Issue link: https://beckershealthcare.uberflip.com/i/1546655
39 SPINE Dr. Gibson sees a potential unintended consequence. An older patient with an arthritic knee may need a full examination to rule out hip or spine pathology before receiving an injection during the same visit. If reimbursement falls below the cost of providing the injection, practices could have a financial reason to schedule the procedure for another day. at means another appointment, another trip and another delay. Dr. Gibson said his practice has calculated the cost of the supplies, medication and staff involved in an injection. At half payment, he said, the economics may no longer work. Orthopedics has already been asked to lower the bill Dr. Gibson's frustration also reflects orthopedics' participation in Medicare cost-containment efforts. Surgeons have moved appropriate procedures from hospitals into ASCs and participated in bundled payment programs. Practices have also invested in registries, electronic health records and patient-reported outcomes. "We've been saving costs for Medicare through the bundles and through moving people to ASCs," he said. "And even though we're saving the money, we're penalized." Dr. Gibson supports value-based care and wants physicians involved in designing longitudinal musculoskeletal models, with opportunities to share in savings when they accept risk and reduce total costs. His broader argument is that reducing physician reimbursement is not necessarily the same as reducing the total cost of patient care. A surgeon who prevents a hospitalization, keeps an appropriate joint replacement in an ASC or reduces post-acute utilization may generate savings well beyond the professional fee. 'Put things on pause' AAOS is not asking CMS to abandon payment reform. It is asking for time. "Let's freeze what we have right now," Dr. Gibson said. "at's not our long-term solution." AAOS wants CMS to maintain 2026 payment values while working toward a more sustainable model. CMS is accepting comments through Sept. 14, and Dr. Gibson said AAOS is coordinating its response with orthopedic subspecialty organizations. e rule remains proposed, meaning CMS could change payment values or revise individual policies. e closures, acquisitions and access problems Dr. Gibson describes remain warnings, not foregone conclusions. His concern is that some consequences would be difficult to reverse. A reimbursement cut can change in the next fee schedule. A physician who retires may not return. An independent practice absorbed by a hospital is unlikely to reappear the following year. A rural community that loses its orthopedic surgeon cannot easily replace decades of experience. Aer more than 30 years watching orthopedic practices become more efficient, participate in bundles, move surgery outpatient and absorb reimbursement reductions, Dr. Gibson's concern about 2027 is not whether orthopedics can adjust again. It is what the healthcare system may lose in the adjustment. n ADVERTISINGINDEX Note: Ad page number(s) given in parentheses Clorox Healthcare. cloroxhealthcare.com (pg. 2) Custom Surgical Partners. customsurgicalpartners.com (pg. 11) Innomed. innomed.net / 1.800.548.2362 (pg. 3) JDJ Consulting. jdjconsulting.net / 1.609.313.7572 (pg 23-26) Karl Storz Endoscopy-America. go.karlstorz.com/karlstorzdifference (pg 31-33) Moximed. moximed.com (pg. 13-18) Stryker. stryker.com (pg. 40)