Charting a Roadmap for Value-based Surgery in the Post-pandemic Era

Functional Outcomes of a Musculoskeletal Integrated Practice Providing Comprehensive Whole Person Care for Hip Osteoarthritis

“…Multiple value-based care models have been launched in the United States over the last decade that shift accountability (and risk) onto physician and hospital providers [8,20]. Although such models have generated some cost savings, the reductions have largely occurred as a result of changes to referral practices (eg, reduced post-acute care utilization) and artifactual changes following coding modifications, rather than meaningful transformation through innovation in care delivery [20].…”

“…Multiple value-based care models have been launched in the United States over the last decade that shift accountability (and risk) onto physician and hospital providers [8,20]. Although such models have generated some cost savings, the reductions have largely occurred as a result of changes to referral practices (eg, reduced post-acute care utilization) and artifactual changes following coding modifications, rather than meaningful transformation through innovation in care delivery [20]. Furthermore, they fail to address the issues of appropriateness, studies suggest that up to a third of joint replacement surgeries for OA in the United States may be inappropriate based on appropriate use criteria leading to poor patient satisfaction and functional outcomes [21].…”

“…Furthermore, they fail to address the issues of appropriateness, studies suggest that up to a third of joint replacement surgeries for OA in the United States may be inappropriate based on appropriate use criteria leading to poor patient satisfaction and functional outcomes [21]. The COVID-19 pandemic has further exposed the lines of stress in current operating models in health care and reinforced the interest in more equitable, whole person models of care [20]. The opportunity to provide comprehensive models of care that improve quality, outcomes, and experience of care through value-based payment and practice reform remains untapped.…”

The Tipping Point of Medical Technology: Implications for the Postpandemic Era

“…There is growing impetus for surgeon-anesthesiologist to collaboratively participate in the "hospital-at-home" paradigm. 13,14 Improving effectiveness and efficiency through clinical pathways will also reduce hospitalacquired infections and other complications, thereby reducing length-of-stay-all of which are paramount as we define the "new normal" in perioperative care. Therefore, current successful experience with remotely triaging and managing asymptomatic COVID-19 patients can pave the way to widespread future RPM implementation in the postoperative discharge setting.…”

“…Others have also suggested this window as a launching point for discussion on value-based care approaches in surgical and perioperative team-based settings. 13 Working collaboratively will incorporate all members of a multidisciplinary team, including surgeons, anesthesiologists, nurses, physical therapists, and others, to embrace care delivery models that promote high value and efficient clinical care pathways and empower patients and caregivers through their coproduction and increased use of patient-reported outcomes.…”