Defining, measuring, and improving value in spine care

This chapter discusses how to measure and improve spine care outcomes and costs. Today’s commonly used outcome metrics, such as readmission and complication rates, are actually process and quality metrics. They are not the outcomes, such as improvement in pain and mobility, that patients expect to enjoy from being treated for spine pain. Similarly, existing cost measurements of spine care, derived from ratios of cost-to-charges or relative value units, are inaccurate and do not track actual resources used to treat spine care patients over complete treatment cycles. We document how to improve the value of spine care by adopting patient reported outcomes measures that can be collected in a standardized way. Similarly, more accurate cost measurement can be achieved by implementing Time-Driven Activity-Based Costing, an approach that helps clinicians identify opportunities to reduce the cost of delivering spine care without adversely affecting, and often improving, patient outcomes.