Value-based care (VBC) has become the buzz phrase in every healthcare strategy meeting. CMS, payers, and consultants all promise better quality at lower cost if we just “align incentives” and “focus on outcomes.”
For small O&P practices, that pitch is both an opportunity and a potential trap.
What VBC Really Means in O&P Terms
On paper, VBC ties payment to outcomes, quality, and total cost of care instead of sheer volume. Avalere Health’s white paper on VBC and O&P puts it clearly: payers want models that reward prevention, coordination, and patient-centered function—not just devices.
That sounds promising because O&P already fits the value-based care mold. When patients receive the right prosthetic or orthotic care, research from the Dobson DaVanzo report shows their total Medicare costs fall over the next 15–18 months while mobility and independence rise. In other words, O&P services already create the “value” policymakers are chasing.
The reality, however, is that nearly all current VBC models position O&P as a downstream cost within someone else’s bundle—usually a hospital, accountable care organization, or large physician group. They hold the contract and the risk; O&P shows up on the spreadsheet.
Why O&P Still Stands to Gain
- Recognition for the value you already create.
Your work keeps people safe, mobile, and out of the hospital. When local health system leaders understand that story—and see supporting data—O&P stops looking like a “nice-to-have product cost” and starts looking like a strategic lever for hitting quality and cost targets. That’s leverage in any partnership discussion. - Earlier and deeper integration in the care team.
CMS’ VBC materials emphasize person-centered, coordinated care. O&P clinicians often know a patient’s real-world function better than anyone else, yet we’re rarely included at the care planning stage. A value-based lens gives you the language to argue for earlier involvement—before falls, before deconditioning, before preventable rehospitalizations. - Potential upside from outcome measurement.
If your patients walk farther, fall less, and stay out of acute care, the system saves money—and under a true value model, you should share in those savings. Practices already tracking outcomes can turn “doing the right thing” into measurable credit rather than unpaid effort.
Where the Trap Starts to Close
All of that opportunity comes with strings attached. The same qualities that make O&P valuable also expose you to risk in a formal VBC environment:
- Outcomes depend on variables you don’t fully control (therapy, patient adherence, follow-up care).
- Bundled payment targets are often designed for hospitals, not small device-based specialties.
- If decision-makers see O&P as a procurement line item instead of a clinical partner, the easiest way to “optimize the bundle” is to squeeze your reimbursement or internalize the service.
That’s the start of the trap: taking on more accountability for outcomes while remaining on the margins of the financial arrangement.
In Part 2, we’ll cover what it actually costs a small practice to “do VBC” and how to stay on the front foot—without getting burned.
Scott Williamson, MBA, CAE (ret), is the president of Quality Outcomes and the executive director of education and events for OPIE Software. He can be contacted at scott.williamson@opiesoftware.com.
