As the U.S. healthcare system faces mounting financial pressure and policy uncertainty, orthopedic leaders are increasingly focused on the structural barriers that shape how care is delivered and funded.
From fragmented care pathways and payer administrative burden to misaligned reimbursement and regulatory constraints, here is what orthopedic leaders say would most meaningfully improve care for patients nationwide.
Question: What policy or system-level change do you think would most meaningfully improve care for orthopedic patients?
Editor’s note: Responses have been lightly edited for clarity and length.
Tan (Dan) Chen, MD. Orthopedic Spine Surgeon at Inova Orthopaedics and Sports Medicine (Fairfax, Va.): Orthopedic care in most health systems remains notoriously fragmented. Patients often ricochet between primary care, radiology, pain management, physical medicine and rehabilitation, neurology and surgical specialists. A meaningful evolution in musculoskeletal care would be the creation of a fully integrated, streamlined care pathway from first symptoms to evidence-based conservative care, to surgery when appropriate, and through postoperative rehabilitation.
David Kalainov, MD. Medical Director of Orthopedics at Northwestern Memorial Hospital (Chicago): Eliminate the laws deterring both the development of new physician-owned hospitals and expansion of existing physician-owned hospitals. Physician ownership of hospitals may improve value-based care payment models via more direct alignment of provider incentives to maximize care quality at acceptable costs and improve competition to lower prices. Data show that existing physician-owned hospitals excel at delivering quality care at acceptable costs. Powerful healthcare lobbying groups and lawmakers seem to ignore or interpret the data differently.
Emeka Nwodim, MD. Orthopedic and Spine Surgeon at The Centers for Advanced Orthopaedics (Bethesda, Md.): The most meaningful and impactful systemwide change to improve care for orthopedic patients would be to remove the prior authorization process coupled with restricting payer retroactive recoveries, commonly referred to as clawbacks, on payments for services appropriately performed after appropriate indications were met.
Bruce Ziran, MD. Orthopedic Surgeon at Atlanta Orthopedic Institute: The most meaningful system-level change to improve care for orthopedic patients would be reforming how healthcare is financed in the United States. Our current payment system is fragmented, costly and administratively burdensome, often misaligning incentives between the government, insurers, hospitals, providers and patients. A shared, three-tier financing model that guarantees universal basic coverage while preserving private-market competition could reduce administrative complexity, improve access, stabilize reimbursement and create more sustainable, cooperative care delivery without the need for a single-payer system.
For additional perspective, click here to read “A new model for healthcare financing in the U.S.” by Dr. Ziran.
