Individual Surgeon's Contribution to Value

Area of Science:

• Health Services Research
• Surgical Quality Improvement
• Health Economics

Background:

• Estimating surgeon-level value in healthcare is an underexplored area.
• Value-based healthcare models necessitate understanding provider-specific performance.
• Linking quality outcomes with costs is crucial for comprehensive value assessment.

Purpose of the Study:

• To estimate surgeon-level value by analyzing quality (mortality/morbidity) against costs.
• To determine trends in surgeon value over time using historical data.
• To assess the utility of value metrics for surgeon performance evaluation.

Main Methods:

• Utilized American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data (2005-2013).
• Linked surgical quality data with institutional total costs.
• Employed 3-level random effects logistic regression models to predict 30-day postoperative mortality or morbidity.
• Defined value as risk-adjusted quality (mortality/morbidity) divided by risk-adjusted costs.

Main Results:

• Risk-adjusted costs demonstrated a downward trend over the study period.
• Mortality value significantly increased by 3.27 points annually (P < .001) on a 100-point scale.
• Morbidity value showed no significant change over time.
• For surgeons with ≥5 years of data, mortality value improved for all but one individual.
• Increasing complication rates from 2008 negatively impacted morbidity value.

Conclusions:

• Surgeon-level mortality value shows an improving trend, suggesting enhanced efficiency in reducing deaths relative to costs.
• Morbidity value has stagnated, potentially due to rising complication rates, indicating a need for focused quality improvement efforts.
• Value metrics, integrating both quality and cost, offer a more nuanced view of surgeon performance than quality metrics alone.
• This approach can guide surgeons in identifying specific areas for performance enhancement.