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11.1%

Rising Operational Costs Outpacing Reimbursement Rates

Orthopedic practices face an average 11.1% year-over-year increase in operational costs — from implant pricing and surgical supply chains to staffing for pre-authorization workflows — while value-based care reimbursement models like bundled payments for total joint arthroplasty (TJA) episodes-of-care leave little margin for administrative overhead. With adults over 65 generating 37% of diagnostic tests and 34% of inpatient procedures, the volume of Medicare patients under fixed reimbursement rates compounds the squeeze.

Patient No-Shows Disrupting Surgical Scheduling and Post-Op Care Pathways

No-show rates for post-operative follow-ups and pre-surgical clearance appointments directly impact OR block utilization and care continuity for procedures like rotator cuff repair, ACL reconstruction, and total knee arthroplasty. Each unfilled slot represents lost revenue under episode-based contracts and delays patient progression through standardized recovery protocols — especially critical when managing outpatient pathways at ambulatory surgical centers (ASCs) where turnover efficiency determines profitability.

Administrative Burden from Prior Authorizations and Claims Denials

Orthopedic practices spend disproportionate staff hours on prior authorizations for high-cost interventions — robotic-assisted orthopedic surgery, patient-specific instrumentation, orthobiologics (PRP, BMAC), and bioresorbable implants — with denial rates climbing under increasingly stringent medical necessity criteria. Manual follow-up on peer-to-peer reviews and appeal letters pulls clinical staff from patient-facing work, while delayed authorizations push elective cases, disrupting surgical scheduling and patient satisfaction scores tied to value-based incentives.