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The article discusses a unit-based, structured, interdisciplinary leader rounding team meant to improve the patient experience and help hospitals avoid monetary issues as of January 2025. Topics covered include the problem of nurse communication, and the process of leaders' self-introduction and stating of their visit's purpose to the patient, and their discussion on the patient's perception of nurse communication. Also noted is the theme of patients' lack of information on the plan of care.

Background: Despite the intense policy focus on reducing health-care-associated conditions, adverse events in health care settings persist. Therefore, evaluating patient safety efforts and related health policy initiatives remains critical. Purpose: The aim of this study was to explore the relationship between hospital patient safety culture and hospital performance on Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) metrics. Methodology/Approach: A pooled cross-sectional study design was used utilizing three secondary datasets from 2018 and 2021: the Hospital Survey on Patient Safety Culture, the American Hospital Association annual survey, and the Hospital Compare data from CMS. We used two multivariable linear regression models to examine the relationship between organizational patient safety culture and hospital performance. The dependent variables included the overall CMS total performance score (TPS) and the four individual TPS domain scores. Hospital patient safety culture, the independent variable, was operationalized using two measures from the Hospital Survey on Patient Safety Culture: (a) the domain score of overall perceptions of patient safety and (b) the patient safety grade. Results: We observed positive and significant associations between hospital patient safety culture and a hospital's overall TPS and the "patient and community engagement" and "safety" domains. Conclusion: Findings suggest that building a strong patient safety culture has the potential to lead health care organizations to achieve high performance on HVBP metrics. Practice Implications: Our findings have important policy implications for both the future of CMS HVBP as a motivator of patient safety and how health care managers integrate culture change into programs to meet external quality metrics. [ABSTRACT FROM AUTHOR]

The landscape of nutrition education within the US healthcare system has a rich history, although the impact remains limited. This article explores various change drivers to address the need for increased value for incorporating knowledge of food and nutrition into health professions education. Key initiatives discussed include the 2022 White House National Strategy on Hunger, Nutrition, and Health; the 2023Medical Education in Nutrition Summit; and recent 2024 Food IsMedicine Summits, which have contributed to reshaping healthcare priorities. This article also underscores the relevance of valuebased care and interprofessional collaboration in addressing the nation's nutrition-related challenges. With acknowledgement of persistent barriers to the effective integration of nutrition education across the medical curricula continuum, the article recognizes the historical perspectives that have contributed to today's landscape. It also explores strategies proposed to enhance medical nutrition education, including funding sources, curriculum development, competency frameworks, culinary medicine programs, and legislation. The authors emphasize the need for sustained advocacy, innovative and intentional curriculum design, and interprofessional collaboration to equip healthcare professionals with the knowledge and skills needed to effectively address the mounting burden of diet-related diseases today. [ABSTRACT FROM AUTHOR]

Up to 40% of care provided to patients is either wasteful or harmful. The practice of audit and feedback can help identify where care can be improved. However, such audits must be executed in a systematic way that engages with clinicians to maximize the impact of feedback, ultimately improving patient outcomes. Currently, audit training is not integrated into formal education pathways and clinicians need guidance to support them in this activity. This paper explores contemporary research, with the aim of providing practical advice for recommendations to maximize the impact of audit and feedback. [ABSTRACT FROM AUTHOR]

Goal: Value-based care is not simply a matter of cost, but also one of outcomes and harms per dollar spent. This definition encompasses three key components: healthcare delivery that is organized around patients' medical conditions, costs and outcomes that are actively and consistently measured, and information technology that enables the other two components. Our objective in this project was to implement and measure a systemwide high-value, evidence-based care initiative with five pillars of high-value practices. Methods: We performed a quasi-experimental study from September 1, 2019, to August 31, 2022, of a new care program at the University of Texas Medical Branch. Drawing from the ABIM Foundation's Choosing Wisely Campaign, the program was based on five pillars-- blood management and antimicrobial, laboratory, imaging, and opioid stewardship--with interdisciplinary teams led by institutional subject matter experts (i.e., administrative leaders) accompanied by nursing, information technology, pharmacy, and clinical and nonclinical personnel including faculty and trainees. Each pillar addressed two goals with targeted interventions to assess improvements during the first three fiscal years (FYs) of implementation. The targets were set at 10% improvement by the end of each FY. Monthly measurements were recorded for each FY. Principal Findings: We tracked performance toward 30 pillar goals and determined that the teams were successful in 50%, 50%, and 70% of their goals for FY 2020, 2021, and 2022, respectively. For example, in the antimicrobial stewardship FY 2021 pillar, one goal was to decrease meropenem days of therapy (DOT) by 10% (baseline was 45 DOT/1,000 patient days; the target was 40.5 DOT/1,000 patient days). We measured quarterly DOT/1,000 patient day rates of 32.02, 30.57, and 26.9, respectively, for a cumulative rate of 26.9. Critical interventions included engaging and empowering providers and service lines (including outliers whose performance was outside norms), educational conferences, and transparent data analyses. Practical Applications: We showed that a multidisciplinary approach to the implementation of an evidence-based, high-value care program through a partnership of engaged administrative leaders, providers, and trainees can result in sustainable and measurable highvalue healthcare delivery. Specifically, structuring the program with pillars to address defined metrics resulted in progressive improvement in meeting value-based goals at the University of Texas Medical Branch. Also, challenges can be embraced as learning opportunities to inform value-based interventions that range from technological to educational tactics. The results at the University of Texas Medical Branch provide a benchmark for the implementation of a program that engages, empowers, and aligns innovative value-based care initiatives. [ABSTRACT FROM AUTHOR]

