Two competing reimbursement systems, the traditional fee-for-service and newer value-based care models, can both be useful for orthopedics if integrated properly.
While value-based care can lead to better care coordination and prevention, procedure-based care is still important due to the complexity of orthopedic outcomes that aren’t always captured with broad metrics, according to one orthopedic surgeon.
Payers and providers will have to come together to find a system that works for all parties involved, which hasn’t quite happened yet.
These two orthopedic surgeons recently connected with Becker’s to weigh in on the fee-for-service versus value-based care debate in orthopedics.
Note: Responses were lightly edited for clarity and length.
Question: Would the orthopedic industry benefit from a move away from traditional fee-for-service in favor of a value-based care system? How can that transition be successful for surgeons, practices and patients?
Michael Gross, MD. Orthopedic Director of Union Middlesex Orthopedics (Woodbridge, N.J.): In my view, value-based care certainly brings important merits to the table, especially in promoting better coordination, prevention and ongoing management of patient health. These aspects can be incredibly beneficial for both patients and providers, as they encourage a more holistic and collaborative approach to care. However, I believe that applying value-based care as the sole reimbursement framework poses significant challenges for procedural specialties like orthopedics. While primary care and cognitive medical services may fit naturally into value-based models, many orthopedic interventions deliver their value through discrete, technically demanding procedures. The outcomes of these interventions, such as restored mobility, pain relief and helping patients return to their daily lives, aren’t always fully captured by broad, population-based metrics.
One concern is that setting reimbursement strictly according to value-based constructs may fail to recognize important variations in patient complexity and the technical quality of care provided. Without robust, specialty-specific quality measures and proper risk adjustment, these models risk undervaluing the critical contributions of procedural care and could inadvertently discourage innovation or appropriate surgical intervention. Meaningful outcomes in orthopedics often extend beyond cost and utilization figures, encompassing improvements in function, quality of life and productivity.
For value-based care to truly succeed across surgeons, practices and patients, I believe it must be thoughtfully designed to complement, rather than replace, procedure-based care. This means incorporating nuanced outcome measures, ensuring accountability at the episode-of-care level and establishing fair reimbursement that reflects both the quality and complexity of services delivered. By doing so, we can foster a system that rewards excellence, encourages innovation, and ultimately delivers better results for patients.
Emeka Nwodim, MD. Orthopedic spine surgeon of Centers for Advanced Orthopaedics (Bethesda, Md.): The answer to that question ultimately depends on how effectively payers and surgeons are able to collaborate. Value-based care has the potential to be highly successful if physicians and surgeons are appropriately compensated for achieving outcomes in clinical care, but also for the additional risk they assume. Ideally, that compensation should be aligned with the manner in which payers have historically been compensated — and have remained profitable — for managing risk.
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