DOI: 10.2106/jbjs.rvw.24.00192 ISSN: 2329-9185

Health Policy Challenges and Reforms: Critical Updates for Orthopaedic Surgeons

Peter Boufadel, Mohamad Y. Fares, Mohammad Daher, Abhay Mathur, Patrick Saunders, Joseph A. Abboud, Hafiz F. Kassam

» Medicare reimbursement: Physician payments have declined 29% since 2001, straining practice sustainability. Proposed legislation (H.R. 2474) could align payments with inflation, although concerns persist about its fiscal impact on Medicare.

» Medicare advantage: These plans provide benefits such as cost caps and premium-free options for patients, but increase administrative burdens, delay care, and restrict provider networks for physicians.

» Prior authorization: Intended to ensure appropriate care and control costs, prior authorization frequently delays treatment, raises administrative workloads, and contributes to physician burnout. Proposed reforms aim to balance efficiency and oversight.

» Noncompete clauses: Advocates argue noncompete clauses protect healthcare investments, but critics highlight their role in limiting physician mobility, disrupting patient care, and reducing competition. Legal challenges to a federal ban add uncertainty.

» Physician-owned hospitals: Supporters emphasize physician-owned hospitals' high-quality care and competitive benefits, whereas detractors warn of risks such as conflicts of interest, inequities in patient access, and strain on community hospitals.

» Advancing nonopioid pain management: Nonopioid strategies reduce dependency risks and improve recovery but may require additional resources and upfront costs. Policies such as the Non-Opioids Prevent Addiction in the Nation Act aim to incentivize their use.

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