LITTLE ROCK--C. Lowry Barnes, MD, chair of the Department of Orthopaedic Surgery at the University of Arkansas for Medical Sciences (UAMS), travels the country frequently to give presentations on orthopaedic surgery. One trend now is that instead of speaking about the latest surgical procedures, he is being asked to talk about cost containment and value in orthopaedics.

“After 20 years, I have been to the podium more times than I like to think,” Barnes said. “Usually in the past, the interest was in new techniques and certain prostheses. Mainly today I am talking about efficiencies, decreasing the length of the hospital stay and cost containment in the operating room for total hip and knee replacements. There is now tremendous interest in true value-based care, alternatives like bundled payments and early discharge from the hospital.”

That trend is being driven by economics. It is an important national concern to control healthcare costs. In orthopaedics, that may be achieved by managing the whole episode of care better.

“Arkansas is at the forefront in this area,” Barnes said. “Arkansas Blue Cross Blue Shield, QualChoice and Medicaid have episodic care payments for four diagnosis groups including hip and knee replacements. The episode of care is managed for 30 days before surgery and 90 days after. The goal is to control episode of care costs and improve quality by more closely managing the process.”

Their surgeon team is now available 24/7 for patients to contact via telephone rather than have patients go to the emergency room. Most problems can be managed over the telephone or by the patient being seen in the physician’s office.

“Sometimes patients are concerned about swelling, so they can call about that,” Barnes said. “There may be wound drainage or minor problems like a low-grade temperature. They can call us instead of going to the ER.”

Complications from hip and knee replacement are rare these days. Pain management is much improved from the past. One thing Barnes talks about around the country is a multi-modal approach to pain so that combined techniques and medication work together to decrease pain, increase mobility, and lead to faster recovery.

“Now most patients are going home post-operative day one,” he said. “When I finished training 23 years ago, they were in the hospital 12 days; now, it is only one day.”

When should primary care physicians recommend someone for knee or hip replacement?

“The time to recommend a candidate for joint replacement is when the pain of arthritis interferes with life,” Barnes said. “It may be that the patient can no longer care for their spouse, shop, cook, or play golf, or that the pain interferes with sleep. Patients always know when their arthritis is interfering enough with their life that they are ready to have treatment.”

When seeing a patient with knee pain, primary care doctors should get a standing anterior to posterior x-ray of both knees.

“Sometimes non-weight-bearing X rays don’t show the arthritis as much because the load is not placed on the joint,” he said. “Most people get joint replacement for wear and tear arthritis. There are things we can do now to prevent the progression of arthritis. There are techniques now for managing injuries better.”

Because of the large number of baby boomers retiring, there is concern about having enough orthopaedic surgeons to meet the demand in the future.

“If the predictions about the tremendous exponential growth in joint replacement are true, we don’t have enough total joint trained orthopaedic surgeons to take care of that need,” Barnes said. “UAMS has been working to address those needs to provide the best orthopaedic care and increase our accessibly. New surgeons have been added to the staff, and a new clinic has opened in West Little Rock. Patients can drive up to the door and park. UAMS has a tremendous medical system with some of the best doctors working here, but big buildings scare people. Figuring out how to navigate a big building when they have a lower extremity problem can be a challenge for them. This new location makes it a lot easier for them.”

Barnes has been a UAMS professor of orthopaedics for the past three years while he continued his private practice at Arkansas Specialty Orthopaedics and St. Vincent Infirmary Medical Center. He became-full time chair of orthopaedics at UAMS on April 1.

“Many have been confused about my transition and thought maybe I was no longer operating,” Barnes said. “I continue to see patients in the office and operate just as much as I have for years. I absolutely love taking care of my patients, and I hope to instill this same attitude in residents and medical students.”

Barnes graduated with honors from the UAMS College of Medicine in 1986, and completed his internship and residency in orthopaedic surgery at UAMS before doing a fellowship in adult reconstructive surgery and arthritis surgery at Harvard Medical School and Brigham and Women’s Hospital in Boston.

In 1998, Barnes was founding managing partner of Arkansas Specialty Orthopaedics. He has long been active at St. Vincent Infirmary Medical Center, serving on the board of directors until 2010 and as president of the St. Vincent Infirmary Physician Hospital Organization.

Barnes is the only Arkansas member of the prestigious Knee Society. He is a past president of the Arkansas Orthopaedic Society, the Southern Orthopaedic Association and the Society for Arthritic Joint Surgery. He serves as treasurer for The American Association of Hip and Knee Surgeons and has recently been named the Distinguished Southern Orthopaedist by the Southern Orthopaedic Association. In addition, he is second vice president of the Mid-America Orthopaedic Association and will be its president in two years.

Barnes has published extensively and is on the editorial boards of peer-reviewed publications including the Journal of Arthroplasty and Clinical Orthopaedics and Related Research. He is editor of the Journal of Surgical Orthopaedic Advances. He holds four patents for orthopaedic surgery devices that he developed, and has designed numerous hip and knee implants.

Barnes and his wife, Tanya, married for 29 years, have three children: Emily, 26, sells real estate for Charlotte John; Chase, 22, sells real estate and manages farms for Mossy Oak; and Sally, 17, is a senior at Episcopal Collegiate School.

As far as hobbies, Barnes admits he “works too much, but I do lots with my family and try to play a lot of tennis and golf.”