Becker's ASC Review

14 ORTHOPEDICS Low pay, high expectations drive a 'rush to the bottom' in orthopedics By Cameron Cortigiano D eclining reimbursements are one of, if not the biggest pressure point facing orthopedics today, which could result in a decline in access to specialists if the situation does not change. ere is currently a huge gap between the high patient expectations and the economic realities in the orthopedic space, according to surgeons. To stop what one surgeon called "the rush to the bottom," the industry needs to find a sustainable model that ensures access to specialty services. Becker's invites all orthopedic surgeons and specialists to respond. Editor's note: Responses have been lightly edited for clarity and length. Question: What external pressures in the orthopedic industry concerns you most today? Jason Brustein, MD. Orthopedic surgeon of Resurgens Orthopaedics (Atlanta): e external pressure in the orthopedic industry that is most concerning to me centers around reimbursement. In our current environment, there has been a "rush to the bottom" in terms of cost that is fostering negativity amongst those providing these essential services. e greatest impact on this is felt primarily in the care of our government-pay patients where declining reimbursement is creating a model that is not favorable. In my conversations with colleagues there is tremendous concern that access to specialty orthopedic care could become limited if we cannot find creative solutions to create a model that fosters continued patient access to specialists, is respectful of surgeon time/expertise and is sustainable long-term. Nicole Montero Lopez, MD. Director of Orthopedic Hand Surgery of RWJBarnabas Health Northern Region (West Orange, N.J.): Ten years into my practice, my primary concern is the unsustainable divergence between declining reimbursements and the escalating costs required to meet modern patient expectations. We are currently navigating a significant paradox: while payers continue to reduce the valuation of surgical services, the market demand for personalized, highly accessible care has never been higher. Today's patients rightfully expect a seamless experience defined by digital accessibility, cost transparency and clear communication. However, the sophisticated systems and specialized personnel required to deliver this level of service represent a major capital investment. When you couple these rising operational overheads with an administrative environment that demands more of a surgeon's time for documentation and prior authorization, the 'margin squeeze' becomes a significant challenge to the long-term viability of the practice. Ultimately, it is becoming increasingly difficult to maintain the premium level of care patients deserve while the financial framework supporting that care continues to erode. We must bridge the gap between the high-tech expectations of 2026 and the economic reality of medical delivery. n A potential framework for evaluating spine tech investments By Carly Behm W ith more and more spine technologies entering the market, the decision whether to invest can be met with challenges between physicians and other stakeholders. It's a problem that Philip Louie, MD, said he wants to change. "Every time we bring in a new technology, it's like a fight," Dr. Louie, of Seattle-based Virginia Mason Franciscan Health, said. "Sometimes it's like who has the loudest voice and who has the most endurance. Surgeons want one thing but the hospital administration might say it's not possible … We don't have a good process, and every hospital has a different sort of value assessment and there's no universal way to start a conversation." His solution? Developing an enabling technology value index. Dr. Louie likened the ETVI to the Kelly Blue Book or Consumer Reports that serves as a conversation point for stakeholders including patients, surgeons, hospital leaders, payers and industry. The goal of it is to break down key factors for stakeholders and help parties avoid arguments over tech decisionmaking. "You just lay it out there," he said. "I think that we would basically say for example 'Here is this technology … Here's are the surgeon's priorities, here's the priorities of the hospital leadership, etc.' There's very few perfect technologies that score super high for every stakeholder group, but it starts the conversation and shows where the deficits are." Laying out these strengths and deficits may let physicians and leaders know how to account for them and come to a compromise. "But you can't really compromise or have a discussion until you understand what the other parties are interested or need, and this just sort of creates the initial floor to move on from," Dr. Louie said. Dr. Louie has been working on a Delphi study involving multiple stakeholders from surgeons to hospital leadership, payers and medtech workers. "The reception to it has been fun as people are interested in the surveys that we're developing to try to hone things down," Dr. Louie said. "I think everyone recognizes that it's a really challenging process and that there needs to be some uniformity between them … I'm not saying this will cure all of that by any means, but at least I can help start it. We all know that the costs are crazy right now, and healthcare doesn't have a ton of money, and systems are losing money, and this helps the responsible evaluation of spine technology. n

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