Orthopedic surgeons say the most complicated part of delivering care today is not surgery — it is navigating the administrative layers behind it, from prior authorization hurdles to performance metric overload and bundled payment programs.
Question: What’s the one part of orthopedic care that’s become too complex — and how would you simplify it?
Editor’s note: Responses have been lightly edited for clarity and length.
Ned Amendola, MD. President of the American Academy of Orthopaedic Surgeons: Orthopedic surgeons face cases that require precision, dexterity and care each day. Ironically, the part of our work that has become most complex isn’t in the operating room, it’s navigating today’s prior authorization system. Complex requirements, improper denials and lengthy appeals impose unsustainable administrative burdens, limiting our time with patients and straining the doctor-patient relationship. When surgeons have demonstrated consistent, appropriate clinical judgment, they should be trusted to make point-of-care decisions without unnecessary interference. Our association is working closely with champions on Capitol Hill and in state legislatures to build a prior authorization process that supports efficient, high-quality care.
David Kalainov, MD. Medical Director of Orthopedics at Northwestern Memorial Hospital (Chicago): Health insurance and all of the requisite performance measures to maximize payments and mitigate penalties has become too complex. The required infrastructure for documentation oversight, data collection and reporting is expensive and one of the drivers of provider/hospital consolidation, which itself increases costs. A lot of money in healthcare is extracted by entities far removed from patient care. One solution that is likely inevitable due to an expanding and relatively unhealthy U.S. population (i.e., unhealthy in comparison to other economically developed nations) could be universal healthcare insurance with unified performance metrics and diligent oversight of fraud and abuse.
Joseph Zuckerman, MD. Chair of Orthopedic Surgery at NYU Langone Health (New York City): In general, the federal government’s programs to decrease the cost of orthopedic care — like the bundled payment programs of the past and the current Transforming Episode Accountability Model program about to start in January — require the input and commitment of multiple specialties to be successful. For TEAMs, three of the five procedures are orthopedic. However, the cost of care for the first 30 days post-op involves multiple specialties and caregivers. This is complex and orthopedic surgeons need to be involved. The institutions where the care is delivered need to be the “captains” of the initiative with orthopedic surgeons also in leadership positions.
