Are insurance companies determining the future of orthopedics?


As the orthopedic industry continues to innovate with new robotic, 3D-printed and GPS-guided navigation options, physicians are concerned that insurance companies won't be open to covering new care options. 

Potential care plan denials by insurers often result in patient care delays and revenue delays for orthopedic surgeons. 

Additionally, as orthopedic and spine procedures expand into the ASC setting, payers are increasingly resistant to covering certain procedures in an outpatient setting. 

While new technologies provide great options for patients, and ASCs provide ideal orthopedic surgical environments for many, the industry won't be able to see benefits if insurers choose to continually deny coverage for these care options. 

Michael Redler, MD, a surgeon at Connecticut Orthopedics in Hamden, told Becker's that the future of many techniques will rely on the payers. 

"Orthopedic surgery is a specialty whereby technology is changing at an ever-increasing rapid pace. There are so many new options for treating patients that didn't exist 10 years ago. The big challenge for orthopedic surgeons today is balancing the role of new technology in an environment where cost savings are going to continue to be very important. Many of these outstanding technologies can be used in an ASC-type setting. The challenge, of course, is getting the insurance companies to agree to pay for these technologies when performed in an ambulatory setting. This not only relates to implants and new techniques, but also to the always important perioperative comfort experience. Our ability to perform opioid-sparing surgery is going to, in part, rely on the insurance companies recognizing the importance of the great advancements that have been made in minimizing the need for narcotics. Insurance companies' acceptance of new injections and devices to minimize opioid use will not only benefit the patient, but society as a whole."

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