Unlocking the Digital Potential in Orthopedic Care

The musculoskeletal healthcare landscape has witnessed exponential changes over the past decade. From the paradigm shift from Fee for Service (FFS) model to value-based care and reimbursements, Medicare’s bundled payments that have significantly lowered costs for hip and knee replacements—patient-centricity is the key in today’s orthopedic healthcare ecosystem. Also, the Final Rule announced by the Centers for Medicare and Medicaid Services (CMS) on April 29, 2021 encompasses a key set of changes to the Comprehensive Care for Joint Replacement (CJR) model.

In the world of consumerism, the Orthopedic care industry comprises complex processes and systems that require comprehensive digital solutions to address the growing patient expectations. This blog is a deep dive into the various components of the orthopedic healthcare system and how organizations can harness digital to transform patient engagement, experience and maximize outcomes.

From the paradigm shift from Fee For Service (FFS) model to value-based care and reimbursements, Medicare’s bundled payments that have significantly lowered costs for hip and knee replacements—patient-centricity is the key in today’s orthopedic healthcare ecosystem

Top Challenges in the Orthopedic Space

Like many other specialties, the topmost challenge in the orthopedic industry remains to be staying independent. To overcome this, Physicians have taken a strategic route to venture into other healthcare related services including diagnostic centers, therapy centers and other business models that yield sustainable results. Orthopedic medical billing and coding is a critical challenge too. Involving complex workflows, the revenue cycle process needs a structured framework, a well-orchestrated strategy integrated with automated billing solutions—in order to streamline operations, enhance patient financial experiences, eliminate friction and optimize outcomes.

Common Causes for Denials in Orthopedic Coding

Unbundling

E/M services with injection

Knee bundles

Shoulder bundles

Fracture Care

Medical Policies

MUA

Imaging guidance

Chiropractic treatment

Source: Centers for Medicare & Medicaid Services (CMS)

Orthopedic healthcare systems are increasingly adopting digital solutions to accelerate health outcomes. Hospitals integrate automated patient engagement platforms to maximize efficiencies of care plans. Advanced orthopedic care coordination solutions and billing solutions leverage the capabilities of Artificial Intelligence (AI), analytics, wearables, Internet of Things (IoT) to combine large volumes of patient data to derive actionable health insights that transform care journeys at scale.

Healthcare personalization is also a key focus area where patients are provided tailor-made recommendations, appointment reminders, secure chat, pre, during and post-surgical care coordination, remote patient monitoring, analytics and reports to further enhance patient experiences and drive health outcomes.

Also Read:

2021 OPPS Final Rule: Key Takeaways from the CMS Policy

Medicare Physician Fee Schedule: CMS Update

CMS Proposes to Permanently Expand Telehealth Service Benefits

CMS Interoperability and Patient Access Final Rule

Top Tactics to get Upfront Healthcare Reimbursements during COVID-19: CMS Accelerated and Advance Payment Program

$2T Stimulus: Restructuring Healthcare Ecosystem

SolvEdge’s orthopedic patient engagement solutions are trusted by 450+ Hospitals, 4000+ Physicians and Millions of Patients across the globe. To learn how our orthopedic care coordination tools can accelerate your patient engagement strategy, talk to our team.