How can value-based care improve in orthopedics? 4 surgeon insights

Payer Issues

Four orthopedic surgeons told Becker's how value-based care can become more effective, from improving data analysis to using a stakeholder-focused approach.

Ask Orthopedic Surgeons is a weekly series of questions posed to orthopedic surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next week's question: How do you anticipate the payer landscape evolving in your market in the next five years?

Please send responses to Carly Behm at by 5 p.m. CDT Tuesday, Oct. 5.

Note: Responses were edited for style.

Question: How can value-based care become more effective in orthopedics?

Ammar Saymeh, DPM. Director of Foot and Ankle Medicine at NJ Spine and Wellness (East Brunswick, N.J.): Value-based care holds each and every physician accountable for their diagnosis, plan of care and ultimate outcome for their patients on a case-by-case basis. The cost is more effective than ever for both the patient and the healthcare system as a whole. To improve effectiveness of the value-based care model, it is important for each practice to undergo in-depth data collection and analysis. This level of analysis of data is essential to improving value-based care in orthopedics.

Alan Valadie, MD. Coastal Orthopedics (Bradenton, Fla.): Value-based care will become more effective if the models are focused on benefiting all stakeholders, beginning with the patients. Patients must see increased efficiency and evidence-based care within a patient-focused system. Providers must be incentivized to provide such care. Within such a system, all stakeholders will benefit.

Robert Peinert, Jr., MD. Orthopedic Surgeon in Harlingen, Texas: From a humanist perspective, value-based care must improve the function and existence of the patient to whom that care is applied. From an economic standpoint, value-based care is the least expensive care that can be given to a patient so that society pays the least possible money and resources, thereby maximizing economic and not clinical outcomes.

The difficulty here is finding a golden mean between treating the patient and attempting to maximize clinical outcome while not breaking the piggy-bank! The solution is to have constant interplay between the patient side of the equation with the administrative/fiscal side in which the two balance each other. The system must not become one that is "profit driven." The key here is finding out statistically those medical and surgical interventions that help the greatest number of patients achieve improvements that are meaningful and objectively improve quality of life.

David Jacofsky, MD. The CORE Institute (Phoenix): Initially, orthopedics was a leading specialty in value-based care models. Bundled payments, which are well-suited for the episodic nature of certain acute orthopedic diagnoses, provided a platform to engage musculoskeletal providers. However, due to pricing differences between facilities in the same market and the unsustainable nature of annually declining price targets with diminishing financial opportunities for providers, there have been a number of unintended consequences that have decreased enthusiasm for acute care bundles among providers and conveners. The best models to drive long-term performance and meaningfully bend the cost curve will be those models that accomplish three goals.

First, models must align all stakeholders in the market for the long term. These models should align payers, providers and facilities. Second, models must recognize the current trend in spend and work to reduce the trend for the total cost of care, rather than drive a "race to the bottom" on simple episode price. Finally, effective models must not only incentivize episode-based savings, but also must reward providers for appropriate indications for interventions, medical optimization efforts, and prevention and wellness activities.

Bundles may effectively lower the "per unit" price for an episode, but this has no impact on managing the number of appropriate episodes in a market, decreasing unnecessary bundles, nor does it engage providers in preventive care. Population health models that are diagnosis- or condition-based will be far more effective at both driving down care cost and eliminating waste while simultaneously improving provider engagement in activities that focus on wellness instead of primarily managing sickness. This would be a win-win-win for all stakeholders involved.

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