Bozic Value-Based Health Care in Orthopaedics

Chapter 16: Orthopaedics as a Service Line

focus on value-based health care. Providing high-value care for patients has shifted to become the primary goal, with value defined as quality of care and outcomes relative to cost. 5 Because value is dependent on outcomes achieved, rather than volume of services rendered, there has been an ideologic paradigm shift within health care and orthopaedics, changing the focus from volume to value. 6 Value improvement has shown to benefit patients, physicians, hospitals, and payers while further increasing health care economic sustainability. 5 Specialized service lines allow both hospital administrators and physicians to monitor out comes objectively and allow resource allocation while delivering optimal patient care. 4,7,8 A notable trend has been reported in the establishment of orthopaedic ser vice lines across large health systems nationally to achieve high quality care at lower expense. 4,7,9,10 COMPONENTS OF AN ORTHOPAEDIC SERVICE LINE An orthopaedic care transformation service line allows health care providers to adopt an integrated, streamlined patient care pathway, track relevant clinical and patient data, and allocate resource consumption efficiently. A streamlined care path way through the establishment of a horizontal hierarchal system is critical, which allows simultaneous multidisciplinary patient management, especially those requir ing subspecialty services. 4 Increased collaboration among clinicians can improve patient safety throughout the episode of care and generate better outcomes by using evidence-based practices and minimizing variations in care. However, physician alignment is one of the greatest challenges to a successful service line as multiple physicians and physician groups may have different ideas, goals, and priorities. Independent physician practices often have competing investments in ancillary ser vices including ambulatory surgery centers, physical therapy, and imaging facili ties that can further obscure a common vision with a hospital service line. Hospital administrators must be able to demonstrate to orthopaedic surgeons on staff at their facilities how a care transformation service line can directly benefit both physician and patient outcomes and further improve quality of care. The value of orthopaedic service lines is embedded in the idea of value-based health care, which focuses on optimizing both clinical and economic success. Clinical success is measured through patient-reported outcome measures, com plications, patient experience, and procedural survivorship. 11,12 Economic success is based on financial profitability for both hospitals and physicians alike, contri bution margins, and overall market share. 4 A relatively new idea is that economic success is also based on saving the healthcare system and society money which can be passed along to patients through decreased premiums. It is critical for hospital administrators, payers, and surgeons to ascertain common goals before investing varying time, effort, and resources into establishing practices. The close working relationship with orthopaedic surgeons and vendor representatives can lead to the introduction of new, expensive products and technologies. 13 If hospital admin istrators and surgeons are not aligned in common principles and cost-containing strategies, the surgeon and hospital relationship can become strained if surgeons begin to view hospitals as inhibitors to progress. 13

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Value-Based Health Care in Orthopaedics