Orthopedic surgeons connected with Becker’s to talk about the fee-for-service vs. value-based care system debate, the prior authorization red tape that needs changing and what the new AAOS president is planning for his term.
Here is what five orthopedic industry leaders told us in March:
Note: Responses were lightly edited for clarity and length.
Kevin Bozic, MD. Chair of Surgery and Perioperative Care at Dell Medical School at the University of Texas at Austin: The fee-for-service payment model drives over and inappropriate utilization. It also leads to moral injury on the part of clinicians and burnout because it’s a hamster wheel designed to get harder and harder, where you have to run faster and faster to keep up.
The future of value-based payment is defining the episode as the longitudinal management of the condition. If it’s hip or knee arthritis, you should be looking at a year-long episode starting with the diagnosis and managing that condition over time.
Wilford Gibson, MD. President of the American Academy of Orthopaedic Surgeons and Orthopedic Surgeon of Atlantic Orthopedic Specialists (Virginia Beach, Va.): I spent a lot of time thinking about this while doing my two previous years as the second vice president, first vice president, and watching our president achieve good things. For me, I think the most important thing is to engage our membership. That’s the first thing. We just have to get members to show up and commit to things like attending the annual meeting. We’ve had to nominate leaders, and once they’re nominated we want them to vote. We want them to join our AAOS political action committee at any level they can afford. We’re a very diverse group, and we have one culture, and I want to promote that.
Tyler Goldberg, MD. Orthopedic Surgeon of Austin (Texas) Orthopedic Institute and Founder and CEO of the North American Orthopedic Concierge Association: Orthopedic surgeons build lots of value for the system, but we don’t get to really take part in that value. We get declining reimbursement, increasing administrative workload and hospital consolidations. That ultimately leads to burnout.
What concierge essentially is, is having access and having all of the things that you will need anticipated for and cared for. It’s definitely reinvigorated my career because this is the style of medicine that I went to medical school to do.
Brian Nwannunu, MD. Orthopedic Surgeon at the Texas Joint Institute (Dallas): Different insurance companies have different criteria, and I don’t believe any of them come from a clinician’s standpoint. It’s all kind of red tape. I just don’t think it’s talked about enough on a granular level, about how insurance companies are able to do that and why patients are suffering from it. I personally have had to cancel a surgery the day of because it didn’t get prior authorization. That morning, I had to call the insurance company while the patient was waiting for surgery and advocate for this patient just to get that surgery put back on. That’s just not a good use of our system.
Richard Yoon, MD. Director, Orthopedic Research Division of Orthopedic Trauma and Adult Reconstruction Surgery of Jersey City (N.J.) Medical Center: I think the standardization of CPT codes has greatly streamlined billing coding and reimbursement; however, at the same time, it has harmed the same process by not allowing for grading of complexity.
A primary total hip or knee replacement can come in a wide range of degrees of severity, and a single code should not reflect those that are most complex. The standardization has indirectly placed quantity over quality and does not reward those surgeons to take on complex clinical cases. As a result, those patients who are likely most in need often get delays in care and needed surgery, finding the surgeon who has the willingness and experience to take on those challenging cases.
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