Not everything that counts can be counted, and not everything that can be counted counts.
We have lost sight of this truth along our journey towards value-based healthcare. The well-intentioned value equation represents a concerted systemwide effort to decrease healthcare expenditures while maximizing the quality of care rendered, but it opened the door for administrative misalignment with the art of medicine.
Despite recognizing that “the business of healthcare depends on exploiting doctors and nurses,” we continue to choose lean principles and line items over patients and frontline workers even in the midst of a pandemic.
In the eyes of the public, physician ownership of the cost conundrum was conflated with a false narrative rooted in physician atonement for their wealth and greed. The hundreds of anecdotal stories related to exorbitant costs from surprise billing, from questionable MRI scans to the out-of-network anesthesiologist, exacerbated the optics of the medical team and primarily positioned the doctor to be the scapegoat.
The entire healthcare team – doctors, nurses, social workers, technicians, therapists, advanced practice providers – absorbed the reprisal and unsurprisingly assumed ownership of the problem. After all, ownership remains a core tenet of patient care. However, the burden of fixing healthcare – a notoriously complex and purposefully opaque system – requires shared responsibility across all players.
It is painfully clear that the pendulum has swung too far. No case better crystallizes this than the treatment of orthopaedic surgeons during the last decade – specifically those who perform hip and knee replacement.
Hip and knee replacement surgery represents one of the highest volume procedures paid for by Medicare, therefore one of the greatest expenses for the hospital and insurance administrator. This set the stage for joint replacement surgeons and their representative society – the American Association of Hip and Knee Surgeons (AAHKS) – to lead the way in policy and payment reform.
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