Prepare for value-based sports medicine care
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Orthopedic surgeons who specialize in sports medicine are aware of the increasing impact of consumerism and competition on their practices. Patients increasingly use online resources to initiate treatment and select health care providers.
The initial focus is a correct diagnosis and a plan for return to preinjury activities. However, with greater availability of data, personal research often leads to questions about outcomes and treatment cost. Added to the complex decision process is the variability of health care insurance with high deductible plans, cash-only offerings for market-driven regenerative medicine products and orthobiologics, and the growing presence of non-sports medicine professionals with unsubstantiated and unproven claims.
A commitment to value-based care is needed to preserve orthopedic sports medicine and patients’ trust in our profession. We need to work toward a system that allows us to collect, analyze and present outcomes data to patients, colleagues and the public. This is not a new concept. However, the need to collect outcomes that truly represents the patient’s perspective and experience are at an all-time high due to external influences that erode our practice opportunities. Outcomes need to be linked to the total cost of care.
To grow and maintain a thriving practice, patient-reported outcomes should be analyzed with the cost of essential resources needed to provide the best value to patients. The more comprehensive the data, including domains that reflect overall wellness, the more likely consumers who seek sports medicine expertise will pursue care with professionals who have patients at the center of the care model.
The transition from a fee-for-service surgeon-centered practice to a value-based care practice can be frightening. Value is usually based on the number of clinic visits and surgical cases performed, OR revenues and the accumulation of work-related value units, as well as contributions to ancillary services. However, many patients with sports medicine-related problems do not need the expertise or expense of an orthopedic surgeon. When injuries require surgery, the options require a high level of expertise, skilled surgical technique, expensive resources, delayed recovery and have the potential for a compromised or an inability to return to sport.
This is the environment in which orthopedic surgeons offer a unique skill set and outcomes. If a vertically integrated system is established, many patients will go to nonsurgical sports medicine providers and the orthopedic surgeon will see less than three new patients for every scheduled surgery. Currently, without a clinically integrated unit or service line directed toward sports medicine care, it is not uncommon for an orthopedic surgeon to see eight to 10 new patients for every surgery scheduled. This raises the overall cost of care for that population and incentivizes a higher rate of surgery that may not have been indicated if the nonsurgical care component was pursued with evidence-based treatment.
Concerns about revenue generated from a certain patient population has led to many practices having an authoritative alignment that leads to decisions best for the surgeon, not necessarily the patient. Orthopedic sports medicine specialists need to move toward a value-based care model to care for patients and athletes in the future. To effectively provide lower costs while maintaining and improving outcomes, we need to embrace the development of evidence-based protocols that reduce unsupported variation in care throughout the continuum of care and help create performance benchmarks to manage the decisions of providers in a vertically integrated care model.
Variations in outcome identified by objective data can drive a system that educates members of the sports medicine team to improve care through education created to remedy the results that fail to provide a patient experience and the outcomes that are consistent with the best available care. Patients with performance-related injuries are provided with an increasing set of resources that will steer them toward orthopedic sport medicine specialists who embrace and promote a value-based care approach, which prioritizes and puts the patient at the center of the health care delivery model.
- For more information:
- Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
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