Value-based care in orthopedics — 5 insights from physician leaders

Angie Stewart -   Print  |
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Value-based care seems to be on every healthcare leader's mind, but many are hesitant to put it into practice.

Here's what five physicians told Becker's Spine Review on the topic:

Paul Cagle, MD, (New York City-based Mount Sinai West Hospital) on observations and expectations: The biggest trends in value-based care are movements focused on ensuring standardization and safety for patients during and after surgery. By focusing on these two pillars, value-based care can be provided to patients. In the next two to three years, increasing local and national standardization should lead to safer and improved value-based care.

Baron Lonner, MD, (New York City-based Mount Sinai Hospital) on orthopedic surgeons' role in value-based care delivery: 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 reoperations and lower complication rates.

John Uribe, MD, (Miami Orthopedics & Sports Medicine Institute) on whether he thinks value-based care is promising for healthcare: I really do. That's one area where [Baptist Health South Florida] has paid attention. I said, "Look, if we're doing all these surgeries and we're seeing all these patients, and we don't know how well we're doing it and whether it makes that much of a difference long-term, then we're missing the boat. So, we need to invest in patient-reported outcomes and really follow these people longitudinally, and know what works and doesn't work." Because [with] a lot of these more expensive technologies — and a lot of it is in orthopedics — you find out that there's no difference [in quality].

Chris Reeves, DPM, (American College of Foot and Ankle Surgeons) on his organization's efforts to promote value-based care: As healthcare continues the shift to value-based payment models, ACFAS members are not only taking notice of the regulations being implemented, but actively working with the college to ensure proper uptake and implementation. This comes in the form of educational materials, peer-to-peer dialogue and sharing measurement tools, such as surveys, that help track patient outcomes. These techniques will be a key component to ensuring performance-based policies are actually improving care delivery from both the patient and provider perspective, and foot and ankle surgeons are working hard to be at the forefront of this evolution.

Michael Chmell, MD, (Rockford-based Ortho Illinois Surgery Center) on how value-based care will affect orthopedics: Regarding bundled payments, I view this as optimal for providing economically correct care for our patients with the highest quality. No one knows the best way to treat a total hip or knee patient better than their surgeon, who under such a system will direct all care. That being said, an infrastructure is needed to carry out bundled payments: risk assessment nursing pre-op, nurse managers to assist with the bundle post-op, dedicated anesthesiology and physical therapy. Once the system is in place, however, private orthopedic practices and ASCs should hugely outperform any hospital system in terms of profitability.

Want to share your thoughts on this topic? Email Angie Stewart at

More articles on orthopedics:
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Dr. Avi Kumar: 2 Qs on innovation in orthopedics and considering new devices 

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