Following 14 major insurers’ commitment to aligning with CMS’ new chronic care outcomes model by 2028, orthopedic and spine leaders told Becker’s the shift could reshape how practices are measured, reimbursed and positioned with payers.
The initiative ties payment to clinical outcomes in conditions, including chronic musculoskeletal pain, creating opportunities to standardize care pathways, strengthen negotiating leverage and streamline reporting. But physicians also warned of added administrative burden, greater financial risk and the challenge of ensuring complex patients are evaluated fairly. Whatever the effects, one thing is clear: outcomes tracking is no longer optional.
Question: With multipayer outcomes alignment gaining momentum, what opportunities — and/or challenges — does this create for orthopedic and spine practices?
Editor’s note: Responses have been lightly edited for clarity and length.
James Bolduc, DO. Resident Physician at Kendall Regional Medical Center (Miami): Multi-payer outcomes alignment creates a meaningful opportunity for orthopedic and spine practices to standardize care pathways, demonstrate value and strengthen negotiating leverage through measurable quality and cost efficiency. Practices with strong outcomes data can gain preferred provider status, negotiate better contracts and attract referrals. However, it also presents challenges, including increased administrative burden, the need for robust data infrastructure and ensuring that standardized metrics accurately reflect patient complexity and procedural nuance. In bundled or risk models, providers assume risk for complications and downstream costs. Additionally, overly rigid protocols may limit clinical judgment.
Interventional pain physicians may face several specific challenges, including the use of surgery-focused metrics that can undervalue pain procedures, the difficulty of measuring outcomes in complex chronic pain populations and uncertainty around how outcomes are attributed when multiple providers are involved.
Emeka Nwodim, MD. Orthopedic and Spine Surgeon at The Centers for Advanced Orthopaedics (Bethesda, Md.): Multi-payer outcome alignment amongst major payers such as Medicare, Medicaid programs and commercial payers has the potential to decrease administrative burden, but also motivate orthopedic and spine practices to achieve quality measures and reporting requirements.
By aligning payers to get on the same page about what defines quality care, with more consistent metrics and incentives, this strategy may be beneficial to everyone involved, including patients, providers and payers. As with most strategies in healthcare, it will require payers to collaborate in a more productive, non-antagonistic way and align their priorities.
David Weiner, MD. Assistant Professor of Orthopedic Surgery at MedStar Health (Columbia, Md.): Multi-payer outcomes alignment is an opportunity for orthopedic and spine practices to standardize quality metrics, streamline reporting and scale evidence-based care pathways across payers. It will also help us standardize our outcomes research and allow for direct comparisons between a wider range of practice types and populations.
This will ultimately help create better protocols and evidence-based care delivery models in both the pre- and postoperative venues. That said, care must be exercised to ensure this data isn’t weaponized against providers. Increased financial risk and inadequate risk adjustment for complex orthopedic and spine patients may challenge practices that lack the appropriate analytics capacity or treat higher-acuity populations. Ensuring that patient-specific and patient-controlled factors are included in any outcomes measurements will be key to a win-win for payers and surgeons.
Aqib Zehri, MD. Neurosurgeon at The Oregon Clinic (Portland): Multi-payer outcomes alignment gives orthopedic and spine practices a chance to standardize care, track outcomes more closely and focus on delivering measurable value for patients. When incentives are aligned, it becomes easier to build consistent care pathways that prioritize quality and durable results rather than volume.
The challenge is ensuring that complex spine patients are fairly accounted for, since higher-risk cases often carry higher costs. Practices that succeed will be those that improve efficiency and outcomes without limiting access to necessary, high-level care.
Joseph Zuckerman, MD. Chair of Orthopedic Surgery at NYU Langone Health (New York City): The emphasis on patient-reported outcomes is here to stay. Every orthopedic surgeon should be part of a system that tracks outcomes, or they will find themselves in a very disadvantageous position. Documentation of outcomes is just one more step towards value-based care.
