We must be good physicians in the office and OR
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In patient care, especially in the OR, orthopedic surgeons are tasked with making important decisions on patients’ health, functional restoration and safety. These decisions take place in a matter of minutes, yet impact the rest of a patient’s life.
In many areas, our care and expertise has reached a level that patients and payers routinely expect successful outcomes. Our focus has been on outcomes and the quality of the interventions provided. However, for the past 20 years, there has been an increasing prioritization on the value of care. Increasingly, the pressure to control the growth of health care costs has led to new methods of determining the impact and expertise of physicians.
Today, the best orthopedic surgeons for a health care system are defined not only by their diagnostic, nonsurgical and surgical expertise in musculoskeletal conditions, but also by their ability to provide patient experiences that distinguish the practice from ordinary care and achieve high satisfaction.
Value-based metrics
Value-based metrics were initially designed to assess the interactions patients had with the various components of the health care delivered. It included assessments of the nursing and ancillary staffs, physicians and even workers not directly related to providing care. The measurements and results are now considered part of the value assessment of the care provided. Their importance has intensified as costs are increasingly displaced to patients, which has heightened the emphasis on consumerism as a way purchasers and payers can increase efforts to drive value-based care through patients, not physicians.
By providing an environment where patient experience and satisfaction are emphasized, health care systems and providers can attract more patients, which provides the opportunity to reduce costs, further advancing the value-based imperative. Access to care in a timely manner, evaluations that respect the patient’s time, good communication skills to educate and set expectations, and the availability of advanced imaging and technology can correlate to improved patient experiences and patient satisfaction scores.
These metrics may or may not correlate to traditional methods of measuring quality of the care. Patients may have improved outcomes when specifically assessing pain relief, range of motion, strength and function, yet complain about their overall experience and be dissatisfied with the value of the care. These components of quality and value can no longer be separated as patient experience has become increasingly present on public domains that rate physicians and health care systems, with low ratings suggesting poor quality of care.
As the business of health care specific to orthopedic surgeons responds to the driving forces of consumerism, patient satisfaction scores are used to assess the overall value of the surgeon to the health care team, the ability to grow the practice and the impact of their practice behavior on the overall perception and financial strength of the practice or organization. With the approval of satisfaction questionnaires and scores as a component to define the value of care by the federal government, then subsequently tethered to reimbursement and incentives, even single-specialty orthopedic practices must factor this into the compensation model knowing the government now pays for nearly 50% of the health care spend.
Driving forces
Orthopedic surgeons must appreciate and respond to the force of consumerism, supported by government and third-party payers, by making efforts to provide the best patient experience possible. Integral parts of a great patient experience should include timely appointment scheduling, the surgeon being on time, access to medical information, including study results and surgical reports, and good communication skills, including the ability to converse face-to-face with patients. Of course, the surgeon should remain up to date with evidence-based treatments and surgical skills to provide the best opportunity for functional restoration and outcomes.
Patient experience and patient satisfaction are not the same. Patient satisfaction with a surgeon will be based on whether the patient’s expectations were met. Surgeons will be increasingly evaluated based on patient satisfaction scores.
One critical component for patients is the sense of the amount and quality of care they received in the office setting. Surgeons should listen carefully to patients; face patients directly and not type into a computer with their backs turned. A working diagnosis based on a careful history, physical exam and radiographs will help patients appreciate efforts to understand them. If necessary, additional tests, especially high-tech imaging studies, support your effort to identify the best treatment. Providing nonsurgical and surgical options provides comfort and lets patients know you are considering all options for care through shared decision-making.
Surgeons cannot define their value solely by their surgical skills. They must also be excellent physicians in the office to define their true value to the health care system or practice.
- 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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