title: Improving Value in Musculoskeletal Care Delivery: AOA Critical Issues.
abstract: Improving value in musculoskeletal health care has emerged as an important objective in both the United States and Canada. In order to achieve this objective, providers need to have a clear definition of value and an infrastructure for measuring outcomes of interest to patients and costs over the episode of care. Although national patient registries have been established in the United States and Canada, they nevertheless lag behind other registries worldwide in terms of collecting patient-reported outcomes and capturing data from a wide cross-section of hospitals and physicians. With the help of professional medical societies and the creation of national initiatives, patient-reported outcomes data collection on a large scale may be possible, but many challenges remain regarding implementation. Alternatives to the fee-for-service payment model, including pay-for-reporting and pay-for-performance, may help incentivize physicians and health-care providers to obtain and improve on patient-reported outcomes data collection. Other payment reforms, such as bundled payments, have been piloted in certain regions, but their sustainability and long-term success are unclear at this time. Novel health-care delivery strategies aimed at improving quality, coordinating multispecialty care, and enhancing patient participation in shared decision-making have shown promise in improving patient-centered outcomes, but delivery models continue to vary greatly throughout the United States and Canada. The current status of musculoskeletal health-care delivery requires substantial change before the goal of improving patient outcomes and lowering health-care costs can be achieved.
authors.affiliation: Department of Orthopaedics, Tufts University Medical Center, 800 Washington Street, TMC Box #306, Boston, MA 02111. E-mail address: davidwei.md@gmail.com.
authors.forename: David H
authors.initials: DH
authors.lastname: Wei
authors.affiliation: Women's College Research Institute, Women's College Hospital, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, ON M5G 2C4, Canada. E-mail address: g.hawker@utoronto.ca.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Hawker
authors.affiliation: Intermountain Healthcare, 652 South Medical Center Drive, Suite 400, St. George, UT 84770. E-mail address: David.jevsevar@imail.org.
authors.forename: David S
authors.initials: DS
authors.lastname: Jevsevar
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MUW320, San Francisco, CA 94143-0728. E-mail address: Kevin.bozic@ucsf.edu.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
mesh_terms: D002170:Canada; D003695:Delivery of Health Care / Q000592:standards*; D018588:Fee-for-Service Plans / Q000639:trends; D006801:Humans; D018803:Models, Economic; D009140:Musculoskeletal Diseases / Q000191:economics / Q000628:therapy*; D014481:United States; D062505:Value-Based Purchasing