As the nation’s population grows older, orthopedic programs are rethinking how to deliver safer, more efficient care that supports independence and long-term outcomes.
At Virginia Commonwealth University Medical Center in Richmond, Stephen Kates, MD, chair of orthopedics, is leading that transformation through value-based models, standardized fracture care and a focus on training surgeons to meet the needs of an aging, yet increasingly active, population.
“We’re in an era where the population is rapidly aging,” Dr. Kates said. “By 2030, every baby boomer will be 65 or older — more than 80 million Americans. We have to train young surgeons to take care of my generation and the one ahead of me.”
For Dr. Kates, that starts with recognizing the special needs of older adults. The goal is to make surgery as safe, efficient and complication-free as possible, and to fix problems in a single operation whenever feasible.
“Some older adults don’t tolerate repeat surgeries well,” he said. “We want to fix the problem the first time — safely, efficiently and with the fewest complications.”
That approach shaped the geriatric fracture model Dr. Kates helped pioneer — a care pathway now used internationally. The model integrates medical optimization before surgery, rapid mobilization afterward and multidisciplinary coordination to minimize readmissions and reoperations.
“Standardization avoids reoperations and hospital readmissions,” he said. “It’s about safer care that’s also cost-efficient.”
As hospitals nationwide confront the realities of an aging population, Dr. Kates said more than 90% have now adopted some form of hip or geriatric fracture program — a sign that hospitals recognize the need for standardized care.
“As you improve the quality of care, the cost goes down,” he said. “If you don’t give good quality of care, the cost goes up. Quality really drives value.”
He said the push toward value-based care in orthopedics hinges on three principles: access, quality and affordability.
“Access to care is critical,” he said. “We want to eliminate barriers — insurance delays, prior authorizations or denials — so patients can see a physician when they need to.”
At VCU, that philosophy extends to everyone.
“We’re a safety-net hospital. We take care of insured and uninsured patients alike. That inclusivity is one of the keys to our success.”
Dr. Kates is also preparing future orthopedic surgeons for a vastly different clinical landscape. His program trains residents in both conventional and robotic techniques, emphasizing judgment over novelty.
“They need to know how to operate with or without a robot,” he said. “Newer technologies aren’t always better, but our trainees should understand both approaches.”
That adaptability is essential as life expectancy rises.
“We’re seeing patients in their 90s who are still active and independent,” Dr. Kates said. “Maybe they had a joint replacement at 70, and now, 25 years later, the implant needs to be redone. We teach our trainees how to handle these situations safely.”
Even for seasoned surgeons, Dr. Kates emphasizes caution and consistency when adopting new tools.
“It’s important to adopt technologies that are proven and not just try something new that may fail and hurt the patient,” he said. “I use implants that have been proven safe over many years. Consistency reduces errors.”
Looking ahead, Dr. Kates expects orthopedic surgery to become even more streamlined and patient-centered, with a stronger emphasis on early intervention, single-stage surgery and rapid recovery.
Long-acting nerve blocks and improved anesthesia, he noted, already allow more fracture and joint procedures to be done on an outpatient basis.
“Early, single-stage surgeries that allow immediate walking are essential,” he said. “When patients can return home instead of going to a facility, they maintain their independence — and that’s what they want.”
His guiding principle is straightforward: treat the whole person, not just the fracture.
“We need to look at the whole patient,” he said. “Fix their vitamin D, treat their osteoporosis and make sure they have high-quality rehabilitation. It’s not just about the broken hip — it’s about getting them back to a comfortable, safe life.”
