What’s Orthopaedic Surgery Worth?

Recent health policy decisions by government and payers seem to question the value of orthopaedic surgical procedures. For example, Medicare Recovery Audit Contractors have targeted total knee replacements, reviewing cases and denying claims based on insufficient documentation of medical necessity.

In Oregon, regulations recently enacted a value-based insurance design (VBID). With a VBID, patients pay less for higher valued healthcare services—such as treatment of chronic conditions and primary care—and more for lower valued healthcare services, which may also be elective or higher cost procedures. Oregon’s Public Employees’ Benefit Board determined that five common orthopaedic procedures, including total knee and total hip arthroplasty (TKA and THA), were “preference-sensitive”—or of a lower value—and assigned $500 co-pays to each of them.

But orthopaedic surgeons know how much patients value their total knees and total hips—and realize that keeping patients moving and living independently, and getting them back to work delivers high value to society. Friday’s symposium on “The Social and Economic Value of Orthopaedic Surgery” makes that case concrete.

The AAOS commissioned KNG Health Consulting, LLC, and its partner, IHS Global, to examine the societal and economic value of musculoskeletal care for a broad range of conditions and treatments. The study findings demonstrate that treatment for the selected conditions—end-stage osteoarthritis of the knee, hip fracture, disk herniation, rotator cuff tears, and anterior cruciate ligament tears—is cost-effective and that the benefits to society, in terms of increased earnings, avoided nursing home costs, and other factors, offset the direct costs of treatment.

This symposium represents the culmination of a two-phase project to develop a model for valuing musculoskeletal care. With the growing emphasis on increaing the value of the U.S. healthcare system, data such as these will be increasingly important to ensure that patients have access to these treatment options.

Join AAOS President John R. Tongue, MD, in Room S406 at 8:00 a.m. on Friday, March 22, and discover how this important study can help you make the case for the value of orthopaedic surgery.

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS22_3_21.asp