Cost, Margin, Mission, and Value: What Every Leader Should Know About the Business of Orthopaedic Surgery

Abstract Orthopaedic surgery, long defined by clinical and academic excellence, now exists within a health-care system increasingly shaped by economic pressures and structural reform. Faced with growing pressures to deliver high-quality outcomes, manage cost, and preserve mission-driven priorities, the field is a focal point for health system transformation given its procedural and financial magnitude. To examine how orthopaedic leaders are balancing cost, margin, mission, and value, this American Orthopaedic Association (AOA) symposium report brings together perspectives from 4 diverse institutions: a fully academic center, an integrated health system, a hybrid institution, and a physician-led multispecialty group. Panelists explore institution-specific approaches to containing costs, incentivizing physicians, supporting financially sustainable growth, and fostering cultures of clinical excellence. Discussions emphasize the importance of transparent costing methods, thoughtful incentive structures, and quality improvement strategies. The report also highlights how orthopaedic surgeons can engage in organizational decision-making by developing a deeper understanding of the financial levers that influence both departmental and system-wide outcomes. As reimbursement models shift and resource constraints grow, orthopaedic surgeons are uniquely positioned to lead. However, this leadership must extend beyond the operating room. By engaging with the business of health care, orthopaedic service lines can remain clinical cornerstones while also driving a system’s transformation.