The future of value-based care in orthopedics


Value-based care has become one of healthcare's biggest buzzwords. But what does it mean for orthopedics? 

Five orthopedic surgeons connected with Becker's to answer, "What is the future like for value-based care in orthopedics?"

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next question: What's next for outpatient orthopedic surgery?

Please send responses to Riz Hatton at by 5 p.m. CDT Thursday, May 2.

Note: These responses have been lightly edited for length and clarity.

James Chen, MD. Orthopedic Surgeon at DISC Sports & Spine Center (Newport Beach, Calif.): Value-based care in orthopedic surgery will begin to integrate more reliable information on patient outcomes. For example, I offer smart implant total knee technology in my office that allows more reliable data in regards to an individual's gait. With this information, we can better standardize progress and positive outcomes for various cohorts of patient populations going forward. 

Ranjan Gupta, MD. Orthopedic Surgeon at UCI Health (Orange, Calif.): Value-based healthcare is a concept introduced by Michael Porter and Elizabeth Olmsted Teisberg in 2006 as a way of reframing healthcare systems with the goal of increasing value for patients — with value being principally defined as health outcomes per unit of cost. Over the ensuing one and a half decades, this concept has matured to include not only a focus on improved measurement of outcomes and costs, but also the changing landscape of provider organizations and bundled payment programs. Furthermore, goals have expanded beyond simply decreasing costs, to more broadly improving delivery and efficacy of medical and surgical treatments to optimize health outcomes for patients. 

The future of value-based healthcare is of direct relevance to all healthcare providers and orthopedic surgeons with a focus on the shift of joint arthroplasty from inpatient to outpatient settings, the increasing cost of surgical implants, private equity purchases, employed physician models, alternative payment models, increasing ancillary services such as orthobiologics, and new clinical growth models in the fiscally constrained reality of healthcare. Of particular importance to orthopedic surgery is the introduction and adoption of new technology — all through the lens of "adding value."  With the increased costs associated with new technology, there must be an improvement in patient outcomes beyond the utility of a marketing edge for health systems and medical centers to embrace the new technology. As orthopedic surgeons, we need to be at the forefront of not only understanding but also championing these issues so as to protect our patients and yet still improve outcomes.

David Kalainov, MD. Clinical Professor of Orthopedic Surgery at Northwestern University Feinberg School of Medicine (Chicago): Value-based care in orthopedics will continue to evolve with government and private health insurance payer sources. One goal of CMS is to have all traditional Medicare and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030.

Louis Levitt, MD. Vice President of the Centers for Advanced Orthopaedics (Bethesda, Md.): When considering the future of value-based care in orthopedics, it's essential to acknowledge the shifting landscape within healthcare delivery and payment models. As a practitioner deeply involved in orthopedics, I foresee both challenges and opportunities in this evolution.

It's evident that value-based care is gaining prominence alongside traditional fee-for-service models. While fee-for-service will persist, value-based care presents a significant revenue stream, especially in engaging with employers and addressing rising healthcare costs. With the rise of self-insurance among smaller companies and the incentive to reduce healthcare costs while maintaining quality, value-based care offers a pathway towards achieving these goals.

Transitioning toward a value-based model requires changes for both employers and physicians. Employers must scrutinize healthcare spending while physicians must adopt data-driven practices. This shift demands a departure from traditional relationships toward evidence-based care plans. Despite challenges, value-based care is poised to become the norm within five to seven years, though corporate interests may pose hurdles.

In summary, while fee-for-service will remain, value-based care represents a crucial avenue for orthopedic practices, requiring adaptation to meet evolving healthcare demands.

Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Tacoma, Wash.): Very complicated, like peering through fog without a compass.

Value-based care, in its most basic form, is founded on a simple equation [value = quality/cost], with value being the highest priority of orthopedic care. The initial wave was full of momentum and fanfare supporting the transition from the long-standing model of fee-for services to a value-based care model, in which reimbursements would follow outcomes, rather than volume. Ultimately, this value-based care model aims to bring all the stakeholders into alignment, centering around the four important elements of access, cost, quality and the patient experience. This lies in conflict with a fee-for-service model. The conflict has always been between the health plan or payer, insurance company, or employer government agency who want to lower costs as much as possible, thus encouraging a drive toward volume to reach a reasonable financial performance.

Aside from the enormous administrative burden that these goals have presented with, we still poorly understand both parts of the equation in orthopedics.

Outcomes: Which ones are the most meaningful? How many should we obtain? Which ones are most centers collecting? Are patients tired of filling out surveys? How do we promote transparency?

Costs: How do we best calculate them? Which costs are most important? What are the main drivers? Traditional cost-accounting methods miss significant variables; can time-driven activity based costing capture the meaningful costs?

The rise of digital health tools will drive the advanced data analytics, which will help with everything from patient engagement to population health management. I still believe in the overarching goal of value-based care in which we aim to align our interests (the healthcare providers) with the health and wellness of the patients. While there are challenges in implementing this model, including the need for significant infrastructure and data capabilities, the potential benefits of ensuring that patients get the right care at the right time in a sustainable fashion keeps us pushing forward.  

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