Orthopaedic surgery is under continuing attack by the federal government, and private insurance companies have followed this lead to reduce the reimbursement for our services. With a failing Medicare financing system and an aging population, part of the plan for balancing the Medicare budget includes further reductions in the reimbursement for surgical procedures commonly performed on Medicare patients. The disproportionate level of reductions indicate a lack of appreciation for the value of our services to patients and to society. For decades we have been assessing and comparing the results of various treatment methods within the musculoskeletal disease segment. It is now incumbent upon us to demonstrate the value of orthopaedic surgery, to the public and to payers, as compared to the value of other services outside the musculoskeletal disease segment.
Value is the ratio of quality to cost.
Trying to combat falling reimbursement with arguments based on value is challenging because both true costs and quality are difficult to measure. To demonstrate the true value of orthopaedic surgery we need to compare outcomes across disciplines. It is ironic but fortuitous for orthopaedic surgery that total hip and total knee replacement have been targeted for further reduction in reimbursement. It is ironic because these interventions have been closely followed since their introduction and the outcomes of these procedures are among the most well-documented. It also is fortuitous because, based on a number of outcome measures, there is a consistent and marked improvement not only in physical function but also in social interaction and overall health, following total hip and knee replacement.