How orthopedic care delivery is changing: 2 industry leaders weigh in


The need for orthopedic services is projected to increase in the coming years, with all baby boomers projected to be age 65 or older by 2030, according to the U.S. Census Bureau.

Two orthopedic surgeons discuss how population health initiatives, value-based care and risk-sharing will evolve as care continues to shift away from hospitals toward outpatient settings.

Note: Responses are lightly edited for style and clarity.

Wael Barsoum, MD. President and chief transformation officer, HOPCo (Phoenix): My belief is that changes in [Bundled Payment for Care Improvement Advanced] and other programs being considered by the federal government clearly signal a broader shift toward population health, which will be the catalyst to orthopedic care being increasingly delivered in vertically integrated systems that align physicians, hospitals and payers. The main driver of this will be reducing variability and cost while improving patient outcomes.

As physicians and health systems take on more financial risk, the ability to manage the entire continuum of care is imperative. Care will shift to lower-cost sites of service, such as surgery centers, and health systems must have a coordinated strategy to maintain volumes and margins in the hospital setting through more integrated value-based care programs and more intensive and effective inpatient care redesign.

Nicholas Grosso, MD. President, The Centers for Advanced Orthopaedics (Bethesda, Md.): We're not going anywhere. With the baby boomers getting older, the need for orthopedics is going to increase, especially on the joint replacement side. Looking at some of the trends of total knees and total hips expected to be done in the U.S. in the coming years, it's almost a vertical line up. We're already starting to see that volume. I think we'll see an acceleration of these surgeries being moved outpatient.

The pandemic hastened that process because a lot of people just don't want to go to the hospitals. Surgery centers that have the capacity are doing more procedures to try and take up some of that volume. We'll see an acceleration of the transition of site of service out of the hospitals to outpatient surgery centers. This has been very good for orthopedics because most of us are owners in our surgery centers. That may help keep the market going and maybe offset some of the CMS cuts.

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