Daniel Resnick, MD, Professor of Neurological Surgery at the University of Wisconsin School of Medicine and Public Health and Research Council Director for the North American Spine Society, discussed the value of spine care at the North American Spine Society Annual Meeting.
He addressed the move from volume-driven healthcare to value-driven healthcare. Value is quality over cost — the problem is quality and costs in spine surgery are not well defined. Currently, surgeons are reporting several measures to the Centers for Medicare and Medicaid Services to assess quality, with 35 percent based on patient satisfaction measures.
"These have been shown to be unreliable, they are inversely correlated with costs and complications," said Dr. Resnick. He cited a study that found the most satisfied patients were the most sick patients who spent the most time at the hospital and used the most resources. However, they didn't necessarily have the best outcomes.
"There are a whole lot of things that go into satisfaction of your care and medical outcome probably isn't a huge determinant of that which is strange since we are really in charge of the medical outcome. It can be quite discomforting to be measured on these perimeters," Dr. Renick said.
The remaining 65 percent of the measures are process measures, which include DVT prophylaxis, perioperative antibiotics, diabetes control and smoking cessation counseling. While these measures "make sense," Dr. Resnick said there isn't any evidence to show they improve outcomes.
"We are spending so much money on trying to get a little bit back that it's totally a perverse incentive in terms of many of these process measures, so these aren't really good either," said Dr. Resnick. However, there is hope, he said. New leadership within CMS could have an impact on how they interact with physicians.
CMS is now turning to medical societies to determine what spine surgeons need to measure. The idea is to collect measurements that are relevant and important for surgeons and patients, and measures surgeons have control over.
He then touched on the importance of comparative effectiveness research, saying that it could benefit spine surgeons. Comparative effectiveness research can show what treatments work the best with which patients and those treatments can be administered as the first line of treatment. Registries need to reflect the real world, he said, and collect meaningful outcomes.
Effective registries must be simple to use. The NASS registry is working on a diagnosis-based registry to compare outcomes, which has made the registry more difficult to design. On Jan. 28, 2014 NASS announced Ortech Data Centre would design and manage the NASS registry. The registry includes a heterogeneous population; allows comparison between treatments, risk stratification and compares natural history data.
"The real reason we want to do this is improve patient care," said Dr. Resnick. In every registry effort to date, he said, outcomes have improved as a result. "We should not be afraid of collecting our data."
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