This is an interesting foray into some methodology for understanding the costs associated with shoulder reconstruction. We salute this effort. The authors state " The bundled payment initiative provides an opportunity for surgeons to take an active role in cost containment. The ultimate goal for surgeons it to decrease cost while maintaining or improving the quality of care delivered. We hypothesize that simply the awareness of costs associated with the episode of care of shoulder arthroplasty surgery will naturally cause surgeons to increase effi ciency of care and decrease associated costs. It is critical that research continues to be performed regarding costs in shoulder arthroplasty to provide every shoulder surgeon
with a method to collect cost and outcomes data."
As we consider methodology for approaching this challenge we need to develop a standard approach for (1) characterizing the benefit of the surgical intervention and (2) capturing the cost of that intervention. The quotient of these two quantities is the value of the intervention to a particular patient. A given surgical intervention may be of different value to to different patients, but with a consistent methodology, we can take a step toward determining which treatments are of the greatest value to which groups of patients.
As for characterizing the benefit of the surgical intervention, the metric needs to be something easy to apply so that its application is not restricted by cost or inconvenience. In that regard we are drawn to a simple patient self-assessment of shoulder function. The difference between the posttreatment and the pretreatment values at a point in time after treatment is the benefit of the intervention at that time.
As for capturing the cost of the treatment, this is more complex. It needs to include the costs of the preoperative assessment (visit, MRI, CT, 3D reconstruction), the implant, the surgeon fees, anesthesiology, medications, pain management costs, hospitalization, physical therapy, and the costs of revisions for failure. Anything that reduces the cost (i.e. avoiding a preop CT or using a less expensive implant or using patient-conducted PT) without reducing the benefit results in increased value.
Now's a good time to focus on the value equation.
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