Declining reimbursements are one of, if not the biggest pressure point facing orthopedics today, which could result in a decline in access to specialists if the situation does not change.
There is currently a huge gap between the high patient expectations and the economic realities in the orthopedic space, according to surgeons.
To stop what one surgeon called “the rush to the bottom,” the industry needs to find a sustainable model that ensures access to specialty services.
Ask Orthopedic Surgeons is a weekly series of questions posed to orthopedic surgeons and leaders around the country about clinical, business and policy issues affecting orthopedic care.
Becker’s invites all orthopedic surgeons and specialists to respond.
Next question: What is one operational change you resisted at first but now wouldn’t want to give up?
Please send responses to Cameron Cortigiano at ccortigiano@beckershealthcare.com by 5 p.m. Central time on March 2.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What external pressures in the orthopedic industry concerns you most today?
Jason Brustein, MD. Orthopedic surgeon of Resurgens Orthopaedics (Atlanta): The external pressure in the orthopedic industry that is most concerning to me centers around reimbursement. In our current environment, there has been a “rush to the bottom” in terms of cost that is fostering negativity amongst those providing these essential services. The greatest impact on this is felt primarily in the care of our government-pay patients where declining reimbursement is creating a model that is not favorable. In my conversations with colleagues there is tremendous concern that access to specialty orthopedic care could become limited if we cannot find creative solutions to create a model that fosters continued patient access to specialists, is respectful of surgeon time/expertise and is sustainable long-term.
Nicole Montero Lopez, MD. Director of Orthopedic Hand Surgery of RWJBarnabas Health Northern Region (West Orange, N.J.): Ten years into my practice, my primary concern is the unsustainable divergence between declining reimbursements and the escalating costs required to meet modern patient expectations. We are currently navigating a significant paradox: while payers continue to reduce the valuation of surgical services, the market demand for personalized, highly accessible care has never been higher.
Today’s patients rightfully expect a seamless experience defined by digital accessibility, cost transparency and clear communication. However, the sophisticated systems and specialized personnel required to deliver this level of service represent a major capital investment.
When you couple these rising operational overheads with an administrative environment that demands more of a surgeon’s time for documentation and prior authorization, the ‘margin squeeze’ becomes a significant challenge to the long-term viability of the practice. Ultimately, it is becoming increasingly difficult to maintain the premium level of care patients deserve while the financial framework supporting that care continues to erode. We must bridge the gap between the high-tech expectations of 2026 and the economic reality of medical delivery.
