Issue: July 2021
Disclosures: Romeo reports he receives royalties from, is on the speakers bureau, is a consultant and does contracted research for Arthrex.
July 15, 2021
2 min read

Use the compass of ‘Quadruple Aim’ to incorporate innovations, resources into practice

Issue: July 2021
Disclosures: Romeo reports he receives royalties from, is on the speakers bureau, is a consultant and does contracted research for Arthrex.
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The upcoming AAOS Annual Meeting will showcase the tremendous growth in innovation and technology recently seen in orthopedics. We are experiencing a transformation of orthopedics from a surgeon-based mentality to a patient-based focus unlike any other paradigm shifts seen in our profession.

It is helpful to understand innovations based on the “Quadruple Aim,” which provides enhanced patient experience, improved quality of population health, reduced costs of care and improved clinical experiences and work-life balance for health care providers. The concept provides a compass to the future of health care.


During the COVID-19 pandemic, the acceptance of telehealth changed almost overnight. It was supported by reasonable reimbursement and liability-protection policies led by the federal government. As the pandemic subsides, telehealth continues to evolve because patients support this method and the ability to connect, assess and initiate care continues to improve.

Anthony A. Romeo, MD
Anthony A. Romeo

Advances in telehealth enhanced the patient experience. We are learning how to perform simple follow-up visits, routine postoperative visits, pre-surgical discussions, wound evaluations and radiological or other testing results reviews. Researchers assess the best methods for remote physical exams and identify key movements or activities that can accurately assess the status of surgical intervention. Innovations with wearable technology and phone-based applications to monitor and measure range of motion and other biometric parameters inform us of patient progress and outcomes. Telehealth has also helped improve the availability and equity of care.


Innovations in the quality of care come from all aspects of orthopedics. From the ability to measure change in pre-intervention status to the results of nonsurgical and surgical interventions, imaging technologies provide detailed information for diagnosis and improved treatment. This also includes precision tools, such as software-aided preoperative planning, intraoperative guides, robotics and augmented reality. As we improve the quality of care based on patients’ perspectives, we also improve the precision of our interventions with sophisticated technology coming from many different disciplines.

The desire to reduce the cost of health care has unevenly affected the health care system. Physician reimbursement has been an easy target for the government and third-party payers. Reimbursement for some Medicare cases prevents migration to an ASC environment even though this is in the best interest of the patient. Alternative payment models have been proposed and trialed, including bundled payment plans. However, the models can be difficult to manage and tend to migrate toward a minimal margin to sustain and grow the program.

More sophisticated technology and third-party businesses that will move toward a population health model are on the horizon. Larger orthopedic groups are developing “carve outs,” thereby accepting the financial risk of providing musculoskeletal care for groups of patients. Remaining revenue after providing benchmarked quality of care can create an opportunity for sustained physician compensation and practice growth.

The concept that improved clinical experience for the provider will facilitate the first three aims of health care has led to increased awareness of burnout and depression. This state of mind adversely affects productivity and is associated with a higher risk of medical and surgical errors. Innovations include improved technology to reduce administrative burden, workflow, autonomy and sense of control through evidence-based clinical care pathways and physician-directed data analytics.

Rapid transformation

To create the future in orthopedics, use the compass of the “Quadruple Aim” to incorporate innovations and resources. Keep in mind the perspective that the patient and patient-physician relationships will be the center of the best health care delivery systems.

We are experiencing the most rapid transformation of technology and innovation ever seen in our lifetimes. Use the “Quadruple Aim” to appreciate areas where your practice has incorporated it. Look for new solutions to improve patient experience, quality of care, cost and professional satisfaction.