A New Model for Non-Operative Orthopedic Care BY L A N G A S TO N
“The more things change, the more they stay the same.” The French writer Jean-Baptiste Alphonse Karr had it right, at least as far as orthopedic care is concerned. Most people would argue that the U.S. has the most advanced medical system in the world, and our approach to orthopedic care specifically is widely lauded as exemplary. Technological advancements have improved recovery time and outcomes, while the trend from inpatient to less expensive outpatient settings has continued to lower costs and improve patient access. Yet with these improvements, musculoskeletal care remains the most expensive and fastest growing segment of our U.S. healthcare system, fueled by a growing demand from an aging and more sedentary population. In a new era of value-based healthcare, maybe it’s a good time to step back and ask ourselves, “Is this working?” According to JAMA, musculoskeletal conditions cost the U.S. over $400 billion annually, or 10% of all healthcare spending.1 That is more than cancer or cardiovascular disease. Lower back pain is one of the top reasons people crowd primary care offices or emergency rooms. Medications (e.g., opioids) and injections are often the tool of choice for many looking for a quick way for the pain to go away. Other patients are sent on to receive unnecessary imaging scans or see specialists without first seeking more conservative and cheaper treatments. And with the proliferation of digital healthcare, dozens of new companies are selling the promise that musculoskeletal telehealth will provide a suitable replacement for in-person care. In short, while we have come a long way to improve procedures and reduce surgery complications, we have only poured fuel on the fire of runaway orthopedic spending—with no measurable return on investment. The opportunity to embrace a value-based world is there—if only we can push away from the dock.
You are prescribed some medication to take the edge off until you can get back to walking upright again. Meanwhile, after weeks of waiting, you get an MRI and are told not only do you have a ruptured disc, but you also have degenerative disc disease and should go see an orthopedic surgeon. You are referred to a pain management physician for steroid injections. Frustrated from lack of improvement, you go to a surgeon and are told you should have surgery to fix the disc problem.
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As the healthcare industry has embraced the path to value, the time for non-operative orthopedic care management has arrived.”
As a patient, you question whether that is the best solution, but no one is there to provide guidance, so you get back on the internet for more research. You discover that your employer has an orthopedic benefit with a wearable device for your low back pain, and you spend frustratingly long hours trying to figure out if you are doing your exercises correctly. Unfortunately, this is a true story and one of millions annually that painfully illustrate how our system is too fragmented, siloed, expensive, and misaligned, and puts the patient last. In a fee-for-service world that rewards volume over value, it’s not the system that is broken—it’s the design.
PUTTING THE PATIENT LAST The current system is not broken; it is working just as it was designed. The scenario plays out every day in the U.S. You hurt your back lifting too many weights at the gym, and you can’t walk the next day. You call your primary care doctor, who sees you in the office and tells you to get an MRI. 20 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Fall/Winter 2021
A DIFFERENT WAY FORWARD Over the past year, the healthcare system was forced to move online as the pandemic made it possible to seek care without crowding waiting rooms. Fee-for-service volumes for elective procedures decreased significantly
