The face of medicine is changing. The Affordable Care Act, signed into law more than five years ago, has caused us all to rethink and adjust to new delivery and payment models. Unfortunately, it attempted to devise a new approach to an existing, unworkable model. 

This is particularly true in Alaska, and while the goal of increased access to high-quality health care is something everyone can agree upon, I often hear from patients who are frustrated that they cannot afford the new insurance premiums they were told would be lower. I also hear from my peers, who have seen dramatically reduced reimbursement for their services. Some of them have had to close their doors or move elsewhere because of the difficulty in keeping their medical practices afloat.

As with most industries, lower reimbursements bring about new economies and innovative approaches to providing care. These include procedures that provide less invasive, more effective outcomes leading to lower costs, reduced recovery times and enhanced quality of life.

This is particularly true in the specialty of orthopedics. Injuries that once required complex, invasive surgeries can now be performed arthroscopically. Hospitals are not always necessary with their high costs and overhead. And sometimes, even more conservative approaches like physical therapy can work better than surgery itself. A Veterans Administration 2002 study in Texas surprised the medical community when it demonstrated that some patients with derangements of the knee fared no better when getting sham surgery than the real thing. (Properly selected patients do benefit from knee arthroscopy, but it turns out that many others may do just as well without it.)

When surgery is indicated, we can often take advantage of new innovations in the operating room. For instance, we sometimes use a product called PRP, or platelet rich plasma, which is from the patient’s own tissues and provides a rich, structural matrix to treat complex acute wounds and minimizes the formation of post-operative complications. The tissues do not evoke an immune response, and they are able to assist healing whatever type of tissue is injured.

A very potent source of new tissue regeneration, stem cells, was introduced several decades ago, but ethical issues arose since they were first derived from fetal tissue, and the practice was limited. Subsequently, it was found that they could be derived from placental tissues, which were usually discarded after labor and the baby’s delivery. One of the most exciting products we and other local providers are now using is similar, but is used in a clinical setting via simple injection into the shoulder, hip, knee, ankle or other injured joint. The products, Amniofix and Bio-D Matrix, deliver stem cells directly to the damaged soft tissue site. Our patient feedback is very positive, with many reporting that their pain is eliminated entirely within a short time. These stem cells allow the body’s own natural healing power to repair injuries, and reduces inflammation and scar tissue formation.

As always, prevention is the best medicine and it is why we vigorously endorse nutritional supplementation, especially Vitamin D3, which is so critical to bone health for those living in high latitudes. New options include “medical grade food” including a product called Replesta, an over-the-counter, orange flavored chewable wafer available locally and taken once per week. It comes in doses of 14,000 IU and 50,000 IU. As always, this or any other high-dose supplement should only be taken under medical supervision.

Orthopedics is no different than other specialties in bringing innovation to our patients, and those changes also stretch beyond specific procedures and therapies, to the nuts and bolts of paying for the services you need. If you find the cost of your treatment too high, consider talking to your provider about negotiating the price, even if it is an expensive surgery. 

According to the Alaska Health Care Commission, medical costs in Alaska average 59 percent higher than the other western states. And because Alaska physicians face higher overhead costs than their colleagues Outside, we often lose patients to “medical tourism,” in which employers or insurers fly patients to the Lower 48 or even overseas for surgeries. While it is often difficult for physicians here to compete with prices elsewhere, it’s important to remember that it is sometimes ill advised for patients to seek certain treatment from afar. The possibility of complications from a surgical procedure become more dangerous and there is less continuity of care.

Older approaches such as the practice of reimbursement by visit or procedure can be very inefficient, encouraging unnecessary surgery and dependency on the part of both doctor and patient.

In the end, traditional medical practices must change to face the realities of the evolving marketplace, by increased efficiency, economic innovation, and increased dialogue. This will result in better quality of care and happier patients and providers.

Dr. Richard Cobden is a board-certified orthopedic surgeon and former chief of staff at Fairbanks Memorial Hospital. He now practices at Fairbanks Orthopaedic Center. His office can be reached at 374-4636 or via the email provided at This column is provided as a public service by the UAF Community and Technical College department of Applied Business.