Information Statement

The Scope of Orthopaedic Practice in Managed Care Arrangements

This Information Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

In our rapidly changing practice environment, managed care organizations are establishing risk sharing arrangements with providers for the management and delivery of musculoskeletal care. In some instances, orthopaedic surgeons are not able to contract for the provision of musculoskeletal care relating to certain anatomical areas, such as the foot and ankle. Instead, these contracts are being awarded to other types of providers. Thus, health care delivery systems are being created which deny patients with musculoskeletal problems access to the type of care which is most appropriate for their conditions.

The American Academy of Orthopaedic Surgeons (AAOS) opposes any arrangement in which orthopaedic surgeons are excluded from the provision of musculoskeletal care. We believe that this type of arrangement detracts from the overall continuity and quality of musculoskeletal care that we, as a specialty, are best qualified to deliver and which our patients need and deserve.

Orthopaedic surgeons are trained in the diagnosis and treatment of disorders affecting the bones, joints, and soft tissues of the entire spine, the upper extremities including the hand, and the lower extremities including the foot. Orthopaedic surgeons treat patients of all ages requiring acute and chronic care. They are trained in the cost-effective use and interpretation of laboratory and musculoskeletal imaging tests and procedures, the use of prostheses, orthoses, and physical modalities as well as the appropriate referral to allied health care providers. By virtue of their medical background and training, orthopaedic surgeons can coordinate the resolution of musculoskeletal problems, including certain neurological and rheumatological conditions, in conjunction with primary care providers.

The AAOS further asserts that orthopaedic surgeons are by training, qualifying exams, and experience, preeminent providers of musculoskeletal care. The scope of practice for orthopaedic surgeons is broad and well defined and should be recognized as such.

In an effort to counter attempts to fragment the management and delivery of musculoskeletal care, the AAOS makes the following recommendations:

1. Orthopaedic surgeons should be proactive and aggressive in educating the public, patients, provider networks, and managed care organizations and other payers on their scope of practice, training, and ability to manage and deliver cost-effective musculoskeletal care.
2. Orthopaedic surgeons should counter attempts by any managed care organization or other payer, or provider network to exclude orthopaedic surgeons from providing musculoskeletal care for specific anatomical areas.
3. Orthopaedic surgeons should pursue as much risk for musculoskeletal care, under a managed care contract, as they are qualified and prepared to assume. They should learn to subcontract with other orthopaedic surgeons, and allied health professionals, as necessary, and act as secondary referral sources so that they remain in the pivotal role of ensuring the overall quality of musculoskeletal care.
4. Orthopaedic surgeons should become educated in the complexities of establishing business relationships with managed care organizations and collaborative arrangements with other providers. This calls for new skills in contract negotiation and practice management.
5. Orthopaedic surgeons should use the resources of the AAOS, of their state medical and state orthopaedic associations, independent consultants, as well as their own research to prepare for the rapidly changing and competitive marketplace.

© October 1994 American Academy of Orthopaedic Surgeons

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons®.

Information Statement 1008

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