January 21, 2025
4 min read
The intersection of politics and medicine shapes the trajectory of health care delivery in the United States.
The Affordable Care Act profoundly affected health care access, introducing alternative payment models beyond fee-for-service and ensuring care for preexisting conditions. However, despite improved access and national health expenditures that increased 7.5% to $4.9 trillion in 2023, the U.S. remains stagnant in global health care rankings. While overall health care revenue has dramatically increased, orthopedic surgeons face inflation-adjusted reimbursements that have steadily decreased, threatening private practices and driving many surgeons into employment.
Health care reforms
As we begin 2025, a new Republican-led administration signals the potential for significant health care reforms. These potential changes will influence the practice of orthopedic surgery — a specialty struggling to maintain world-class care within complex regulatory frameworks, reimbursement models, patient-centered care and a steady downward trend in reimbursement from the government and third-party payers.
This pivotal moment presents a unique opportunity for orthopedic surgeons to realign incentives and improve the environment for musculoskeletal care. To ensure our profession thrives, we must actively shape the policies that will define the future of health care.
The previous Republican administration emphasized deregulation, which was often thwarted by a polarized Congress. With more unified leadership in 2025, we will see efforts to reduce federal oversight, creating opportunities for orthopedic surgeons to lead in the establishment of musculoskeletal-specific quality care standards to drive best practices. Reducing compliance burdens tied to value-based care metrics can lower administrative costs and allow surgeons to focus on patient outcomes.
Collecting and analyzing quality and cost data specific to orthopedic care remains essential. Data-driven care should be the cornerstone of demonstrating the value of our services. Quality metrics must become the primary currency in health care, followed by contribution to the revenue of ancillary services, ensuring the focus remains on patient outcomes and experience rather than administrative checkboxes.
Previous efforts to introduce Medicaid block grants have granted states greater control in spending, often resulting in reduced or unpredictable reimbursement. These efforts further limited Medicaid patients’ access to the private sector, pushing the patients to government-subsidized institutions while the overall enrollment in the program steadily increases.
Advocacy at the state level is critical to establishing fair reimbursement priorities and ensuring equitable access to care for all patients, especially children. Orthopedic surgeons must engage with policymakers to address disparities and promote sustainable models of care.
Individual autonomy
The emphasis of the new administration on individual autonomy in health care decisions aligns with opportunities for private practice orthopedic surgeons to adopt direct-pay models. Transparent bundled payments, concierge care and direct-to-employer contracting may provide patients with predictable costs and access to high-quality care. Surgical tourism may also gain traction as patients seek timely procedures unavailable in their area.
Transparency and education will be crucial to empower patients. Surgeons must provide evidence-based guidance to help patients navigate the misinformation and make informed decisions. Technologies, such as orthobiologics, robotics, advanced surgical planning and augmented reality, will increasingly factor into discussions about care while also requiring honest appraisals of their benefits and limitations.
Holistic approaches to nutrition, lifestyle and alternative therapies align with improved health, but can also pose challenges for orthopedic surgeons. Unproven treatments for osteoarthritis and pain management may gain traction, which will necessitate orthopedic surgeons to guide patients toward evidence-based options. Medical device companies continue to introduce novel orthobiologic treatments based on studies, but without precisely determining limitations, potential risks and clear definitions of outcomes. To optimize patient outcomes, surgeons should discuss perioperative nutrition, the use of glucagon-like peptide-1 medications and nutraceuticals, which can impact the perioperative management.
Tort reform
Tort reform, a longstanding Republican objective, could gain momentum in 2025. Caps on noneconomic damages may lower malpractice insurance costs and reduce the need for defensive medicine, alleviating some financial and psychological burdens for orthopedic surgeons. A predictable legal environment could also encourage surgeons to perform high-risk but necessary procedures without fear of litigation.
State-level advocacy remains essential for advancing malpractice reforms, repealing noncompetitive restrictive covenants and certificate of need regulations, and improving oversight of health care mergers and private equity transactions. Efforts to streamline the prior authorization process, which frequently delays surgical care to the detriment of the patient, should also be a priority.
Be agile, proactive
As health care evolves, orthopedic surgeons must be agile and proactive. Employed surgeons should recognize employers may not always act in their best interests when systemic challenges arise. Collecting and leveraging patient-related data and realistic assessment of their contributions to ancillary revenue are vital to demonstrate value and negotiate fair terms with employers and payers. Outcomes data should guide continuous improvement in care delivery and empower patients to make evidence-based decisions.
The 2024 election underscores the need for collaboration and compromise. Political polarization often dominates the headlines. However, shared goals can unite policymakers and stakeholders. Debates that shackled meaningful legislative change in the past are now vulnerable as we evaluate purpose, efficiency, appropriate use of funding and benefit to patients.
Orthopedic surgeons have a critical role in shaping legislation that supports musculoskeletal care and addresses the health care challenges. Today presents an unparalleled opportunity to influence the future of our profession and the care we provide. Together, we can ensure orthopedic surgery in the U.S. remains the worldwide leader with a governmental policy that supports innovation, education, training and patient-centered care.
- For more information:
- Anthony A. Romeo, MD, is the Chief Medical Editor of Healio | Orthopedics Today. He can be reached at Healio, 6900 Grove Road, Thorofare, NJ 08086; email: [email protected].
Sources/Disclosures
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Source:
Expert Submission
Disclosures:
Romeo reports receiving royalties from, being on the speakers bureau and a consultant for, and doing contracted research for Arthrex.
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