Orthopedic surgeons need to lead conversation on quality, value in musculoskeletal care
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Orthopedic surgeons are facing an urgent challenge. The meaning behind “value-based care” has been corrupted in terms of the care provided by orthopedic surgeons.
Originally intended to balance care quality with cost, it is now primarily focused on reducing expenses, with little consideration of what defines quality in orthopedic care. Health care systems and multispecialty groups with population health models emphasize the cost of musculoskeletal care without the technology or data to adequately measure its quality.
When assessing the financial impact of orthopedic care, the benefits of ancillary services — both in revenue and patient care — are often excluded. Value-based care models are established without valid orthopedic quality measures, driving processes focused solely on controlling costs.
True value of care
We cannot allow nonorthopedic surgeons to define our value using superficial metrics that fail to represent the actual quality of care. Orthopedic surgeons must step beyond the confines of CPT codes, bundled payments based solely on surgical procedures and other procedure-based discussions.
Care extends across a wide spectrum of musculoskeletal diagnoses, better captured by ICD-10 codes. By focusing on diagnostic codes and playing an active role in defining quality measures, we can ensure value-based care models reflect the true value of orthopedic care. We are uniquely positioned to lead in determining what value means for musculoskeletal health, particularly because we understand the full scope of care patients need.
Authentic value-based care should balance patient outcomes with the resources used to achieve them. However, current models disproportionately emphasize cost-cutting measures, using general administrative metrics that do not reflect the nuances of the quality of orthopedic care. Commonly used indicators, like hospital readmission rates or general health outcomes, fail to capture what truly matters to orthopedic patients — pain relief, restored mobility and long-term functional improvement. The value of musculoskeletal care is not in how cheaply a surgery is performed, but in how well patients are managed long term, including successful surgeries and nonsurgical treatments to improve quality of life.
If we allow nonorthopedic surgeons to continue defining value by choosing quality metrics that fail to reflect key components, our work will be undervalued, and the quality of musculoskeletal care will suffer. Cost-focused criteria alone cannot capture the complexity of orthopedic treatment. Therefore, orthopedic surgeons must lead the effort to redefine value-based musculoskeletal care or risk accepting a flawed, financially driven model.
Meaningful assessments needed
A significant issue is health care systems are trying to define value for a mosaic of patient care service lines and, therefore, default to the pursuit of simple, efficient measures of quality that bypass meaningful assessments. Administrative metrics, such as patient satisfaction, readmission rates and broad health outcomes, provide a superficial snapshot of care delivery. These metrics are inadequate for evaluating the intricacies of musculoskeletal treatment and the substantial value orthopedic surgeons bring to patient care. The metrics are too broad, often influenced by factors outside orthopedic surgeons’ control, like hospital-wide performance or unrelated comorbidities. Moreover, they tend to focus on short-term outcomes or protocol adherence and fail to capture the long-term success critical in orthopedic care.
An equally pressing concern is proper risk adjustment for complex cases. Orthopedic surgeons often treat high-risk patients with multiple comorbidities or severe injuries. Current systems minimize or overlook the additional challenges, which penalize surgeons who take on complex patients and discourage others from doing so. Without appropriate risk adjustment, the value of musculoskeletal care is masked, and the system fails to recognize the difficulty and importance of managing high-risk patients.
Limitations of CPT codes
To accurately define value in orthopedic care, we must move beyond the limitations of CPT codes, which only capture surgical procedures. While necessary for representing procedural care, CPT codes account for a fraction of overall care. Our work extends beyond the OR, and our impact is better reflected by ICD-10 codes encompassing the full range of musculoskeletal diagnoses. By emphasizing ICD-10 codes in value-based care models, we can ensure the whole spectrum of orthopedic care is appropriately evaluated and not limited to surgical interventions.
Orthopedic surgeons need to lead the conversation on how to define quality and value for musculoskeletal diagnoses. Commonly used methods primarily evaluate our work based on procedural costs, yet surgery represents a small portion of the overall care. This approach reduces the contribution to a financial metric, ignoring the total value we provide across the care continuum. In a fee-for-service model, orthopedics is regularly recognized as one of the most valuable specialties. However, in the context of value-based care, the perception of high costs undermines the actual value of care.
In the long run, this misrepresentation threatens patient outcomes. Low-cost care options may be prioritized instead of more effective interventions simply because it costs less. This shift could reduce patients’ overall quality of care, as comprehensive orthopedic treatments are sidelined in favor of short-term financial gains. Without proper quality metrics, orthopedic surgeons may be discouraged from treating high-risk patients. A value-based care model that fails to account for patient complexity will further disincentivize surgeons from taking these cases, reducing the quality of care available to the most vulnerable patients.
Taking ownership
Orthopedic surgeons and leaders must no longer accept value-based care models imposed by administrators and financial analysts who lack insight into musculoskeletal care. The current trajectory threatens to erode the quality of care we provide and compromise the outcomes that matter most to patients.
If health care systems are to appreciate the long-term, sustainable value of orthopedic surgeons, then they need valid quality measures specific to orthopedic care, proper risk adjustment for complex cases and recognition of the full scope of care as reflected in ICD-10 diagnosis codes. Now is the time for the orthopedic profession to take ownership of defining quality and value in musculoskeletal care, ensuring it reflects the true impact of our work and the outcomes most important to patients.
- For more information:
- Anthony A. Romeo, MD, is the Chief Medical Editor of Healio | Orthopedics Today. He can be reached at Healio, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
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