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According to the Dartmouth Institute, “Payor-driven shared-risk payment models will force increased hospital/physician collaboration on programs that reduce cost and increase efficiency without sacrificing quality care.” Collection, reporting and application of operational, clinical and functional outcomes data will emerge as a primary driver for contracting and reimbursement, and will increasingly become a source of comparative effectiveness for physicians and hospitals. When conducting assessments, we routinely ask medical and hospital staffs what they collect for outcomes. While virtually every hospital and physician will acknowledge they should be (and should have been) collecting outcomes, very few actually do. Most hospitals reply that they collect patient satisfaction and mandated measures. The most common physician response is that they (anecdotally) have high patient satisfaction. One surgeon shared that an Oswestry was collected on every surgical spine patient but the information was not used. John Pracyk, MD, PhD, a neurological surgeon and medical director for the Center for Spine and Brain Health at Mercy Medical Center in Oshkosh, Wis., coined the term “surgical meritocracy” to denote a new culture of measurement. Because consistent and broadly based outcomes have not been collected, many surgeons are naturally skeptical of the means and uses of such data. Dr. Pracyk’s experience is that measurement precedes understanding and provides a genuine basis for improving care and substantiating value. “The surgeon may believe they are good, but does someone who’s keeping score or paying for care believe they are good? Physicians will be weighed, measured, and perhaps found wanting. Performance of all types, including the level of patient engagement and satisfaction are now, or will soon be, subject to measurement.” While this can be a challenging transition, Dr. Pracyk offered encouragement. “This is the new culture that could bring a new found honesty and satisfaction back to the practicing surgeon,” he says. “Being able to translate outcomes data into actionable items is the next step.” At present there are few nationally established standards for collection of orthopedic, spine and pain care outcomes. Several professional associations have initiatives to define standards but none are universally accepted. This absence creates opportunities for physicians and hospitals to advance the definition of best practice for outcomes. When done properly, outcomes collection, reporting and application is a joint responsibility for hospital and physicians. Because of their operational infrastructure and resources, in most cases, initiatives should be resourced by hospitals and collaboratively managed by both hospital and medical staff. Defining quality With the advent of pay for performance and other reimbursement models, hospitals and physicians will increasingly measure and report data such as: Time to do more of what you want to do, including surgery. Your profession will consume as much of your time as you allow. ASC ownership with Blue Chip Surgical helps you coordinate and balance the important things in your life. A healthy caseload, of course, being one. www.bluechipsurgical.com/insights 513-561-8900 BC_BeckersAd_Time.indd 1 2/8/10 5:16:21 PM 10 10th Annual Orthopedic, Spine and Pain Management-Drive ASC Conference – Full Conference Brochure Inside, p. 31 • Patient experience • Functional outcomes (i.e., non-surgical, post-surgical/interventional results) • Operational data (i.e., ALOS) • Clinical indicators (specialty specific) • Financial data (i.e., contribution margin, market share) This data will be used to benchmark individual hospital and physician care against national, regional and payor data on a specialty specific basis. Additionally, data can be used to seek specialty certification, accreditation, preferred reimbursement, or in the mid- to long-term, inclusion or exclusion from provider panels. This will require investment now to yield long-term benefits. Our perspective is that there will be a window of opportunity for hospitals and their medical staff to proactively and collaboratively define quality metrics with their payors. While the Centers for Medicare and Medicaid Services and other government agencies will proceed with quality and payment demonstrations; community, academic and private hospitals have an incredible opportunity to pilot with private payors on a small scale and proliferate novel and effective models of care and management. Furthermore, rather than being dictated to, providers can collegially define quality and best practice. According to physiatrist John Hart, DO, of PeaceHealth Medical Group, “This is the time for institutions and hospitals to learn from their past and step into the future. By inviting the insurers, not only to the table, but into the living room and having a long discussion on what the ideal future should look like, proactive institutions and physicians can be fundamentally involved in constructing their future in matters of quality. Simply put, if we do not engage with payors, they will dictate the future to us ... and with reason.” With the history between providers and payors being antagonistic, such proactive collaboration can result in trusted partnerships that lead to true innovations and sustained engagement. Changes in reimbursement and greater physician-hospital
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