Becker's ASC Review

57 Becker's ASC 22nd Annual Meeting - The Business and Operations of ASCs – Call (800) 417-2035 H ow are physicians — especially spe- cialists — interacting with population health? The healthcare system is moving physicians from the fee-for-service model where "more is better" to the risk-based model where "less is more." But physicians are still accountable for providing good quality care and outcomes in addition to lowering costs. So where are the biggest opportu- nities to reach these goals? • Eliminating waste • Reducing medical errors • Eliminating unnecessary testing • Preventing 30-day readmissions "We are a healthcare system on the edge of a big decision. Are we really able to make the change from volume to value?" asked David B. Nash, MD, MBA, Founding Dean of the Jefferson School of Population Health at the 13 th Annual Spine, Or- thopedic & Pain Management-Driven ASC Con- ference + The Future of Spine. Patients come in all shapes and sizes, and a variety of factors im- pact their health, from their socioeconomic status to socialization. The biggest predictor of a per- son's health isn't what you think. "The most important five-digit number I need to know about you to predict your life span is your zip code," says Dr. Nash. Bedside medical care is only about 10 percent to 20 percent of what makes a society overall healthy considering popu- lation health. "From a society perspective, the access to good medical care is only a small part of the story," says Dr. Nash. "Twenty percent is mom and dad; 20 percent is where you live; 50 percent is indi- vidual behavior. But if you look at how we spend our money, most of it is on medical services. We spend so much on a small percentage of what ac- tually contributes to make us healthy. That's the conundrum. That's the inner guts. That's what the complexity of population health is all about." Healthcare delivery changes Healthcare delivery is changing, and the most successful providers in the future are already beginning to reshape care delivery around care coordination. These providers are connecting patients with rehabilitation, occupational ther- apy, behavior modification and pain control in addition to their specialists. The information about each patient circulates among all their care providers. "That is what population health, in a very practi- cal way, is going to be all about," says Dr. Nash. "Even five years ago, none of this existed. As we move from volume to value, the challenges are incredible." There are physicians doing things like pre-habili- tation to engage core strength activity and physi- cal therapy before surgery to prepare for better outcomes. Exercising can also help the patient lose some weight before surgery, which is associated with better outcomes. Practices are also hiring nutritionists, exercise physiologists and diabetes nurse practitioners to help patients live healthier lives. Others are working with home health pro- viders to ensure patients have a consistent care plan when they return home from surgery. "At the moment, we don't get paid to improve be- havior, but we will be paid to improve behavior in the world that's moving from volume to value," says Dr. Nash. Payment models The move toward population health, coordinated care and risk-based payment models will have an impact on specialists in the future. Primary care physicians are already going at-risk for their pa- tient outcomes at a higher rate than ever before, and they share payments with their specialists. "If a primary care physician is sharing his money with a spine surgeon, he's going to pick the high volume spine surgeon who has good outcomes and not a lot of waste," says Dr. Nash. The pri- mary care physicians will look for surgeons who can control pain well and have high patient sat- isfaction, because the patient's surgical experi- ence will impact the final payment. There will be transparency in outcomes not only between the physicians, but also with payers and hospitals. Ultimately, much of this data will be published online and other media outlets. "If you're going to be naked, you better be buff," says Dr. Nash. "If there's no outcome, there's no income; no measurable, good coordinated care, reduced readmissions, no payment or low pay- ment." Dr. Nash suggests spine surgeons focus on these areas to prepare for population health: 1. Practice based on the best available evi- dence 2. Reduce unexplained clinical variation among specialists in the practice 3. Reduce slavish adherence to professional autonomy 4. Continuously measure and close the feed- back loop. 5. Engage patients across the continuum. n Population Health and Spine: 5 Ways to Prepare for the Future By Laura Dyrda INTRODUCING Sterile, Safe, Powerful, and Cost-Effective The Bone Shark Disposable Bone Mill is the safest, most powerful, versatile and cost-efficient product of its kind on the market today. Learn more, call 888.422.7717 or visit www.leemedicalnj.com Watch the Video © Copyright 2015 Lee Medical. All Rights Reserved. The First Disposable Bone Mill

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