Advertisement

Value-Based Health Care in Hand Surgery: Where Are We & Where Do We Go From Here?

Published:August 05, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.06.019
      Health care delivery is broken. The cost of care continues to skyrocket and the outcomes most important to patients are often a mystery. Further, care is often delivered via a fee-for-service model where surgeons are rewarded for the quantity, not the quality, of services provided. Such a health care delivery system is not sustainable and does not incentivize stakeholders to focus on the most important element of the health care delivery “puzzle”: the patient. Fortunately, we are in the midst of transforming our health care delivery system, with a focus on optimizing the value of care delivery (ie, health outcomes achieved per dollar spent across a full care cycle). In hand surgery, progress has been made as part of this health system evolution. However, there remains much to accomplish. In this article, the authors review the 6 components of a strategic agenda for moving to a high-value health care delivery system for hand surgery, focusing on where we are today and where we need to go from here.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Porter M.E.
        Value-Based Health Care Delivery: Core Concepts. Partners HealthCare Residents and Fellows Course.
        • Martin A.B.
        • Hartman M.
        • Lassman D.
        • Catlin A.
        National health care spending in 2019: steady growth for the fourth consecutive year.
        Health Aff (Millwood). 2021; 40: 14-24
        • Porter M.E.
        What is value in health care?.
        N Engl J Med. 2010; 363: 2477-2481
        • Porter M.E.
        • Teisberg E.O.
        Redefining Health Care: Creating Value-Based Competition on Results.
        Harvard Business School Press, 2006
        • Porter M.E.
        Institute For Strategy & Competitiveness: Value-Based Health Care. Harvard Business School.
        • Keswani A.
        • Koenig K.M.
        • Torchia M.T.
        • Jevsevar D.S.
        • Bozic K.J.
        Designing and implementing value-based care delivery and payment models for musculoskeletal care.
        Instr Course Lect. 2019; 68: 651-658
        • Porter M.E.
        • Lee T.H.
        Integrated practice units: a playbook for health care leaders.
        NEJM Catal. 2021; 2
        • Stukstette M.
        • Hoogeboom T.
        • de Ruiter R.
        • et al.
        A multidisciplinary and multidimensional intervention for patients with hand osteoarthritis.
        Clin Rehabil. 2012; 26: 99-110
        • van der Giesen F.J.
        • Nelissen R.G.
        • Rozing P.M.
        • et al.
        A multidisciplinary hand clinic for patients with rheumatic diseases: a pilot study.
        J Hand Ther. 2007; 20 (quiz 261): 251-260
        • Mou D.
        • Sisodia R.C.
        • Castillo-Angeles M.
        • et al.
        The surgeon's perceived value of patient-reported outcome measures (PROMs): an exploratory qualitative study of 5 different surgical subspecialties.
        Ann Surg. 2022; 275: 500-505
        • Vakalopoulos K.
        • Arner M.
        • Denissen G.
        • et al.
        Current national hand surgery registries worldwide.
        J Hand Surg Eur Vol. 2021; 46: 103-106
        • Calfee R.P.
        • Antes A.L.
        • Rozental T.D.
        • et al.
        Applying the Delphi method to define a focus for the National Outcomes Registry for Tracking the Hand (NORTH).
        J Hand Surg Am. 2021; 46: 417-420
        • International Consortium For Health Outcomes Measurement
        Standard Sets: Hand And Wrist Conditions.
        • Wouters R.M.
        • Jobi-Odeneye A.O.
        • de la Torre A.
        • et al.
        A standard set for outcome measurement in patients with hand and wrist conditions: consensus by the International Consortium for Health Outcomes Measurement Hand and Wrist Working Group.
        J Hand Surg Am. 2021; 46: 841-855.e7
        • Kaplan R.S.
        Improving value with TDABC.
        Healthc Financ Manage. 2014; 68: 76-83
        • Keswani A.
        • Sheikholeslami N.
        • Bozic K.J.
        Value-based healthcare: applying time-driven activity-based costing in orthopaedics.
        Clin Orthop Relat Res. 2018; 476: 2318-2321
        • Koehler D.M.
        • Balakrishnan R.
        • Lawler E.A.
        • Shah A.S.
        Endoscopic versus open carpal tunnel release: a detailed analysis using time-driven activity-based costing at an academic medical center.
        J Hand Surg Am. 2019; 44: 62.e1-62.e9
        • White M.
        • Parikh H.R.
        • Wise K.L.
        • Vang S.
        • Ward C.M.
        • Cunningham B.P.
        Cost savings of carpal tunnel release performed in-clinic compared to an ambulatory surgery center: time-driven activity-based-costing.
        Hand (N Y). 2021; 16: 746-752
        • Porter M.E.
        • Kaplan R.S.
        How to pay for health care.
        Harv Bus Rev. 2016; 94: 88-100
        • US Centers for Medicare & Medicaid Services (CMS)
        Bundled Payments for Care Improvement (BPCI) Initiative: General Information.
        • Freeman R.
        • Coyne J.
        • Kingsdale J.
        Successes and failures with bundled payments in the commercial market.
        Am J Manag Care. 2020; 26: e300-e304
        • Vanderbilt University Medical Center
        VUMC creates MyHealth Bundles, providing innovative options for employee health coverage.
        • Ding Q.
        • Trickey A.W.
        • Mudumbai S.
        • Kamal R.N.
        • Sears E.D.
        • Harris A.H.S.
        Prevalence and factors associated with low-value preoperative testing for patients undergoing carpal tunnel release at an academic medical center.
        Hand (N Y). 2022; 17: 28-34
        • Thompson N.B.
        • Calandruccio J.H.
        Hand surgery in the ambulatory surgery center.
        Orthop Clin North Am. 2018; 49: 69-72
        • Goyal K.S.
        • Jain S.
        • Buterbaugh G.A.
        • Imbriglia J.E.
        The safety of hand and upper-extremity surgical procedures at a freestanding ambulatory surgery center: a review of 28,737 cases.
        J Bone Joint Surg Am. 2016; 98: 700-704
        • Lalonde D.
        • Eaton C.
        • Amadio P.
        • Jupiter J.
        Wide-awake hand and wrist surgery: a new horizon in outpatient surgery.
        Instr Course Lect. 2015; 64: 249-259
        • Lalonde D.H.
        Latest advances in wide awake hand surgery.
        Hand Clin. 2019; 35: 1-6
        • Porter M.E.
        • Lee T.H.
        • Murray A.C.A.
        The value-based geography model of care.
        NEJM Catal. 2020; 1
        • Birkmeyer J.D.
        • Stukel T.A.
        • Siewers A.E.
        • Goodney P.P.
        • Wennberg D.E.
        • Lucas F.L.
        Surgeon volume and operative mortality in the United States.
        N Engl J Med. 2003; 349: 2117-2127
        • Woods L.
        • Slotkin J.R.
        • Coleman M.R.
        How Employers Are Fixing Health Care. Harvard Business Review.
        • Feeley T.W.
        • Landman Z.
        • Porter M.E.
        The agenda for the next generation of health care information technology.
        NEJM Catat. 2020; 1