Navigating the MSK Decision Gap: A Clinical Perspective

The Orthopedist's Evolving Role and Responsibility in Delivering Direct MSK Care

Written by April John, MD

It’s too easy to make a bad MSK decision.
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I'd have a hard time finding someone to dispute this claim from the patient's perspective.
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However, there's less discussion about the clinical complexities orthopedic care providers encounter in decision-making, especially in a direct care setting.

Executives and physician leaders of independent orthopedic groups, well positioned own the end-to-end MSK journey by “going direct”, will find themselves facing new clinical challenges and asking new questions.

This piece presents two such challenges in this new light:

• The impact of comorbidities in orthopedic management
• The pressure of cost-conscious care

By highlighting these challenges and sharing my direct care insights, I hope to spark a deep conversation between you and your physician leaders on your group's evolving clinical role in responsibility on your journey to remain independent and achieve sustainable growth.

Challenge one: The impact of comorbidities in orthopedic management

In the United States, 75% of health dollars go toward treating chronic conditions with related comorbidities. Patients with chronic MSK conditions commonly live with comorbidities.

• 62% of people with osteoarthritis had at least one comorbidity. (Hypertension (37%), heart disease (8%), and diabetes (7%) being most common.)
• 30% of people over 45 who report living with a chronic condition, also have a MSK condition.
• Over 50% of people who live with comorbidities are under 65 years of age.

Diabetes drill down

Diabetes is widely recognized as causing significant morbidity and premature mortality.

What’s less known is diabetes is associated with a number of MSK conditions.
(See Table A.)

These musculoskeletal problems are essential to recognize because of their impact on quality of life, particularly as many respond to treatment, helping to prevent complications in a patient’s care journey.¹

Table A‍

For the effective treatment of MSK conditions, especially in the presence of diabetes, care should involve orthopedic surgeons, endocrinologists, primary care physicians, physical therapists, and potentially other specialists like cardiologists and neurologists.

My direct care insight

Optimized structures and pathways of care are necessary to achieve the best outcomes for patients with comorbidities and the associated conditions of MSK.‍

Integrated care models where communication pathways are clearly established are essential.‍

These measures can all ensure healthcare providers are on the same page regarding the patient's overall health status and treatment plans:

• Regular multidisciplinary meetings
• Shared electronic health records
• Designated care coordinators

Challenge two: The pressure of cost-conscious care

Physicians are ethically responsible for providing the best medical care.

But they face challenges:

• Medical bills are a major cause of bankruptcy in the U.S., even for insured patients.²
• Doctors often don't know how their choices affect patient costs.
• Many tests and treatments may not improve health, like routine lab tests or unnecessary imaging.³

A study found:

• Physicians are unclear about the main cost drivers in healthcare or don't see cost management as their role.⁴
• Yet, most agree on reducing unneeded tests (97%), following guidelines (98%), and managing costs (92%).
• But, 33% feel balancing cost concerns with patient welfare is unfair.
• 40% worry cost pressures may compromise patient care, particularly in prescribing medications or conducting essential tests.

My direct care insight

A strategy to combat the contradicting forces of cost-effectiveness and quality begs us to answer the following questions:

• How do we develop strategies to balance cost efficiency with the highest standards of patient care so that physicians can focus on providing quality care
• What technologies can be implemented to support clinical decision-making for cost-effectiveness without compromising health outcomes?
• How do we create frameworks that enhance communication and collaboration amongst healthcare providers to mitigate these risks?

In summary

Navigating the MSK decision gap is complex with systemic and ethical challenges.

To ensure optimal patient care, an integrated approach across specialties, supported by technology and clear communication, is essential.