LAS VEGAS — Reimbursement. Physician pay. Value over volume. All are words that were pretty common at the American Association of Orthopedic Surgeons (AAOS; Rosemont Illinois), annual meeting held last week at the Venetian/Sands EXPO in Las Vegas.

Physicians are having to shift their way of thinking – from volume or amount of procedures done, to getting better results for the patient from those procedures. Several panels and even a round table discussion at the conference delved into the issue at length – seemingly putting the punctuation mark on the upcoming changes.

"We're in the midst of a major transition in paying for value instead of volume," Thomas Barber, Chair of the AAOS Council on Advocacy, said during a round table discussion on Wednesday afternoon.

At the center of the talks is the ailing sustainable growth rate (SGR) formula, which Congress has used patch after patch to fix. But a permanent fix is needed and accountability will be more stringent for physicians and the device makers that provide them their tools.

"The burden of proof won't be to say it's a fancy technology, but that it improves quality and costs," Barber said. "Where we're looking for device vendors to help is to be able to track our prosthetics and [implants]."

The key will be able to tell how well these devices have served the patient, since reimbursement and pay models will revolve around performance and patient satisfaction. There has already been some work done in this area in the form of the American Joint Registry.

The registry is 4-year, $12 million national research project funded by the Agency for Healthcare Research and Quality (AHRQ) and has surpassed its original goal, culminating in the establishment of the most comprehensive U.S. database on total hip and knee joint replacement patients and their surgical outcomes.

A consortium of more than 150 surgeons from representative practices across the U.S., led by researchers at the University of Massachusetts Medical School (Worcester) collected information from more than 30,000 diverse total joint replacement (TJR) patients to establish a statistically significant cohort for the AHRQ-funded database. FORCE-TJR goes beyond the traditional collection of information on only implant device failure or repeat surgeries. It is the first U.S. TJR database to include PROs - patient-reported measures of pain and function pre- and post-surgery, as well as clinical measures such as readmission and infection rates, adverse events, clinical co-morbidities and other patient risk factors and demographics that may influence patient outcomes.

"This registry will allow us to compare prosthetics around the world," he said.

While its a start, there is a sense of urgency to get it full steam. Barber noted that on the ground level, most physicians are not aware of the scope of the issue and what it could mean.

"Most people [surgeons] today don't understand that 6% of their pay is at risk," he said.

But the message at the conference was that surgeons had best get prepared for their worlds to change and to take ownership to help develop and mold a model where they defined quality and not government agencies or elected officials.

"The healthcare reform train left along time ago," said Stuart Weinstein, Professor in the Department of Orthopedics and Rehabilitation for University of Iowa Health Care (Iowa, City), in a panel dealing with reimbursement issues that was held prior to Barber's round table discussion with journalists. "We need to embrace change. The Affordable Care Act is not going away. [Orthopedic surgeons], not the government, and not the insurance companies need to determine [quality measures] for orthopedics."

To further illustrate the point fellow panelist Mark Piaso, orthopedic surgeon at DuBois Regional Medical Center (Dubois, Pennsylvania), put up a slide with quality metrics and values physicians should follow. The problem – it was totally illegible. Looking like a Microsoft excel spread sheet that would give even the toughest statistician eyestrain – the chart was an illustration of what quality measures would look like if defined by an outside agency.

"If we don't get right what we're doing then this is going to be our reality," Piaso said as he pointed to the chart. He gave a final plea for surgeons to get involved before this reality can come to pass.

"It's a new market," he said. "It's a new world, let's embrace it."