Improving Value: Prespectives from Oral Surgeons

An interesting editorial appears in the 2014, issue of the Journal of Oral and Maxillofacial Surgery titled “The Value of Improving Value,” by James Hupp (pp. 843-845, issue 72). In this Dr. Hupp presents a formula for patient value

Value = A(Q + PS)/C

A = appropriateness, Q = quality, PS = patient satisfaction, and C = costs

The author states

“First, one can improve outcomes while keeping costs the same. Second, one can decrease costs while keeping outcomes the same. Or third, both outcomes and costs increase, but outcomes per unit of cost improve.”

In the article the author discusses how in the past, value in health care was really just about cost cutting. Clinical outcomes were not really taken into account. Now that health care outcomes are being considered, physicians need to find ways to measure value using the new equation.

Dr. Hupp describes an antidotal example of a group of Swedish orthopedic surgeons who discuss hip replacement strategies at a meeting and share their outcomes data. From this they saw some surgeons had better outcomes and attempted to learn why those surgeons had better outcomes. Dr. Hupp points out that sharing outcome data and then using this to improve outcomes is a process commonly used in the business world. He thinks oral surgeons should learn from this example.

The author states

“We as oral-maxillofacial surgeons should begin the process of striving to improve the outcomes of the procedures we provide to our patients, and do so through the sharing of treatment strategies and outcomes.”

Dr. Hupp proposes that Clinical Interest Groups (CIGs) that meet every year at the AAOMS Annual Meeting, could serve to focus on increasing value. He says

“For example, a CIG could decide to pick one condition per year to analyze. Members of the CIG, hopefully with some patient representative input, could determine the characteristics of a good outcome for managing a chosen condition, such as mandibular hypoplasia, or analyze outcomes of a procedure(s) used to manage the condition, such as sagittal split osteotomies. Practitioners across the country (and eventually even the world) would be provided the designated parameters and asked to measure their actual outcomes using those parameters. The following year outcome data would be collated and (here’s the major leap forward) those with the best outcomes would then be asked to share their treatment planning and treatment techniques as examples of best practices.”

The author points out that since cost is part of the value equation, this should also be discussed amongst surgeons. This should include all pre, intra, and post operative fees. The author feels that oral and maxillofacial surgeons should demonstrate leadership in showing the value in the care they provide and more specifically show they provide better value over other specialties that may perform the same surgeries and procedures.

Moving towards increasing value in health care is welcome and I look forward to seeing this developments occur in the future.

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