The value-based care and direct-to-employer payment models are gaining traction in both the orthopedic and spine spaces, but there are still some significant hurdles to industrywide adoption.
Orthopedic and spine outcomes can be difficult to standardize, surgeons have to take on some additional risks and the infrastructure for the system is not ready quite yet, according to surgeons and leaders.
These five orthopedic and spine surgeons and executives have connected with Becker’s this year about where value-based care stands and the system’s future in the industry.
Note: Responses were lightly edited for clarity and length.
Michael Gross, MD. Orthopedic Director of Union Middlesex Orthopedics (Woodbridge, N.J.): For value-based care to truly succeed across surgeons, practices and patients, I believe it must be thoughtfully designed to complement, rather than replace, procedure-based care. This means incorporating nuanced outcome measures, ensuring accountability at the episode-of-care level and establishing fair reimbursement that reflects both the quality and complexity of services delivered. By doing so, we can foster a system that rewards excellence, encourages innovation, and ultimately delivers better results for patients.
For value-based care to truly succeed across surgeons, practices and patients, I believe it must be thoughtfully designed to complement, rather than replace, procedure-based care. This means incorporating nuanced outcome measures, ensuring accountability at the episode-of-care level and establishing fair reimbursement that reflects both the quality and complexity of services delivered.
Dan Tasset. Founder of NueHealth (Leawood, Kan.): When the model works really well, the physician or the surgeon is convening the episode of care bundle, and not the facility. When you convene it around the surgeon, they pay the downstream providers.
In the value-based care world, if a surgeon is willing to convene the episode of care bundle, and they’re willing to stand behind their product and even guarantee the product with a warranty, they can make four times what they’re making today for the same case. It is the same volume and they don’t have to work any harder. The key is that they have to be able to take and manage the downside risk.
Leo Spector, MD. Orthopedic Spine Surgeon and CEO of OrthoCarolina (Charlotte, N.C.): If you tell me I’ve got the opportunity to have zero out of pocket with as good, if not better, results, that’s a win for everybody. It starts to reward those practitioners who are willing to lower the cost of care and improve outcomes.
I think it’s definitely doable in the orthopedic space. The question is going to be, can you replace an entire commercial pay? Where you see the direct-to-employer take off are the areas that are much more amenable to value-based care, especially the bundle payments.
Vijay Yanamadala, MD. Spine Surgeon of Hartford (Conn.) Healthcare: Value-based care in spine is in an awkward adolescence. The promise is real, but the infrastructure hasn’t caught up. Most spine surgeons are still paid for procedures, not outcomes. Bundled payment models have shown early promise in joint replacement, but spine is harder: the indications are murkier, the patient populations more complex, and the long-term recovery windows don’t fit neatly into 90-day episodes.
My five-year outlook: the shift will accelerate, driven by three forces. First, payers — both commercial and CMS — are running out of patience with the cost trajectory of spine care. Second, AI-enabled tools will make it possible to identify who actually needs surgery versus who will do equally well with structured conservative care — and to document that distinction at scale. Third, a generation of younger spine surgeons is entering practice with outcome-based thinking already baked in; the cultural shift is coming from within the specialty, not just from payers.
Nikhil Shetty, MD. COO of Midwest Interventional Spine Specialists (Munster, Ind.): The insurance and the payer landscape is one of the biggest headwinds right now. That’s something we’re all battling as private practitioners. But our government is moving toward a value-based care system. I see the pros of linking reimbursements to outcomes and improvements, and I do think that it does make sense across the board as long as it’s equitable.
Site-neutral payments I think are the lower hanging fruit. That’s an easier problem to solve once we neutralize the payments for procedures done agnostic of their site. I think we can see big cost savings right then and there. From there we can then move toward a value-based system where we take care of a patient with a bundle payment across a series of related events to a related healthcare issue where we eliminate unnecessary services, coordinate care and reduce complications.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
