Becker’s Orthopedic Review Asks Dr. Mandelbaum About How to Fix The Biggest Problems in Sports Medicine

Dr. Bert Mandelbaum: If you step back and look at what is sports medicine and the tripod of sports medicine — which is prevention, optimize performance and rehabilitation and injury care — [you can see] the business model that we have in this country does not support sports medicine.

It doesn't focus on prevention, [but rather] on how we optimize performance. A lot of times [with sports medicine] and with the injuries we treat, the payer says, "You have 24 visits, but none of the visits involved return to play progression or prevention."

The whole circle of prevention to optimized performance, to injury and back to prevention is inconsistent with our business model.

[To fix it] I think a whole paradigm change has to occur in healthcare reform.

When you look at some of the elements, so much is focused on who is picking up the tab for insurance rather than what you're buying with your insurance.

The key for me when you're talking about sports medicine is about [athlete] empowerment — how to empower the athlete and how to empower the individual who is trying to maintain his fitness and wellness. We're trying to prevent a variety of illnesses in our lives, whether it be heart disease or obesity. These are all important elements of sports medicine, none of which [payers pay for] from primary care all the way to quaternary care [settings].

When a primary care physician sees a patient and says "You're 280 pounds overweight, I can refer you to a doctor who can do A, B and C." But when it comes to some of these elements [within healthcare], we're really quite thin when it comes to benefits.

In my view, when you say what's the big problem in sports medicine, we as an industry have to articulate that tripod. I think the central portion is focusing on what it is we do, rather than say what is sports medicine. [It is] also about focusing on the various elements [of the tripod] and how we can develop some type of resource or business model around so we can optimize each consumer and patient situation.

Many times it's not patients we're talking about. We're talking about population management, we're talking about young girls in soccer fields, we're talking about understanding concussions and preventing concussion in high school athletes. These are the big challenges we have from now into the future.

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