The Centers for Medicare & Medicaid Services (CMS) has finalized a landmark national policy to standardize and expand the collection and reporting of patient-reported outcome measures (PROMs) following total hip arthroplasty (THA) and total knee arthroplasty (TKA). This policy will be rolled out through phased implementation, beginning with voluntary reporting starting in 2023 and transitioning to mandatory reporting starting in 2025, which will be tied to hospital payment determinations in fiscal year 2028. The overarching goal of this policy is to gather meaningful pre- and postoperative PROM data directly from patients to enhance clinical care, shared decision-making, and quality measurement forthese common elective procedures. This national initiative underscores the value of incorporating patient perspectives and priorities into assessments of surgical care quality. For orthopaedic surgeons and hospitals, participating in the initial voluntary reporting period provides an opportunity to integrate PROM collection into clinical workflows and to leverage these data to improve patient care. The achievement of robust PROM response rates and a strong performance on the underlyingTHA/TKA Patient-Reported Outcome-Based Performance Measure may have increasing relevance as payment models shift toward value-based care. The aim of the present forum was to provide an in-depth review of this new CMS policy and key details regarding required PROM instruments, data-collection time frames, and other specifications that surgical teams should understand as they prepare for implementation. The goal was to equip orthopaedic surgeons with actionable information as they embark on this new era of national PROM collection and reporting. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patient experience is a key factor in measuring hospital performance, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey tool is used to assess patient perceptions. Hospitals with positive patient experience tend to have a better quality of clinical care, lower readmission and mortality rates, and an overall shorter inpatient length of stay. Studies have identified several organizational determinants of highand low-rated patient experiences, including hospital size, type, staffing levels, and patient demographics. This study aims to explore the determinants of consistently high- and low-rated patient experience, as well as factors associated with positive and negative changes in patient experience over time. Method: The 2014 to 2019 American Hospital Association annual survey and the Centers for Medicare and Medicaid Services Hospital Value-Based Purchasing database were used. A total of 2801 acute-care hospitals were included in this study. A series of multivariate logistic regressions were used to model the probability of “1” (being a superior hospital or an inferior hospital). In addition, a generalized linear mixed model for binary responses was used to analyze the change (probability of positive and negative change). Results: The results showed that most hospitals did not sustain superior or inferior performance, and competition decreased the likelihood of a hospital consistently performing well in terms of patient experience. Superior performance was associated with hospital ownership (P < .001), size (P = .026), location (P = .002), teaching status (P = .009), average Herfindahl-Hirschman Index value (P = .005), and Medicaid and Medicare patient population. On the other hand, inferior performance was associated with hospital ownership (P = .003), size (P < .001), teaching status (P = .003), safety net status (P = .020), and Medicaid and Medicare patient population. Conclusion: This study aimed to examine the trends in hospital patient experience performance and the influence of hospital organizational characteristics on those trends. Our findings allow us to question the widely held belief that patient experience is a metric of differentiation and industry competition, suggesting that performance in this domain has not been utilized by most hospitals as a source of sustainable competitive advantage. The findings from this study highlight the importance of considering changes in performance over time and the need for significant organizational efforts to improve hospital performance in terms of patient experience. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review. Objectives. To evaluate (1) patient satisfaction after adult spine surgery; (2) associations between the number of abnormal PROMIS domain scores and postoperative satisfaction; and (3) associations between the normalization of a patient’s worst preoperative PROMIS domain score and postoperative satisfaction. Summary of Background Data. Although “legacy” patient reported outcome measures correlate with patient satisfaction after adult spine surgery, it is unclear whether PROMIS scores do. Materials and Methods. We included 1119 patients treated operatively for degenerative spine disease (DSD) or adult spinal deformity (ASD) from 2014 to 2019 at our tertiary hospital who completed questionnaires preoperatively and at ≥1 postoperative time points up to two years. Postoperative satisfaction was measured in ASD patients using items 21 and 22 from the SRS 22-revised questionnaire and in DSD patients using the NASS Patient Satisfaction Index. The “Worst” preoperative PROMIS domain was that with the greatest clinically negative deviation from the mean. “Normalization” was a postoperative score within 1 SD of the general population mean. Multivariate logistic regression identified factors associated with satisfaction. Results. Satisfaction was reported by 88% of DSD and 86% of ASD patients at initial postoperative follow-up; this proportion did not change during the first year after surgery. We observed an inverse relationship between postoperative satisfaction and the number of abnormal PROMIS domains at all postoperative time points beyond 6 weeks. Only among ASD patients was normalization of the worst preoperative PROMIS domain associated with greater odds of satisfaction at all time points up to one year. Conclusion. The proportion of DSD and ASD patients satisfied postoperatively did not change from six weeks to 1 year. Normalizing the worst preoperative PROMIS domain and minimizing the number of abnormal postoperative PROMIS scores may reduce the number of dissatisfied patients. PROMIS data can guide perioperative patient management to improve satisfaction. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor discussing the potential of generative artificial intelligence (AI) and large language models (LLMs) to contribute to value-based healthcare. The letter highlights recent regulatory actions and advancements in AI technology, such as deep learning and transformer LLMs. It emphasizes the need for clinical leadership and alignment between AI policy and healthcare goals. The author suggests that AI systems should support human intelligence and decision-making while prioritizing patient-centered care. [Extracted from the article]

