectively as a group is to try to decipher, which things we are presenting to our care teams, our physicians and their teams, that are a benefit to patients and, which things are more harm than good.
Bre Cunningham: More a hindrance?
Dr. Froimson: Yeah. Although there may be some potential benefit, as in anything in life, the risk or the downside outweighs the potential benefit. And those are trade [inaudible 00:07:50] to make those decisions all the time. And we have to be dynamic, we have to be flexible. We have to try things. And when we find that, despite our best intentions, we’ve introduced something that really doesn’t add value, really doesn’t provide for a better experience either for the patient or the provider, and hopefully both, then maybe we ought to take a step back, look at that innovation, look at that technology, and tweak it, adjust it, iterate on it, so that it actually can live up to its promise.
I think what you’re seeing, for many of the companies here and for many innovative companies, is, there’s no problem with the technology that they’ve developed. There’s no problem with their innovation. They are really smart people developing exciting products. What we want to do is ensure that, as they develop these products, they understand the end-user. They’re understanding the physicians and the care teams. They’re understanding the impact of the workflow of those teams, and how it affects the patients. Does it enable them to see more patients, to have better conversations with their patients?
And we think that if you can answer that question, yes, that innovation is gonna thrive and flourish in the marketplace. And if the answer is, we’re not sure, or no, let’s go and find out … let’s go ask those care teams to help us co-develop or iterate on that product to make it better. And that’s what the opportunity of this conference is. It’s really, I think, a tremendously exciting time for all of us here.
Bre Cunningham: It’s my favorite that I go to every year, no joke.
Dr. Froimson: Yeah, there’s a lot of energy here.
Bre Cunningham: There is. It’s really cool. So last question for you. In 2018, what do you see the [fame 00:09:35] in total joints?
Dr. Froimson: I think there’s no question that people are starting to understand the principles behind joint replacement, and behind recovery. And when I say, people, I’m saying, providers, patients, payers. So it’s starting to allow us to reimagine the way we deliver joint replacement care. I frame it that way, as opposed to saying, well, we’re shifting from in-patient to out-patient. Or we’re not using skilled nursing facilities. Because there will be patients who require in-patient stays, plenty of them.
There will be patients who may require extended stay in a facility. But what we’re driving towards is understanding the principles that drive the best outcomes, and trying to be somewhat agnostic about what care setting is required. So that we can be very flexible and ensure that the patient gets the right resources, that are personalized to their specific needs, their social factors, their medical factors, their orthopedic factors. We’re getting a lot better at predicting, based on understanding of those three things …. their medical comorbidities, their orthopedic specific deformities and needs, and the social environment, which they come from, among others.
There are probably others, but let’s focus on those three. That we can predict what resources would be required, whether they’re best in a hospital, best in an outpatient setting. Whether they require extended rehab, whether they require home care, whether they can have self-directed therapy. How fast they can recover. I think we’re gonna see that type of work accelerate in 2018, and much, much better types of realizations about how we can personalize the care we deliver to the individual patient.
Bre Cunningham: I love it.
Dr. Froimson: Yeah, it’s gonna be fun.
Bre Cunningham: So what patients need, not what’s in the [order said 00:11:32].
Dr. Froimson: Yeah. Because, as you can think about it, we tend to think about, what do joint replacement patients need? Well, joint replacement patients are a large set of very diverse patients, with very diverse needs. And our job is to ensure that we’re not looking at them as this monolith, or this undifferentiated group of patients. But that we are identifying the individual characteristics that each patient has, that are gonna be the determinants of their outcomes, and how we can adjust the resources we apply to them to maximize their chance for a successful outcome.
The science is improving, the data science is improving, the surgical tools are improving. It’s a great time to be in the field of joint replacement. It’s a great time to be a physician performing joint replacement, a developer. And most importantly, as a patient, I think that the reliability of the procedure is clear. It’s a great time to know that you can get your joint replacement done safely and reliably all across the country by really experienced and high quality teams.
Bre Cunningham: Love it.
Dr. Froimson: So I’m really excited. We’re very optimistic about what’s in store for us as we move forward.
Bre Cunningham: It sounds like 2018 is gonna be really exciting for the total joint
Dr. Froimson: And then there’ll be things we can’t predict, and we don’t know. And I think the other piece is that we are very confident that as things pop up that may produce new challenges for us, we’ve got the right conversations in place, and we’ve got the right types of collaborations, that we’ll be able to address them with optimism.
Bre Cunningham: That’s so exciting.
Dr. Froimson: Yeah, it’s a lot of fun.
Bre Cunningham: Bre Cunningham here with Dr Froimson, president of AAKHS. And we are out.
Dr. Froimson: Great. Thank you.