Value-based care models can reduce costs and improve outcomes for patients, but they are not without drawbacks. Sometimes, the model can lead to patient denials and higher pressures for physicians and surgeons.
Becker's spoke with orthopedic surgeon James Loging, MD, about the opportunities and obstacles posed by the integration of value-based care in orthopedics and spine.
Editor's note: Responses have been lightly edited for clarity and length.
Where do you see value-based care headed in orthopedics and spine?
James Loging, MD. Orthopedic surgeon at Palmetto Bone and Joint (Chapin, S.C.): Value-based care is a healthcare delivery model that focuses on achieving the best possible outcomes for patients, while also reducing costs. In the context of orthopedic and spine surgery, value-based care is becoming increasingly important as providers look for ways to deliver high-quality care while also reducing costs.
One of the key features of value-based care is the use of outcome-based payment models. In these models, providers are incentivized to focus on patient outcomes, rather than just the volume of procedures performed. This can lead to better outcomes for patients, as well as reduced costs for the healthcare system overall. For example, a provider who is paid based on the number of procedures performed may be incentivized to perform more procedures, even if they are not necessary. In contrast, a provider who is paid based on patient outcomes may be more likely to recommend non-surgical treatments or minimally invasive procedures, which can be less expensive and have shorter recovery times.
Another important aspect of value-based care is the use of data and analytics to improve patient outcomes. Providers are increasingly using data to track patient outcomes and identify areas where improvements can be made. A provider may use data to identify patients who are at risk of developing complications after surgery and then take steps to prevent those complications from occurring. Similarly, providers may use data to identify patients who are at risk of developing chronic pain after surgery, and then develop a customized treatment plan to address those risks.
In addition to improving patient outcomes, value-based care can also help to reduce costs. By focusing on preventive care and early intervention, providers can help to reduce the need for expensive procedures and hospitalizations. Similarly, by reducing the number of unnecessary procedures, providers can help to reduce the overall cost of care.
Despite the potential benefits of value-based care, there are also challenges associated with implementing this model. One of the biggest challenges is the need for accurate and reliable data. In order to implement a value-based care model, providers need access to comprehensive data on patient outcomes, as well as data on the cost of care. This can be a challenge, particularly for smaller providers who may not have the resources to collect and analyze this data.
Another challenge is the need for collaboration among providers. In a value-based care model, providers must work together to coordinate care and ensure that patients receive the right care at the right time. This can be a challenge, particularly in cases where providers are located in different geographic areas or work for different organizations.
An unfortunate consequence of value-based care would be the development of denial of care of certain patient populations. Patients are essentially denied care because they have comorbidities that make them higher risk, such as obesity and diabetes. This leads surgeons to deny these patients surgery because they are at higher risk leaving these patients unfortunately without the ability to receive care.
Despite these challenges, the trend towards value-based care is likely to continue in the coming years. Providers are under increasing pressure to deliver high-quality care while also reducing costs, and value-based care is one way to achieve these goals. In addition, patients are increasingly demanding more personalized and effective care, and value-based care can help to deliver on these expectations.