The most contentious trends in orthopedics


Three orthopedic surgeons connected with Becker's to discuss what they believe to be the most contentious surgical and nonsurgical trends in orthopedics today. 

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next question: How will surgeons in 10 years look back at how orthopedic procedures are performed today?

Please send responses to Riz Hatton at by 5 p.m. CDT Thursday, March 30.

Note: Responses have been lightly edited for length and clarity.

Asheesh Bedi, MD. Director of Comprehensive Sports Medicine and Joint Preservation at NorthShore Orthopaedic & Spine Institute (Glenview, Lincolnshire and Skokie, Ill.): There are many active trends in orthopedic practice that are generating controversy and some frustration amongst surgical providers. Probably one of the most common areas of discussion is around a more rigorous preauthorization process for advanced imaging as well as both nonsurgical therapies (i.e. viscosupplementation injection) and surgical interventions.  Practitioners feel more burdened with the additional peer-to-peer consultations and documentation requirements and more frustrated with payor-dictated practices that are restricted by consultants who are not directly involved in the care of the patient. The workload and economic impact of patient cancellations is significant. Striking a balance of evidence-based decision-making that is economically responsible, but also respectful of provider judgment and experience is critical to the future of musculoskeletal practice.

Louis Levitt, MD. Chief Medical Officer of MedVanta: Value over volume should always be the top priority of clinical practice. The contentious surgical trend is whether doctors have a low threshold for selecting surgery when there may be more appropriate care pathways. In the current fee-for-service environment, surgeons are reimbursed for performing surgery. Consequently, surgeons often bypass more conservative care plans and are in favor of a more aggressive surgical care option. Orthopedics, like other surgical specialties, is long overdue for data-driven clinical decision-making. Data should be the basis of creating a comprehensive treatment plan for the patient. The surgeon must ask themselves: What will produce the best outcome? Often, focusing on social factors such as improved psychology, weight loss and general medical optimization will in fact eliminate the need for surgical considerations. Data is in fact the currency of value-based care.

In the nonsurgical sphere, the contentious trends involve private equity aggressively trying to control healthcare. Private equity has no place in healthcare because private equity is profit-driven, not value driven. The business of medicine is currently replacing clinical healthcare decision-making. Private equity's goal is to increase profitability in three to five years and sell the practice for a profit. Healthcare must remain in the hands of physicians to combat this ongoing issue. Physicians need to come together to leverage their clinical strength and push back against private equity. 

Isador Lieberman, MD. Orthopedic Surgeon at Texas Back Institute (Plano): The most egregious and contentious trend in orthopedics today is the insatiable desire of nonsurgeons to become proceduralists. This desire is fueled by medical device manufacturers' unconscionable marketing efforts in response to Wall Street pressure. Those who can't recognize when they are in trouble, or are unable to get themselves out of trouble should not be doing spinal surgery. 

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