My colleague J.P. Warner kindly invited me to a recent virtual meeting of the Codman Shoulder Society that he founded. There I met Professor Robert Kaplan from the Harvard Business School. The topic of the meeting was Innovation and Value. Professor Kaplan's presentation was crisp, to the point and engaging.
He defines value as the following quotient
and he points out that
In other words, it is incomplete to measure costs and outcome only in terms of those recognized while the patient is in the hospital or for the first 90 days after discharge - rather cost and outcome accounting must start at the first encounter (including imaging and planning) and extend through a period of followup that is sufficiently long to capture complications, readmissions and revision surgery.
This reminds me of a speech by
Kofi Annan, who spoke at my son's Stanford graduation. Secretary Annan pointed out that the cost of nuclear energy must include not only the cost of building the structure, hiring the people and buying the materials, but also the cost of waste disposal, reactor meltdowns, clean up, and habitat damage that may not be evident until years or decades later. And as pointed out in
The Danger Within Us: America's Untested, Unregulated Medical Device Industry and One Man's Battle to Survive It, the cost of metal on metal total hips should include the costs of failure and revision, which again may not be recognized until a long time after surgery.
Professor Kaplan points out that incremental value of an innovation can be accomplished either by improving outcomes or reducing cost. To make this type of comparison visible, he demonstrated the utility of the radar chart in Communicating Value in Health Care Using Radar Charts:A Case Study of Prostate Cancer. A greater contribution to value in the different domains is indicated by a greater distance from the origin (thus he uses the reciprocal
of cost). The chart compares three different modes of treating prostate cancer. In this example, the outcomes for each of the three modes are essentially the same, while the costs are remarkably different (protons being the most expensive and brachytherapy (implanting radioactive seeds) the least).
As suggested by Professor Kaplan, one can imagine an analogous radar chart that would compare the preoperative, in hospital and postoperative costs as well as the improvements in patient self-assessed comfort and function.
If such data were available, such a chart would help surgeons, patients, and payers of health care evaluate the incremental value to the patient of new innovations.
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Shoulder arthritis - what you need to know (see this link) The smooth and move for irreparable cuff tears (see this link) The total shoulder arthroplasty (see this link). The ream and run technique is shown in this link. The cuff tear arthropathy arthroplasty (see this link). The reverse total shoulder arthroplasty (see this link).
Shoulder rehabilitation exercises (see this link).
