5 Points on Value in Orthopedic Surgery

Over the past few years, there have been major changes in the healthcare climate at local, regional, and national levels. Rising healthcare costs, an aging population, and exponential growth in new and expensive technologies have drawn the interest of providers, policy makers, insurance companies, and hospital administrators. Pressures to cut costs and maintain excellence in healthcare are constant and can be burdensome for orthopedic surgeons.

Compared with other medical fields, orthopedic surgery has attracted much attention, because of the high incidence of musculoskeletal disease, the increasing costs of orthopedic implants, and the relative paucity of high-quality evidence.^1,2 Although evidence-based practice in orthopedic surgery has become more commonplace, and the level of evidence and quality of orthopedic publications have improved over time,^3-5 improvements have been slow, and the current trajectory is unsustainable given the increasing costs of care.

Healthcare costs exceed 17% of the national gross domestic product (GDP) and are expected to rise to 20% of the GDP by 2020.⁶ In 2009, $2.5 trillion was spent on healthcare in the United States; this spending is projected to exceed $4.6 trillion by 2020. Per capita healthcare spending was $8000 in 2009 and is estimated to increase almost 70%, to $13,700, by 2020.

The relative contribution of musculoskeletal disease to these costs is alarming. In 2004, the estimated total cost of managing musculoskeletal conditions was $849 billion, or 7.7% of the GDP. Direct costs accounted for $510 billion of the total, or 4.6% of the GDP, and indirect costs accountedfor the rest.7 In 2005, more than 107 million US adults (1 in 2) reported having a musculoskeletal condition for more than 3 months, and almost 7% of US adults reported that a musculoskeletal condition made routine activities of daily living significantly difficult.⁷

Given the combination of increasing costs, an aging population, and the high incidence of musculoskeletal disease, orthopedic surgeons will face many challenges in the coming decade. Reimbursements will continue to decrease, patient volume will increase, and surgeons will find themselves under pressure to provide cost-conscious, effective care. We believe that applying the principles of value-based care in orthopedic surgery will lay the framework for necessary improvements in care and will significantly benefit both patients and the healthcare system through improved outcomes and reduced costs. [introductory paragraph]