Bozic Value-Based Health Care in Orthopaedics

Chapter 16: Orthopaedics as a Service Line

• Creating a surgeon-centric culture that speaks to surgeons’ lifestyle and performance needs is important • A successful orthopaedic service line needs to be reflective of orthopedists’ specific practices including the technological needs and wants

All stakeholders must continue to improve future outcomes by learning from past mistakes

A surgeon champion will help drive programmatic change and provide leadership both on a macro and micro scale within the healthcare organization

Administration Champion

Operational Team

Program Vision

Future Vision

Surgeon Champion

Service Line Director

Administration champions need to understand a surgeon’s perspective regarding clinical, perioperative, and postoperative growth, areas for improvement and optimization

Clearly articulating common goals and the vision of the service line provides all staff members, physicians and stakeholders a clear direction and sense of purpose

Case management, perioperative nursing, physical therapy, multidisciplinary physicians all need to be committed to the program’s common vision and goals

neglecting the necessary resources to provide a special patient experience. 13 Because orthopaedic care is predominantly elective for quality-of-life improve ment, patients often select their physicians. Perioperatively, the care provided often transforms a medically stable individual into a sick patient for the short term. Because transient patient disability is often anticipated postoperatively from orthopaedic surgeries, approaching patient care with a high-touch model by proactively addressing patient concerns by preventing any potential pitfalls and obstacles will improve the patient experience. This approach to patient care can help distinguish orthopaedic service lines from its competitors and help bolster its clinical reputation in the community, which can ultimately drive procedural volume. MUSCULOSKELETAL POPULATION HEALTH As health care transitions from volume-based to value-based care, alternative pay ment models have been created to incorporate quality and cost into the reimburse ment process. The fee-for-service (FFS) reimbursement model is the traditional and most commonly used health care model, whereby providers charge based on individual services (including diagnostic and therapeutic) rendered. FFS is a vari able system, unless explicitly capped, because providers can increase their profits (indefinitely) by providing more services. Although FFS facilitates access to care, it places little to no value on coordinating care across activities, providers, or set tings, which results in a fragmented healthcare system that makes it a challenge for patients and providers to navigate. FIGURE 5 Example of time-drive activity-based costing (TDABC) of a knee injection procedure. The left side describes the components of TDABC. The right side outlines all the steps that are used to calculate estimated cost. (Data from Keswani A, Sheikholeslami N, Bozic KJ: Value-based healthcare: Applying time-driven activity- based costing in orthopaedics. Clin Orthop Relat Res 2018;476[12]:2318-2321.)

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Value-Based Health Care in Orthopaedics