So, a few days into 2018 and bringing better value to US Healthcare is off to a strong start.  Yesterday, the Center for Medicare Medicaid Innovations announced the continuation of the Bundled Payment for Care Improvement (BPCI) Initiative through the voluntary BPCIA.  The “A” is for advanced.  For hospitals and surgeons who are confident in their skills, it’s welcome news.  These programs do a fantastic job of rewarding great outcomes coupled with lowering costs. And in measuring performance, everyone’s thoughts immediately go to OIC’s October 2012 blog entry, of course.  The blog reported the highlights of the 2012 OTA annual meeting and tells the story of a surgeon who was ahead of his time in driving transparency and measuring outcomes as it relates to surgeon performance. This surgeon, Dr. Ernest Codman, had his privileges revoked by Mass General Hospital at the turn of last century for suggesting surgeon performance should be measured.  It might be taking us a little longer than Dr. Codman would have liked in creating programs like BPCIA, but then again, he was always about the long term and The End Result. Enjoy revisiting the post:


The 28th Annual Orthopaedic Trauma Association Meeting was a stage for great thinking and ideas on safety, quality and cost containment. Dr. Robert Probe’s presidential address featured Dr. Ernest Codman’s pursuit of the ‘End Result Card’ – a card devised at the turn of last century to track patients’ demographics, diagnosis, method of treatment and long-term outcome. Of course, like many good ideas, it was met with arctic enthusiasm. Measuring surgeon performance was apparently frowned upon in the medical circle, as Ernest’s privileges were promptly revoked at Mass General in 1914 after proposing it. The  monitoring and understanding of patient experience to improve the quality of delivered care may be a norm now, but was considered a radical idea back in those days. The End Result Card was just the beginning. Dr. Codman’s vision was for an End Results System where all doctors would be required to submit standardized information into a central repository that would be made available to the public. He understood the power of data. And good data reveals the truth.

Two posters hung on the wall adjoining the auditorium as Dr. Probe challenged the doctors to strive for quality while reducing costs in his address. Two posters that would have Dr. Ernest Codman proud: ‘The clinical and economic impact of generic implant usage for the treatment of femoral neck fractures’ and ‘The Clinical and Economic Impact of Generic 7.3 mm Cannulated Sacroiliac Screws’. Like Ernest, some doctors today are forward thinkers – taking the challenges they face in stride and finding better and less costly ways to arrive at the same outcomes patients so rightly expect and financially need. The  conclusive, emphatic outcomes have had the naysayers on mute. Humanly driven practices, innovative pricing, design and manufacturing have started to gain nods of approval by hospitals and surgeons.

Dr. James Kellam, who delivered the John Border Memorial lecture at the conference, made the case for humanity.   He, rather humbly, attributed his longevity as a traumatologist to the bond made with patient – a bond that does not end with the patient during outpatient protocol, but rather continues for life. While one could argue that Dr. Codman would only be concerned that Kellam kept good records of his diligence, the noble spirit of healing people is undeniable – doctors want to do good. His recant of Dr. Loxtercamp’s aphorism, “To fix a problem is easy. To sit with another’s suffering is hard.”, struck a chord with every member he addressed. Making the right decision for peoples’ care requires close attention to the cost associated with it. If costs of implants are escalated unjustly and unfairly priced, it starts a cascading effect for the patient. The ‘healed’ femoral neck fracture gives rise to a new pain induced by the aftermath of ER medical bills. Will we stop this pain? Will we encourage ideas like the End Result card? The data is served on humanly-priced implants. Will you ignore the undeniable outcomes of this brave new pursuit of low cost patient care?

If Ernest Codman attended the Annual OTA conference this year, the cost proposition would certainly be added to his End Result Card. The applause for it would have been rousing.

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