Orthopedic Surgeons Decry Disconnect Between Insurance Policies and Clinical Reality

Surgeons say prior authorization delays, standardized codes, and quality metrics fail to capture the nuances of orthopedic care.

Published on Feb. 22, 2026

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Four orthopedic surgeons and leaders discussed the areas where insurance company policies clash with the day-to-day clinical realities they face. Key issues include prior authorization delays creating administrative burdens, standardized codes that do not measure case variability, and quality metrics that prioritize short-term cost savings over long-term patient outcomes and functionality.

Why it matters

Orthopedic care requires nuanced clinical judgment to account for each patient's unique physiological factors, medical history, and social support. However, insurance policies often rely on standardized metrics and approval processes that fail to capture this variability, leading to delays in care, increased administrative strain, and suboptimal patient outcomes.

The details

The surgeons cited several examples of the disconnect between policies and reality. Prior authorization requirements force patients to undergo step-by-step conservative treatments even when the surgeon deems immediate surgery necessary. Standardized billing codes do not reflect the complexity of each case, leading to denials and administrative burdens. Quality metrics focused on short-term costs and efficiency overlook the long-term benefits of more expensive but higher-quality interventions. Overall, the surgeons argued that insurance policies need to evolve to better recognize the clinical judgment of specialists, ensure timely access to appropriate care, and prioritize durable patient outcomes.

  • The Becker's Hospital Review article was published on February 18, 2026.

The players

Adam Bitterman, DO

Chair of the Department of Orthopaedic Surgery at Huntington (N.Y.) Hospital.

Cassandra Lee, MD

Orthopedic Surgeon and Chief of Sports Medicine of University of California at Davis Health (Sacramento).

Michael Russell, MD

Orthopedic Spine Surgeon and Past Chairman of OrthoLoneStar (Houston).

Alex Vaccaro, MD, PhD

President and Spine Surgeon of Rothman Orthopaedics (Philadelphia).

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What they’re saying

“One of the biggest disconnects between orthopedic policy decisions and day-to-day clinical reality is that policy is built around measurable metrics, while orthopedic care depends on nuanced clinical judgment.”

— Adam Bitterman, DO, Chair of the Department of Orthopaedic Surgery at Huntington (N.Y.) Hospital (Becker's Hospital Review)

“The time required to take care of patients doesn't match the productivity metric. Say you come in with knee injury, when I actually start seeing you, first clinic visit to get your history, examine you, look at imaging and come up with a plan. Sounds easy, but wait, I'm a specialist, so I have to get your images uploaded into my system so that I can view them, half the time patient doesn't bring their images (because they were told it was sent), the other half it supposedly accessible by a share agreement, but they still can be seen.”

— Cassandra Lee, MD, Orthopedic Surgeon and Chief of Sports Medicine of University of California at Davis Health (Sacramento) (Becker's Hospital Review)

“In my opinion, the biggest disconnect between orthopedic policy and day-to-day clinical reality is prior authorization. What was supposed to act as an administrative guardrail has evolved into a significant barrier to care. Prior authorization has seemingly prioritized standardized rules and checklists over personalized care and patient-centered decision-making.”

— Alex Vaccaro, MD, PhD, President and Spine Surgeon of Rothman Orthopaedics (Philadelphia) (Becker's Hospital Review)

What’s next

The article does not mention any specific next steps, as it is focused on highlighting the disconnect between orthopedic policies and clinical reality.

The takeaway

This article underscores the need for insurance policies and quality metrics in orthopedics to better align with the nuanced, patient-centered approach required in orthopedic care. Reforms are needed to streamline administrative burdens, recognize clinical urgency, and prioritize long-term patient outcomes over short-term cost savings.