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Appropriateness criteria could decrease inappropriate TJA procedures

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To control the cost and demand of elective procedures, such as joint replacement surgery, U.S. health care leaders should determine which patients are most in need of elective procedures through new appropriateness criteria, even if the achievement of savings will depend on the acceptance of the criteria by physicians and patients, according to a perspective recently published in the New England Journal of Medicine.

“The purpose behind establishing criteria is to use evidence-based metrics to prioritize patients most in need. We don’t want to sacrifice necessary care when thinking of cost-containment,” Hassan M.K. Ghomrawi, PhD, MPH, assistant professor of public health at Weill Cornell and an outcomes research scientist at Hospital for Special Surgery, stated in a press release. “Evidence-based criteria, if applied wisely and fairly, may be the most powerful tool for controlling the cost and enhancing the quality of elective procedures.”

Current cost-containment proposals focus primarily on payment reforms, such as pay-for-performance and bundled payments. But in the perspective, the authors conclude that the development and implementation of evidence-supported criteria that identifies the appropriate patients who are most likely to benefit from surgery will also slow the increasing costs of the procedures.

“Although implementing appropriateness criteria for total joint arthroplasty has not succeeded in the past, there are reasons why it is more likely to work now,” Bruce R. Schackman, PhD, chief of the division of health policy and associate professor of public health at Weill Cornell, stated. “Opinion leaders in the U.S. orthopedics community recognize the importance of such criteria, and health information technology has developed to allow more sophisticated appropriateness criteria to be integrated into decision-support tools.”

Reference:

Ghomrawi HMK. N Engl J Med. 2012;doi:10.1056/NEJMp1209998.

Disclosure: Ghomrawi and Schackman have no relevant financial disclosures.