Quality has always been extremely important in healthcare, but the Patient Protection and Affordable Care Act refocused providers toward data-driven results.
New catch words like "patient-centered care" are at the tip of everyone's tongue, but truly what is the spine surgeon's role? Have their responsibilities changed or did healthcare reform just usher in the status quo with a new name? Max Steuer, MD, a spine surgeon with Peachtree Neurosurgery and on staff at Northside Hospital Health System in Atlanta discusses how to balance cost and quality to provide better patient-focused care in the future.
"Healthcare reform and the advent of [accountable care organizations] have put the focus more firmly on quality in every arena of healthcare, including spine care," says Dr. Steuer. "In fact, the subjectivity of choosing spine care options, as well as the ubiquity of the need for spine care, makes this area an important focal point."
1. Adverse incentives sometimes shape quality measures — take a patient-centric view. Providers, payers and other healthcare organizations are developing treatment protocol for patients that may or may not have the patients' best interest in mind. Focusing just on quality could miss opportunities to provide lower-cost healthcare, while protocol based on cost data could compromise outcomes. As data is released on patients and providers, it's important to note extenuating circumstances.
"Unfortunately, some payers are focusing solely on dollars expended when rating physicians and hospitals," says Dr. Steuer. "With this methodology, the physicians who do instrumented cases are essentially penalized, even if their cases are the most appropriate and cost effective means of resolving the patient's clinical issue. Based on our respective experiences, we believe it's important to take a patient-centric long view in determining what quality measures to use."
2. Knowledge empowers decision-making; don't let new opportunities slip away. Never-before seen tools for gathering massive patient data is now available in one spot and mining that data is quicker than ever. Patient data registries at the local and national level — like the American Association of Neurosurgeons' National Neurosurgery Quality and Outcomes Database (N2QOD) — allow surgeons to examine cases submitted from across the country and see how other surgeons were successful in cases similar to their particular patients. These new initiatives are invaluable to surgeon decision-making and could produce much better outcomes at lower overall cost to the healthcare system.
"The initial model [of N2QOD] is focused on lumbar spine outcomes, which is clearly one of the critical areas of focus," says Dr. Steuer. "As a general principle, more knowledge empowers surgeons to make better choices for their patients; therefore, we are not working with blinders on which enables us to be better advisors to our patients on the efficacy of their options."
3. Healthcare is becoming consumer-drive. How can you add value? Healthcare data on quality — and increasingly cost — are published online for all potential patients to see. The general public is more computer- and internet-savvy than in the past and a huge percentage of patients research their providers before even stepping into their medical practice. Patients seek out providers who can have excellent outcomes with low costs, as well as provide a great patient experience.
"As more insurance plans move toward increasingly consumer-driven healthcare, we have also found that our staff have a growing, prominent role in providing patients with accurate information on their cost exposure, even as we counsel them on which clinical options are appropriate," says Dr. Steuer. "The complexity is daunting for patients and we are here to help with that."
One of the ways surgeons can impact patient satisfaction is finding ways to add value to the patient experience, which might include joining an ambulatory surgery center as a facility with traditionally lower infection rates, higher patient satisfaction and lower-cost site of care. "We understand that we are all in this together," says Dr. Steuer. "The trend toward ambulatory care is another example of ways in which physicians and healthcare systems can provide leadership in the area of cost-containment."
4. Liability hangs over healthcare decisions and could hamper the optimal cost/quality balance. The ACA didn't include meaningful tort reform, so unless medical liability changes were made at the state level over the past few years, most physicians still feel the burden of lawsuits down the road with every decision they make. Delaying surgical intervention, ordering too many tests and acting too cautiously to avoid medicolegal issues could negatively impact the quality and cost of care.
"[Spine surgeons] in particular always strive to make choices for the patient based on truly aligned incentives. The shadow of litigation is cast over much of what we do, but with maturity of judgment and effective risk management practices, we believe spine surgeons and their respective practices can successfully navigate these, at times, turbulent waters."
5. Patient partnerships are the new frontier. Surgeons are becoming more aligned with hospitals, surgery centers and payers, and in the future achieving patient-centered care will require partnering with the patient as well. "We believe patients are increasingly going to have to gauge for themselves the value of the care they receive and allocate their expenditures accordingly," says Dr. Steuer. "We, as physicians, are here to partner with patients through that process and I believe that relationship will be increasingly crucial."
Surgeons will make changes in their practice, but it's short-sighted to only focus on dollars per incident of care. Cutting corners that sacrifice value will lead to trouble. "These choices must always be made with consideration toward the value for the patient," he says.