Paul Bruning on Exploring the Real Value of Patient-Reported Outcomes

Exploring the Real Value of Patient-Reported Outcomes with Paul Bruning, DHA

A Note From CODE: We are pleased to announce this thought leadership guest blog from Paul Bruning, Director, Orthopedic Service Line, and a member of AAOE.

Value-based healthcare is a trending concept, but can sometimes be confusing when used interchangeably with quality. Quality, process outcomes, patient-reported outcomes, patient satisfaction, and value are often expressed as meaning the same thing, yet each is very different.

When speaking of value, the economic equation of value is quality over cost. Individual perceptions of value are influenced by these two factors (quality and cost) which are unique to various people based on current circumstances and concept of what is valuable to them at that time.

For example, a $1.00 hamburger from a fast food restaurant may not seem like a great value. However, if a mother is buying hamburgers for an entire little league team of 10-year-old kids, that may be of value to her at that moment. This assumption is based on the cost and not necessarily the “quality” of the hamburger.

At the same time, staying at the Ritz-Carlton provides a high-quality hotel stay, packed with amenities. For some, this quality at the cost per night ($120+) may be of value. For others, a value would be staying at a Super 8 for $68 a night based on cost and perceived quality.

Defining value in medicine

In medicine, the challenge in proposed “value” is difficult because of two concerns. First, patients are insulated from cost. As high-deductible plans become more prominent and co-pays are larger, the cost can play a factor. Yet insurance pays a large portion of medical expenses for most individuals removing true cost from the value equation. When medical issues and emergencies arise, often the cost is not a concern compared to an individual life. Cost becomes of lesser importance to value but to insurance companies and other payers of medical expenses remains an issue.

Secondly, individuals receiving medical care often do not have a true way to determine the quality of care they receive. Patients perceive quality based on their outcome and the patient-care experience. An emergency department patient could end up with a terrible outcome. However, how that patient was treated can dramatically influence their perception of quality care. In fact, the patient could have received excellent care by medical standards, but lost a limb or suffered a debilitating injury or illness.

Defining value-based care requires considering perceptions of quality and patient experience, along with comparative outcomes and total cost of care. One of the most prevalent means of measuring and comparing quality through outcomes is utilizing patient-reported outcomes (PROs).

While PROs may have some negative connotations, providers need to consider:

• Whom they provide services for … the patients; and
• Why they became providers … to help patients with injuries and illness.

Why PROs are so important

From a truly patient-centered perspective, monitoring and comparison of patient-reported outcomes provide the single most important measure of perceived value by the patient.

Individuals see providers for pain, disability, and to regain function within their daily lives. PROs use provided measures that demonstrate patient status when first reporting to the provider, and then at specific increments during and following care. Treatments should improve PRO scores. When compared to other providers, PRO scores can demonstrate quality compared to the cost and provide payers with a measure of value offered to their beneficiaries.

Patient-reported outcomes are most often collected using surveys. These range from one question, Visual Analog Scale for pain, to over 60 questions. Patients are asked to fill PRO surveys out at various stages to evaluate improvements in function, activities of daily living, pain, and various other factors. These scores are compared throughout their medical care demonstrating a degree of quality provided. The hardest part of PRO use is collecting the survey data. Many solutions on the market help providers collect PRO data and provide reports to providers and administrators.

The value to providers, using the same equation, is in how the data is collected (quality), at appropriate time frames (quality), and how that influences a provider’s practice (quality of life and patient throughout). Some providers may choose to use a higher-cost solution because they feel the quality, or how it influences their practice, is worth the additional cost.

Another value to providers comes from the ability to demonstrate their “value” and quality of care. Payers can compare providers and incentivize those providers who consistently out-perform peers. PRO results can be posted on websites to demonstrate quality and value provided to patients and payers.

This transparency provides patients with a true measure of quality when making determinations on value. If provider A has better outcomes (PRO) data than provider B, and provider A charges X as compared to provider B charging Y (for the same care or procedure), patients then have the information available to decide and seek care based on a true measure of value (quality over cost).

Medicine is a service industry. If individuals would not stay at a hotel (poor value because of quality or cost) that service would not be needed or sought out. Likewise, if there were no patients, a provider would not be needed and hospitals would be empty. PRO measures provide an important tool for collecting data on services provided and the value they offer, making PRO data collection necessary for providing value information as health care moves to value-based reimbursement.