Now is a time of great promise for orthopedics
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As 2024 ends, we can reflect on our achievements this year and the challenges and opportunities awaiting us in 2025.
During the past year, the impact of the COVID-19 pandemic has continued to influence a dramatic shift toward outpatient surgical care. With its expansion, orthopedic surgeons have proven the safety, efficacy and cost-effectiveness of outpatient surgical care for most orthopedic procedures. ASCs have become indispensable in offering superior patient and surgeon experiences, as well as faster recovery and lower costs. Physician-led ASCs have exemplified value-based care and showcased teamwork across surgical, anesthesia, nursing and rehabilitation disciplines. The value of the facilities is directly related to surgical cases, which are made possible by orthopedic surgeons. ASC ownership is crucial to maintain orthopedic private practice vs. health care system employment.
Technological advancement
Additional advances to patient care are being realized with modern technology, such as robotics, preoperative surgical planning and AI. However, continued analysis is necessary to support the perceived improvement in patient outcomes, which is critical to improving value due to additional costs of care.
AI is refining surgical indications, risk assessments and radiographic interpretation. Once limited to hospitals, robotic platforms are now critical in ASCs. Many joint replacement and spine surgeons will base their site of surgical procedures on the availability of robots and advanced imaging devices.
The routine use of patient-reported outcome measures (PROMs) and wellness assessments highlights our leadership in delivering holistic and comprehensive care. By evaluating physical, mental and social well-being, we can address the multifaceted factors that influence surgical outcomes. These measures have also prepared orthopedic surgeons for the government reimbursement requirements that are tied to PROMs in joint replacement surgery.
Increased threats
Despite our patient-centered accomplishments, there is an increasing threat to our autonomy to make decisions on behalf of our patients. The employment of orthopedic surgeons by hospitals and health systems continues to increase. Hospitals can view orthopedic surgeons as essential revenue generators, leveraging ancillary services, especially outpatient surgery, to offset narrow margins in clinical care. Employing orthopedic surgeons who use the health care system’s facilities captures revenue that would be lost to a private practice group.
The incentives have also led to the increasing involvement of private equity investors. While both employment models are incentivized by financial metrics, the distribution of the investment’s return can be distinctly different. Private equity investors are typically allowed into practice ownership by the senior surgeons in exchange for significant payouts to the senior surgeons.
The practice leadership is attracted by the promise of growth and additional financial rewards. Prioritizing short-term profitability often leads to resource reduction, reduced compensation, staff dissatisfaction and increased debt burden. Younger surgeons may bear the brunt of unmet expectations and additional liabilities.
Both models can inherently threaten surgeon autonomy, disrupt traditional practice cultures, disincentivize innovation and shift priorities away from patient-centered care. However, in 2025, we may see new relationships in which surgeon leadership and autonomy are preserved in both types of employment models.
Opportunities ahead
The coming year will offer many opportunities to build and strengthen our commitment to patient-centered, surgeon-directed value-based care. The acceleration of technology will continue at a pace not seen in our lifetime. Robots and AI will not replace surgeons; however, surgeons who do not embrace the advances will be replaced by surgeons who learn to incorporate these into practice. The fusion of AI and robotics will revolutionize preoperative planning and intraoperative precision, shortening learning curves and ensuring consistent, expert-level outcomes. This technology also addresses skill attrition later in a surgeon’s career, preserving excellence throughout a lifetime of practice.
Wearable devices and telehealth innovations promise to improve remote and continuous patient care. During the COVID-19 pandemic, the move toward telehealth indicated that a significant portion of our care could be provided remotely. However, due to inefficiencies of managing patients, perceived increased liability and reimbursement concerns, telehealth in orthopedics and musculoskeletal care still needed further development. Integrating new tools will enhance access, efficiency and proactive management of musculoskeletal conditions, fulfilling the untapped potential of telehealth.
As we anticipate and incorporate transformative innovations, our role as the leaders in musculoskeletal care becomes more crucial than ever before. We must remain proactive in establishing and maintaining a patient-centered health care model. The effort can be incredibly challenging when the prominent metric for defining appropriate care is financial, not medical.
We need to cultivate leadership roles within practices, hospitals and professional organizations to guide decision-making and influence the future of orthopedics. Our involvement is critical. The alternative is ceding control to administrators, investors or policymakers, which risks compromising our profession and patient care.
Inspired effort
As we celebrate the ingenuity and resilience of orthopedics in 2024, let us look forward to a transformative 2025. Our specialty has thrived on innovation, and next year promises to bring incredible technological advances to patient care.
This is a time of great promise for orthopedics, and we must commit to elevating the standard of care for every patient we serve. Beyond clinical practice, we must engage in the broader issues shaping our profession, including political advocacy. The price we pay for lack of involvement or indifference is to be ruled by others. Together, we can secure and sustain a legacy of excellence, innovation and value for our patients and the future of our profession.
Happy holidays to you and your families, and best wishes for an inspired effort in 2025.
- 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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