Improving Value in Musculoskeletal Care Delivery

Abstract

Improving value in musculoskeletal health care has emerged as an important objective in both the United States and Canada. In order to achieve this objective, providers need to have a clear definition of value and an infrastructure for measuring outcomes of interest to patients and costs over the episode of care. Although national patient registries have been established in the United States and Canada, they nevertheless lag behind other registries worldwide in terms of collecting patient-reported outcomes and capturing data from a wide cross-section of hospitals and physicians. With the help of professional medical societies and the creation of national initiatives, patient-reported outcomes data collection on a large scale may be possible, but many challenges remain regarding implementation. Alternatives to the fee-for-service payment model, including pay-for-reporting and pay-for-performance, may help incentivize physicians and health-care providers to obtain and improve on patient-reported outcomes data collection. Other payment reforms, such as bundled payments, have been piloted in certain regions, but their sustainability and long-term success are unclear at this time. Novel health-care delivery strategies aimed at improving quality, coordinating multispecialty care, and enhancing patient participation in shared decision-making have shown promise in improving patient-centered outcomes, but delivery models continue to vary greatly throughout the United States and Canada. The current status of musculoskeletal health-care delivery requires substantial change before the goal of improving patient outcomes and lowering health-care costs can be achieved.

Pay-for-performance in orthopedics: how we got here and where we are going

“…Defining and improving value in orthopedics has been deemed a critical issue of the American Orthopedic Association [3]. To succeed in an environment where competition itself is of value, providers must (1) understand the value of service, (2) create an infrastructure to measure and report outcomes relevant to patients, and (3) understand the actual cost of care while actively engaging to lower cost through aligned incentives [3, 6•, 7].…”

“…To advance quality of care in the USA, improved registries are needed [3]. The USA has lagged behind some other countries in this endeavor.…”

“…The USA has lagged behind some other countries in this endeavor. P4P, via MIPS, should incentivize physicians to engage in patient-reported outcome data collection, thereby increasing participation and establishment in registries, and eventually leading to optimized quality of care [3]. However, there is concern this may limit the "art of medicine," and create homogenized care [6•].…”

“…Combined with the everrising cost to Medicare beneficiaries reliant on the sustainable growth rate formula, the IoM findings prompted policymakers to redesign the Medicare reimbursement model to be more focused on value of care rather than volume. Under the FFS model, overutilization of resources without regard to quality of care was rewarded financially [3]. Over the next several years, the Centers for Medicare and Medicaid Services (CMS) studied initiatives to bend the cost curve while promoting quality outcomes; this culminated with the passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA).…”

Quality and Value in an Evolving Health Care Landscape

“…Similar initiatives are under way in many other parts of the world. 3,4 A firm understanding of the definitions and influence of quality and value on current and emerging health initiatives allows the hand surgeon to better prepare for these initiatives and help shape them.…”