Using financial incentives to improve value in orthopaedics.

Area of Science:

• Health Economics
• Orthopaedic Surgery
• Healthcare Policy

Background:

• Healthcare reforms are shifting payment and benefit designs in the US.
• Financial incentives are increasingly considered for orthopaedics, but their implementation and impact on quality and cost are unclear.

Purpose of the Study:

• To review physician- and patient-oriented financial incentives in orthopaedics.
• To discuss challenges and prerequisites for payment reform and value-driven policies in orthopaedics.

Main Methods:

• Searched MEDLINE for provider payment and consumer incentive models.
• Reviewed 169 articles, none met inclusion criteria; supplemented with Google searches for known orthopaedic incentive models.

Main Results:

• Reviewed provider incentives (payment for reporting, performance, safety, episode payment) and patient incentives (tiered networks, value-based design, reference pricing, value-based purchasing).
• Challenges include lack of cost-reduction evidence and complex existing payment schemes.
• Prerequisites for reform include data infrastructure, new business structures for cost sharing, and adjusted patient expectations.

Conclusions:

• Insufficient literature exists to determine if implemented financial incentive models in orthopaedics improve quality or reduce costs.
• National cost concerns will drive continued experimentation, requiring enhanced collaboration and data reporting for successful innovation.