Defining the Value of Spine Care Jeffrey A Rihn, Alexander R Vaccaro, Todd J Albert
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1Defining the Value of Spine Care2
3Defining the Value of Spine Care
EDITORS Jeffrey A Rihn MD Assistant Professor Department of Orthopaedic Surgery Thomas Jefferson University and Hospitals The Rothman Institute Philadelphia, PA Alexander R Vaccaro MD PhD The Everrett J and Marion GordonProfessor of Orthopaedic SurgeryProfessor of Neurosurgery Co-Director of the Delaware Valley Spinal Cord Injury CentreCo-Chief Spine Surgery Co-Director Spine Surgery Thomas Jefferson University and Hospitals The Rothman Institute Philadelphia, PA Todd J Albert MD Richard H Rothman Professor and Chairman Department of Orthopaedic Surgery Professor of Neurosurgery Thomas efferson University and Hospitals President - The Rothman Institute Philadelphia, PA Foreword David B Nash
4
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Defining the Value of Spine Care
First Edition: 2012
9789350254905
Printed at:
5I would like to dedicate this book to my wife Theresa, my children Maggie and Charlie, and my parents Tom and Karen. Their unconditional love and support have gotten me to where I am today and enable me to keep moving forward.
Jeffrey A Rihn
I would like to dedicate this book to a very special woman in my life, Lauren DeRitis, who lives a life of goodness, kindness, hard work and integrity, while having time to care and love for family and friends.
Alexander R Vaccaro
I would like to dedicate this book to our patients who have demonstrated the importance of measuring all that we do and the value of our interventions.
Todd J Albert6
7Contributors 11Foreword
More than a decade ago I was faced with a significant, personal health-related challenge. After three years of crippling sciatic pain, I was told I would have to undergo a transforaminal lumbar interbody fusion of L5 and S1 in order to seek long-term pain relief. As a tenured professor of Health Policy, at the time, within the nation's largest private medical school, I set out on a quest to better understand the outcomes of spinal fusion surgery.
Imagine my chagrin when I realized weeks later that there simply was no literature related to my personal health challenge. I felt abandoned by my own field of study and literally naked in the face of an important, potentially life altering surgical decision. Fortunately, I was able to find the best spinal fusion team (based on privately available data) right under my nose at the Rothman group on the campus of Thomas Jefferson University. Thankfully I had an excellent outcome and remain pain-free and very active in my personal life.
Today anyone contemplating similar surgery could simply reach for this wonderful new book by Dr Jeffrey Rihn and his colleagues. A book that I wish I had a decade ago!
Surely spinal fusion surgery has been vilified in the lay press as a poster child for everything that is wrong with our current healthcare delivery system. Spinal surgery, of all types, is clearly over-utilized and the best evidence we have, most especially from the Dartmouth atlas, shows inexplicable differences in the utilization of these services and equally confounding differences in the outcome from these procedures. In addition, recent national front page news in places like the Wall Street Journal, have called attention to other chicanery regarding payback for the use of particular spinal surgical hardware and the like. All in all, not a pretty picture.
In the face of this public scrutiny, both in the academic and lay press, Rihn and his colleagues have produced a critically important volume, perhaps representing a watershed event in the evolution of our thinking about defining value for spinal care. Their timing is exquisite. With the advent of health reform, I envision the world characterized simply by “no outcome, no income”. Every leader of an Accountable Care Organization or supporter of a Pay for Performance scheme will need to read this book.12
In short, it is all here. The current table of contents mirrors the scientific landscape regarding how we evaluate all aspects of spinal surgery, measure the processes, outcomes and decide on its ultimate economic value. When I read the book I felt like a kid in a candy store with an unlimited parental budget. I could not decide which chapter to read first.
Oftentimes, multi-authored edited texts share certain unenviable characteristics, such as an inability to link one chapter to another, sudden and jarring changes in style and approach. This book suffers none of those aforementioned shortcomings. In fact, it is a tightly woven story that to me reads almost like a novel as the critical aspects of spinal surgery are all equally well explained. Even a knowledgeable lay person would gain a great deal from a review of many of the important chapters present in this volume.
As the nation grapples with all the aspects of health reform, whatever one's politics, it will remain clear that we must deliver greater value for the resources we spend. This will be particularly true regarding all aspects of spinal surgical care as the population ages and thousands of baby boomers become eligible for aspects of surgical care. It is also axiomatic that there is no more money available in our broken system. This must mean then that given the declining dollars, the aging population and the coming of payment reform, the value story will be front and centre. This book ought to be the first purchase that every leader makes as we collectively grapple with these powerful social forces.
Kudos to Rihn and colleagues for their lucid prose, tightly organized arguments and compelling description of the need for change. I believe that Chapter 15 says it all on page 158, “creating value in spine care calls for transparency and consistency in the reporting of outcomes geared with incentives for better performance. Aligning interest to maximize quality of care for patients will enable lower costs by discouraging mistakes, fostering preventative care, and making efficient treatment decisions.” All I can add is simply, Amen!
David B Nash
Dean, Jefferson School of Population Health
Summer 2011
13Preface
Although value-based healthcare is increasingly impacting on our profession, the concepts of value in the context of healthcare are not widely understood. Specific to spinal care, the value of spinal procedures and interventions is neither widely discussed nor understood. The coverage of and payment for spinal care is, currently, and will be increasingly linked to the value of the care provided. For this reason, an understanding of these concepts of value is essential to the spine care provider. This book was written in order to introduce the concepts of value-based spinal care to the spine care provider. What is the definition of value in the context of spinal care? How is value determined? What outcome measures and cost measures should be used in the value equation? What is a cost-effectiveness analysis and how is it performed? How is the value of new spine-related technologies assessed? These questions and many more are answered within this book, which is written by well-recognized experts in the fields of spine care, outcomes measurement, healthcare policy, and healthcare quality improvement. The compilation of topics covered by this group of experts offers the spine care provider with an in depth understanding of the key concepts of value-based spine care. Furthermore, the book is very practical in that it provides the measurement tools and methods necessary to begin measuring value in your own practice. It is becoming more evident that spine care providers will be required to, in some capacity, measure the quality and value of the treatment that they provide. This book is intended to provide the necessary tools and understanding for this challenging task.
Jeffrey A Rihn
Alexander R Vaccaro
Todd J Albert