A surgeon scorecard is associated with improved value in elective primary hip and knee arthroplasty

Angela Winegar, Lauren W. Jackson, Tanmaya D. Sambare, Tiffany C. Liu, Sean R. Banks, Thomas Erlinger, Randall Schultz, Kevin Bozic

Research output: Contribution to journalArticle

Abstract

Background:Despite increasing interest in total joint arthroplasty registries, evidence of the impact of physician-level performance on the value of care provided to patients undergoing hip and knee arthroplasty is lacking. The purpose of this study was to examine the effectiveness of an unblinded orthopaedic surgeon-specific value scorecard in improving patient outcomes and reducing hospital costs.Methods:We retrospectively analyzed patient outcomes and hospital costs associated with total joint arthroplasties before and 9 months after the introduction of a Surgeon Value Scorecard at an urban tertiary care center. From August 2016 to May 2017, orthopaedic surgeons received an unblinded monthly Surgeon Value Scorecard summarizing a rolling 6-month view of results by surgeon for patients attributed to Diagnosis Related Group 470 (major lower-extremity arthroplasty without comorbidity or complication). Prior to implementation, surgeons were educated on the scorecard and participated in the development of a document outlining the definition and calculation of included metrics. Scorecard metrics were grouped into 5 categories: patient demographic characteristics, patient outcomes (for example, length of stay, discharge disposition, readmissions), patient experience, financial, and operational (for example, operative times). Financial (cost) measures and patient outcomes were selected as the key performance indicators analyzed in this study. Continuous variables were analyzed using the t test when a normal distribution was assumed and using Mann-Whitney tests when a non-normal distribution was assumed. Categorical variables were compared using chi-square tests. Significance was defined as p < 0.05.Results:After 9 months of unblinded Surgeon Value Scorecard distribution, the mean total costs for total joint arthroplasties decreased by 8.7%, from $17,996 to $16,426 (p < 0.001). The mean total direct variable costs decreased by 17.1% from $10,945 to $9,070 (p < 0.001), and implant costs decreased by 5.3% (p < 0.001). Length of stay also decreased by 0.2 day to 1.7 days (p < 0.001), and, although there was improvement in the home-discharge rate, 30-day readmission rate, and 90-day readmission rate, the differences were not significant (p > 0.05).Conclusions:The implementation of a surgeon-specific value scorecard for lower-extremity joint arthroplasties was associated with reduced total and direct variable hospital costs, reduced implant costs, decreased variation in costs, and reduced postoperative length of stay, without compromising clinical outcomes.Clinical Relevance:Sharing unblinded clinical and financial outcomes with surgeons may promote a culture of shared accountability and may empower surgeons to improve value-based decision-making in care delivery.

Original languageEnglish (US)
Pages (from-to)152-159
Number of pages8
JournalJournal of Bone and Joint Surgery - American Volume
Volume101
Issue number2
DOIs
StatePublished - Jan 16 2019

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Knee Replacement Arthroplasties
Hip
Arthroplasty
Hospital Costs
Joints
Costs and Cost Analysis
Lower Extremity
Length of Stay
Patient Readmission
Diagnosis-Related Groups
Normal Distribution
Social Responsibility
Chi-Square Distribution
Operative Time
Surgeons
Tertiary Care Centers
Registries
Comorbidity
Decision Making
Demography

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

A surgeon scorecard is associated with improved value in elective primary hip and knee arthroplasty. / Winegar, Angela; Jackson, Lauren W.; Sambare, Tanmaya D.; Liu, Tiffany C.; Banks, Sean R.; Erlinger, Thomas; Schultz, Randall; Bozic, Kevin.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 101, No. 2, 16.01.2019, p. 152-159.

Research output: Contribution to journalArticle

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abstract = "Background:Despite increasing interest in total joint arthroplasty registries, evidence of the impact of physician-level performance on the value of care provided to patients undergoing hip and knee arthroplasty is lacking. The purpose of this study was to examine the effectiveness of an unblinded orthopaedic surgeon-specific value scorecard in improving patient outcomes and reducing hospital costs.Methods:We retrospectively analyzed patient outcomes and hospital costs associated with total joint arthroplasties before and 9 months after the introduction of a Surgeon Value Scorecard at an urban tertiary care center. From August 2016 to May 2017, orthopaedic surgeons received an unblinded monthly Surgeon Value Scorecard summarizing a rolling 6-month view of results by surgeon for patients attributed to Diagnosis Related Group 470 (major lower-extremity arthroplasty without comorbidity or complication). Prior to implementation, surgeons were educated on the scorecard and participated in the development of a document outlining the definition and calculation of included metrics. Scorecard metrics were grouped into 5 categories: patient demographic characteristics, patient outcomes (for example, length of stay, discharge disposition, readmissions), patient experience, financial, and operational (for example, operative times). Financial (cost) measures and patient outcomes were selected as the key performance indicators analyzed in this study. Continuous variables were analyzed using the t test when a normal distribution was assumed and using Mann-Whitney tests when a non-normal distribution was assumed. Categorical variables were compared using chi-square tests. Significance was defined as p < 0.05.Results:After 9 months of unblinded Surgeon Value Scorecard distribution, the mean total costs for total joint arthroplasties decreased by 8.7{\%}, from $17,996 to $16,426 (p < 0.001). The mean total direct variable costs decreased by 17.1{\%} from $10,945 to $9,070 (p < 0.001), and implant costs decreased by 5.3{\%} (p < 0.001). Length of stay also decreased by 0.2 day to 1.7 days (p < 0.001), and, although there was improvement in the home-discharge rate, 30-day readmission rate, and 90-day readmission rate, the differences were not significant (p > 0.05).Conclusions:The implementation of a surgeon-specific value scorecard for lower-extremity joint arthroplasties was associated with reduced total and direct variable hospital costs, reduced implant costs, decreased variation in costs, and reduced postoperative length of stay, without compromising clinical outcomes.Clinical Relevance:Sharing unblinded clinical and financial outcomes with surgeons may promote a culture of shared accountability and may empower surgeons to improve value-based decision-making in care delivery.",
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AU - Jackson, Lauren W.

AU - Sambare, Tanmaya D.

AU - Liu, Tiffany C.

AU - Banks, Sean R.

AU - Erlinger, Thomas

AU - Schultz, Randall

AU - Bozic, Kevin

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