How to stay at the forefront of value-based care in orthopedics: Q&A with Dr. Baron Lonner

Laura Dyrda -   Print  |

Baron Lonner, MD, professor of orthopedic surgery and professor of pediatrics at Icahn School of Medicine at Mount Sinai in New York City, examines the trends in value-based orthopedics today.

Question: What are the biggest trends you're seeing in value-based orthopedic care? What should we expect over the next two to three years?

Dr. Baron Lonner: Many of us saw the 'value equation' coming into view beginning a decade or more ago. The healthcare system, contrary to other industries, has not conducted itself, in terms of healthcare policies and expenditures as a zero-sum game in which costs, charges, and reimbursements need to line up in order for the system to sustain itself. There has been a poor effort, in the past, to improve upon efficiencies in healthcare and control rising costs.

Today, there is a competitive tug of war between the introduction of promising new technologies in spine surgery, my specialty, for example, and the desire to lower costs. However, a number of trends have emerged, which will hopefully level off rising costs but at the same time improve value for the patient and maintain fair compensation for the surgeon and other members of the healthcare team. The value equation is essentially an assessment of cost per benefit or outcome achieved on behalf of the patient. As the durability of the outcome persists over the lifetime of the patient, the relative cost per intervention decreases. Therefore, current trends are largely aimed at impacting cost and improving outcomes.

On the cost side, improvements in operative efficiency through improved technology and training, decreased length of stay, less costly settings for delivery of care, and improved quality and safety reduce complications and enhance the speed of recovery for the patient to allow the individual to return to being a productive member of the workforce. Less invasive procedures in orthopedics have allowed for decreased length of stay and more rapid recovery from surgery. This is permitted through the introduction of better technologies emerging in spine surgery and total joint arthroplasty and sports medicine as well as other fields within orthopedics. Many procedures are being shifted to less costly ambulatory surgery centers rather than traditional hospital settings, which are notoriously inefficient.

Finally, improved outcomes arise out of improved processes including the use of standardized operative teams, protocols, and quality and safety programs. Big data, the collection of data on the performance of thousands of procedures can help to risk-stratify patients at greatest risk for complications, which can then be used to help mitigate complications by informing improved treatment strategies or alternatives including non-operative treatment for those at highest risk. The use of image guidance and as technology improves, robotically assisted techniques, may improve accuracy of implant placement, which can reduce neurological complications in spine surgery, for example, and longevity of implants in total joint arthroplasty. These approaches have begun to emerge and will increase in the future.

Finally, there will be an enlarging role for telemedicine, which will improve access to care for patients on a global scale as well as improve access to expertise for surgeons in their learning curve.

Q: How can orthopedic surgeons get on the forefront of value-based care and delivering a great patient experience in addition to a great outcome?

BL: The surgeon can be at the leading edge of value-based care by being the ultimate physician-surgeon. One who strives to provide the best care, the most effective procedures, with the most efficient recoveries, and with the best long-term outcomes and who studies these outcomes to constantly search for better approaches. The surgeon must acknowledge cost in the equation and be mindful of whether or not, expensive technologies result in improved outcomes and eventual cost savings through less re-operations and lower complications rates.

Q: How have you seen postoperative pain management change in the wake of the opioid epidemic? What solutions do you see becoming more prominent in the future?

BL: The opioid epidemic has been a wake-up call for the healthcare community including orthopedic surgeons, members of the care team, and pharmaceutical companies. There has been an increased effort to dramatically decrease the length of time narcotic medications are prescribed following surgery. Pain is now treated with several non-opioid medications, an approach termed multimodal pain therapy. In addition, locally injected, long-lasting anesthetics are being utilized. Finally, less invasive procedures with smaller incisions are associated with less pain and more rapid recovery from surgery that results in less pain medication needs.

Register today for Becker's 17th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference June 13-15, click here. To learn more about exhibitor and sponsorship opportunities, contact Maura Jodoin at

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