Health Policy Challenges and Reforms: Critical Updates for Orthopaedic Surgeons.

Abstract

» 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.