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Value-Based Care and Musculoskeletal Rehabilitation

  • Thiru M. Annaswamy
  • Donald Kasitinon
  • Alexa Royston
Musculoskeletal Rehabilitation (J Friedly, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Musculoskeletal Rehabilitation

Abstract

Purpose of Review

The purpose of this study is to summarize published literature on health-care quality, and value-based principles in musculoskeletal (MSK) medicine as it relates to physical medicine & rehabilitation (PM&R) practitioners. This review specifically focuses on spine care as a case example. Related policy and practice issues and future research needs will also be discussed.

Recent Findings

Results of a recent study on the effects of required PM&R consultation prior to surgical evaluation for low back pain management contradicted the conclusions of a previous landmark study on a similar topic.

Summary

Physiatrists involved in musculoskeletal care need to be aware of the shift in focus from volume of care to value-based care. Clinical registries and practice guidelines are increasingly available, practical to use, and should be utilized to improve quality of care provided to patients with MSK disorders. Continuous improvements in quality of care provided and cost savings will drive upward the value of MSK care delivered. Future research in MSK care outcomes needs to evaluate not only effectiveness and efficacy but also cost and value.

Keywords

Rehabilitation Value-based care Musculoskeletal Spine Health care Outcomes 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Annaswamy T, Houtrow A, Saxena D, Yang W. Quality and outcome measures for medical rehabilitation. In: Cifu D, editor. Braddom’s physical medicine and rehabilitation. 5th ed. New York, NY: Elsevier; 2015. p. 117–30.Google Scholar
  2. 2.
    Porter M. What is value in health care? N Engl J Med. 2010;363:2477–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Medicine Io. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy of Sciences; 2001.Google Scholar
  4. 4.
    Services DoHH. Quality payment program-MIPS overview. 2017. https://qpp.cms.gov/mips/overview. Accessed 01–05-2018.
  5. 5.
    Weinstein JN, Tosteson AN, Tosteson TD, Lurie JD, Abdu WA, Mirza SK, et al. The SPORT value compass: do the extra costs of undergoing spine surgery produce better health benefits? Med Care. 2014;52(12):1055–63.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Lu Y, Qureshi SA. Cost-effective studies in spine surgeries: a narrative review. Spine J. 2014;14(11):2748–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Johnsen LG, Hellum C, Storheim K, Nygaard ØP, Brox JI, Rossvoll I, et al. Cost-effectiveness of total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain: a Norwegian multicenter RCT. Spine. 2014;39(1):23–32.CrossRefPubMedGoogle Scholar
  8. 8.
    Udeh BL, Costandi S, Dalton JE, Ghosh R, Yousef H, Mekhail N. The 2-year cost-effectiveness of 3 options to treat lumbar spinal stenosis patients. Pain Pract. 2015;15(2):107–16.CrossRefPubMedGoogle Scholar
  9. 9.
    Lenza M, Buchbinder R, Staples MP, dos Santos OFP, Brandt RA, Lottenberg CL, et al. Second opinion for degenerative spinal conditions: an option or a necessity? A prospective observational study. BMC Musculoskelet Disord. 2017;18(1):354.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. Cost-effectiveness of non-invasive and non-pharmacological interventions for low back pain: a systematic literature review. Appl Health Econ Health Policy. 2017;15(2):173–201.CrossRefPubMedGoogle Scholar
  11. 11.
    Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine. 2012;37(9):775–82.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Karvelas DA, Rundell SD, Friedly JL, Gellhorn AC, Gold LS, Comstock BA, et al. Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults. Spine J. 2017;17(3):380–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Cheng J, Chambless L, McGirt M. Trends in geriatric low back pain. AANS Neurosurgeon. 2011;20(2). http://v1archives.aansneurosurgeon.org/200811/6/807. Accessed 19 Oct 2017.
  14. 14.
    O'Lynnger TM, Zuckerman SL, Morone PJ, Dewan MC, Vasquez-Castellanos RA, Cheng JS. Trends for spine surgery for the elderly: implications for access to healthcare in North America. Neurosurgery. 2015;77(Suppl 4):S136–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Manchikanti L, Falco FJ, Pampati V, Cash KA, Benyamin RM, Hirsch JA. Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome. Pain Physician. 2013;16(3):E129–43.PubMedGoogle Scholar
  16. 16.
    Price C, Arden N, Coglan L, Rogers P. Cost-effectiveness and safety of epidural steroids in the management of sciatica. Health Technol Assess (Winchester, England). 2005;9(33):1–58. iiiGoogle Scholar
  17. 17.
    Fritz JM, Kim J, Dorius J. Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs. J Eval Clin Pract. 2016;22(2):247–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Kovacs FM, Arana E, Royuela A, Cabrera A, Casillas C, Piñero P, et al. Appropriateness of lumbar spine magnetic resonance imaging in Spain. Eur J Radiol. 2013;82(6):1008–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Herzog R, Elgort DR, Flanders AE, Moley PJ. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J. 2017;17(4):554–61.CrossRefPubMedGoogle Scholar
  20. 20.
    de Schepper EI, Koes BW, Veldhuizen EF, Oei EH, Bierma-Zeinstra SM, Luijsterburg PA. Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general practice. Fam Pract. 2016;33(1):51–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Ip IK, Gershanik EF, Schneider LI, Raja AS, Mar W, Seltzer S, et al. Impact of IT-enabled intervention on MRI use for back pain. Am J Med. 2014;127(6):512–518.e511.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Kennedy SA, Fung W, Malik A, Farrokhyar F, Midia M. Effect of governmental intervention on appropriateness of lumbar MRI referrals: a Canadian experience. J Am Coll Radiol: JACR. 2014;11(8):802–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Fox J, Haig AJ, Todey B, Challa S. The effect of required physiatrist consultation on surgery rates for back pain. Spine. 2013;38(3):E178–84.CrossRefPubMedGoogle Scholar
  24. 24.
    Goodman RM, Powell CC, Park P. The impact of commercial health plan prior authorization programs on the utilization of services for low back pain. Spine. 2016;41(9):810–5.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Varela E, Oral A, Ilieva E, Küçükdeveci AA, Valero R, Berteanu M, et al. Musculoskeletal perioperative problems. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med. 2013;49(5):753–9.PubMedGoogle Scholar
  26. 26.
    Indrakanti SS, Weber MH, Takemoto SK, Hu SS, Polly D, Berven SH. Value-based care in the management of spinal disorders: a systematic review of cost-utility analysis. Clin Orthop Relat Res. 2012;470(4):1106–23.CrossRefPubMedGoogle Scholar
  27. 27.
    NASS. Spine registry. 2017. https://www.spine.org/ResearchClinicalCare/Research/SpineRegistry.aspx. Accessed 25 Nov 2017.
  28. 28.
    Asher AL, Speroff T, Dittus RS, Parker SL, Davies JM, Selden N, et al. The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American outcomes registry to advance value-based spine care. Spine. 2014;39(22 Suppl 1):S106–16.CrossRefPubMedGoogle Scholar
  29. 29.
    CMS.GOV. The quality payment program overview fact sheet. 2016. https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_Fact_Sheet.pdf.
  30. 30.
    Group TL. CMS bundled payments for care improvement initiative models 2–4: year 2 evaluation & monitoring annual report. Falls Church: The Lewin Group; 2016.Google Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Thiru M. Annaswamy
    • 1
  • Donald Kasitinon
    • 2
  • Alexa Royston
    • 2
  1. 1.PM&R ServiceVA North Texas Health Care System and University of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Physical Medicine and RehabilitationUniversity of Texas Southwestern Medical CenterDallasUSA

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