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Does reimbursement impose an increase in surgical procedural volume?
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Reimbursements made to orthopaedic departments and clinics after patients have consulted with us are, traditionally across Europe, related to either a fixed-fee for a visit to the outpatient clinic or a fixed-fee related to the type of surgical procedure that has been performed on the patient.
These reimbursements are related to either a “show-up” visit at the outpatient clinic with a traditionally low-fee or a higher fee related to the surgical procedure. Neither of these fees are related to the quality or outcome of the treatment, thus making the outcome not a mandatory goal for some orthopaedic surgeons and their respective departments in these situations.
Running a successful orthopaedic practice or department will, therefore, logically focus mainly on productivity and the numbers of cases passing through the clinic and operating theaters. This has a potential risk for the quality and final outcome of a given treatment not to be the main focus; instead more patients may be offered surgery to keep the budget and thereby the annual income.
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More countries in Europe have reported unexpected increases in orthopaedic surgical procedures over the last few years, and the question must be raised whether this is due to more patients needing treatment, newer surgical techniques bringing more patients in the orthopaedic/traumatology programs, or simply that patients are treated at an earlier level, giving less time for conservative or wait-and-see — less costly — methodologies which sometimes resulted in full recovery, as has been proven for several procedures such as low back surgery, shoulder arthroscopy and joint replacement.
We, as orthopaedic surgeons, must keep our indications for surgical intervention at a high and respected level and make sure that conservative treatment in the single case is still an option. Just because we are surgeons and are good at performing surgery, this is not necessarily what should be offered for every patient.
Politicians in Europe — mainly in Brussels — can assist us in creating relevant reimbursement related to the outcome of treatment — ie, making joint replacement surgery equal in reimbursement to nonsurgical procedures, and allowing the patients to judge the quality of treatment and the final outcome.