New York—May 8, 2013
Leading historians, scholars, scientists, physicians and health policy experts from around the country offered their insights at the symposium, “Honoring the Past, Envisioning the Future,” on May 3 and 4.
The event featured a wide range of topics and issues, including little-known facts about the hospital’s early days; New York City, Lincoln and the Civil War era; inspiring narratives from Special Surgery patients; research and advances that will transform medical care; imminent health care reform; and the many challenges facing our “broken” health care system.
Internationally recognized today as a leader in orthopedics and rheumatology, HSS had its humble beginnings in 1863, when a kindhearted doctor opened a 28-bed hospital in his own home for destitute children with severe disabilities.
It was a fascinating time in history, and noted Lincoln and Civil War scholars, Ronald C. White, Jr., Ph.D., and Harold Holzer, shared their expertise on Lincoln, New York City and the political culture of the era. David B. Levine, M.D., a former HSS spine surgeon and author of the new book, “Anatomy of a Hospital” about the history of HSS, discussed Special Surgery’s early days.
The symposium also premiered a documentary that told the remarkable story of how HSS, the nation’s oldest orthopedic hospital, grew to become a world leader in its specialties. Among the interesting facts: HSS was the first hospital in the country to establish a residency program to train orthopedic surgeons; HSS surgeons and bioengineers designed the first knee implant to recreate the way a real knee works, which became the prototype for modern knee replacements; Special Surgery was the first hospital in New York City to open a public school for its young patients.
After the documentary, two former patients discussed how doctors at HSS helped save their lives after they were stricken with polio in the 1950s. A third patient presented photos of his incredible climb to the top of Mount Everest after hip replacement surgery at HSS, the first person believed to do so after having a hip replaced.
The symposium’s afternoon session was devoted to global health care and the economics of medicine. Thomas P. Sculco, M.D., surgeon-in-chief at HSS, led the first day’s program. “The extraordinary historical perspectives and discussions of current health care challenges presented by our distinguished speakers expanded our horizons and gave us food for thought,” he said. “I think everyone who attended gained a better understanding not only of how Hospital for Special Surgery grew to become the premier hospital for musculoskeletal care, research and innovation, but of the difficult road ahead for the health-care system as a whole.”
A “Broken” Health System and Ways to Fix It
Arguing that the current health system is broken, David B. Nash, M.D., MBA, professor of Health Policy at Thomas Jefferson University in Philadelphia, emphasized the need for a paradigm shift that stresses “population health” management. Dr. Nash, dean of the Jefferson School of Population Health, explained that the term refers to the health outcomes of a group of individuals and the distribution of such outcomes within the group. Factors that determine health include lifestyle habits, such as diet, smoking and exercise; genetic predisposition; social circumstances and environmental factors.
Dr. Nash talked about the need to create a “culture of wellness” to influence and improve the health of the American people as a whole. He also highlighted the importance of moving from the current fee-for-service based health system to a new model that rewards health outcomes, which he called “moving from volume to value.” He discussed the need to tie medical reimbursement to evidence and outcomes, and underscored the importance of transparency and accountability.
Elliott S. Fisher, M.D., MPH, picked up on the theme with a discussion of accountable care. Dr. Fisher is director of the Dartmouth Institute for Health Policy and Clinical Practice and co-director of the Dartmouth Atlas of Health Care. His research has documented glaring variations in how medical resources are distributed and utilized across the United States. He discussed his finding that higher spending does not result in better care, an increase in survival rates or better functional outcomes.
Dr. Fisher focused on the need for reform to improve care and lower costs, arguing that the fee-for-service model is flawed. His research and policy initiatives have led to the implementation of Accountable Care Organizations (ACOs) in the United States. ACOs are groups of doctors, hospitals and other health care providers who come together voluntarily to give coordinated quality care to patients, while avoiding unnecessary care. These organizations align provider financial incentives with patient needs for better health and lower-cost care, according to Dr. Fisher.
Both Drs. Fisher and Nash emphasized the urgent need for change. “We’re spending 18 to 20 percent of the GDP on health care, and we’re wasting 30 percent of it,” Dr. Fisher said. “It’s bankrupting our country.”
A Life-Long Dream of Building a Hospital in Ghana
Oheneba Boachie-Adjel, M.D., chief of the Scoliosis Service at HSS, discussed the realization of his dream to build an orthopedic hospital in Ghana, Africa, and the many challenges he faced. Dr. Boachie, founder and president of the Foundation of Orthopedics and Complex Spine (FOCOS), opened a 50-bed specialty hospital providing comprehensive orthopedic and rehabilitative services for adults and children last year.
Dr. Boachie’s presentation included photos of children with heartbreaking deformities whose lives were changed by FOCOS. “FOCOS’s mission is to provide affordable orthopedic care to those who would not otherwise have access to such treatment,” said Dr. Boachie, who was born in Ghana and immigrated to the United States in 1972.
Research Transforming Medical Care
The symposium’s research sessions featured renowned investigators from HSS, Case Western Reserve University, Duke University, Harvard Medical School, the Mayo Clinic, Memorial Sloan-Kettering Cancer Center and Rockefeller University. Topics included the human genome, arthritis prevention and treatment, cartilage repair, how robots are impacting orthopedic surgery and the quest for a cure for rheumatoid arthritis.
During the session on the human genome, scientists noted that it will transform the understanding of biology and eventually lead to a new era in medical care. By pinpointing genetic mutations that cause disease, scientists believe they will be able to develop new and better treatments down the road. Every area of science is involved in genomics.
“Because research is such an important part of the HSS mission, it was important for the symposium to highlight the extraordinary advances that have taken place and what lies ahead for the future of orthopedic and rheumatologic care,” said Louis A. Shapiro, Hospital for Special Surgery president and CEO. “We were privileged to have some of the world’s leading investigators share their groundbreaking research at our symposium.”
The entire symposium and all presentations will be posted for everyone to see online at HSS’s e-university within a month at www.hss.edu/euniversity. For a link to the program to see speakers and topics, visit http://www.hss.edu/files/HSS-Symposium-150.pdf.