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February 21, 2017


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California Orthopaedic Association Produces Two White Papers on Value-Based Reimbursement

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California Orthopaedic Association Produces Two White Papers on Value-Based Reimbursement

WhitepaperIn the quickly changing healthcare landscape, both public and private payers are shifting from fee for service to a value-based reimbursement structure that takes a population health approach. According to these payers, the evolution toward value-based reimbursement benefits the patient, the physicians and the payer. The California Orthopaedic Association (COA) has produced two white papers that support their members in the shift towards value-based reimbursement.

The first paper, titled Patient-Reported Functional Outcomes: How to Collect and Report Risk-Adjusted Musculoskeletal Patient-Reported Functional Outcome Data in an Orthopaedic Practice, was initially commissioned by the California Orthopaedic Association (COA) in 2013. The goal of the paper was to provide recommendations on practical, cost-effective processes and standards to encourage more widespread, consistent use of patient-reported outcome (PRO) instruments for orthopaedic surgeons treating shoulder, hand, spine, foot and ankle conditions. PROs, also called patient-reported functional outcomes are being widely recognized as critical tools to improve care management by enabling clinical providers to, in real-time, assess the results of their treatments for the purpose of continuous quality improvement (CQI).  Historically, PROs were used routinely in controlled research studies as part of developing evidence-based practices. Now, their promise is to help clinicians ensure they are providing care that is likely to result in the best outcomes for patients, adjusted for various risk profiles.  The demand for objective, useable measurement tools is driving the identification, development and study of standardized tools most appropriate for specific disease areas.  Risk prediction tools should satisfy the three priorities of enhancing the informed consent process, guiding risk mitigation efforts, including reversible co-morbidities, and calculating accurate risk adjusted outcomes.

To read the report on Patient-Reported Functional Outcomes, click here.

The second paper, titled Clinical Data in the Era of Value-Based Care: Rules of the Road for the Orthopaedic Surgeon, aims to educate physicians in private and hospital practice settings on the value of physician outcome data, importance of the data being collected in a transparent manner, management of outcome data, including patient-reported outcome measures (PROMs) data in business relationships and contractual arrangements, and objectives of the primary entities that are looking to use the data. Healthcare outcome data, specifically PROMs and patient success metrics, have historically been difficult to access and time-consuming to aggregate.  Interpretation of these metrics has been further complicated by the often biased and sometimes proprietary nature of the data.  Recently, COA has seen an increased demand for outcome data primarily due to the rapid move to value-based healthcare as a way of measuring quality care implemented by the Affordable Care Act (ACA) and the Centers for Medicare & Medicaid Services (CMS). Healthcare payers are actively seeking mechanisms that will allow them to track, report and analyze outcome data across providers and specialties.  The payers are not alone in this quest. Newly insured, cost-conscious patients, many of whom have high deductible plans through healthcare exchanges, are making decisions about the care available to them and nudging the landscape towards a more retail-based market.  Additionally, health systems, hospitals, and even orthopaedic device companies are looking for trends in outcome data to help guide their long-term strategies around services and new products.

To read the report on Clinical Data in the Era of Value-Based Care: Rules of the Road for the Orthopaedic Surgeon, click here.