Background and Objectives: To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes. Methods: Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). We performed 2 sets of multivariable regressions using data gathered from US hospitals, linked to AHRQ and CMS performance outcomes. We examined 10 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption within hospital IT departments. We then focused only on those hospitals that adopted Lean in IT to identify specific practices associated with performance. Results: Controlling for other factors, adoption of Lean IT management was associated with lower length of stay (b= -0.098, P= .018) and inpatient expense per discharge (b= -0.112, P= .090). Specifically, use of visual management tools (eg, A3 storyboards, status sheets) was associated with lower adjusted inpatient expense per discharge (b= -0.176, P= .034) and higher earnings before interest, taxes, depreciation, and amortization margin (b= 0.124, P= .042). Such tools were also associated with hospital participation in bundled payment programs (odds ratio = 2.326; P= .046; 95% confidence interval, 0.979-5.527) and percentage of net revenue paid on a shared risk basis (b= 0.188, P= .031). Conclusions: Lean IT management was associated with positive financial performance, particularly with hospital participation in value-based payment. More detailed study is needed to understand other influential factors and types of work processes, activities, or mechanisms by which high-functioning IT can contribute to financial outcomes. [ABSTRACT FROM AUTHOR]

Goal: To address healthcare spending growth, coordinate care, and improve primary care utilization, a majority of states in the United States have adopted value-based care coordination programs. The objective of this study was to identify changes in national healthcare utilization for children with developmental disabilities (DDs), a high-cost and high-need population, following the broad adoption of value-based care coordination policies. Methods: This retrospective study included 9,109 children with DDs and used data from 2002--2018 Medical Expenditure Panel Survey. We applied an interrupted time series design approach to compare pre- and post-Affordable Care Act (ACA) care coordination policies concerning healthcare utilization outcomes, including outpatient visits, home provider days, emergency department (ED) visits, inpatient discharge, and inpatient nights of stay. Principal Findings: We found statistically significant increases in low-cost care post-ACA, including outpatient visits (5% higher, p < .001) and home provider days (11% higher, p < .001). The study findings also showed a statistically significant increase in inpatient nights of stay post-ACA (4% higher, p = .001). There were no changes in the number of ED and inpatient visits. Overall, broad implementation of care coordination programs was associated with increased utilization of low-cost care without increases in the number of high-cost ED and inpatient visits for children with DDs. Our study also found changes in population composition among children with DDs post-ACA, including increases in Hispanic (16.9% post-ACA vs. 13.4% pre-ACA, p = .006) and non-Hispanic multiracial children (9.1% post- ACA vs. 5.5% pre-ACA, p = .001), a decrease in non-Hispanic Whites (60.2% post-ACA vs. 68.6% pre-ACA, p = .001), more public-only insurance (44.3% post-ACA vs. 35.7% pre-ACA, p = .001), fewer children with DDs from middle-income families (27.4% post-ACA vs. 32.8% pre-ACA, p < .001), and more children with DDs from poor families (28.2% post-ACA vs. 25.1% pre-ACA, p = .043). Practical Applications: These findings highlight the importance of continued support for broad care coordination programs for U.S. children with DDs and potentially others with complex chronic conditions. Policymakers and healthcare leaders might consider improving care transitions from inpatient to community or home settings by overcoming barriers such as payment models and the lack of home care nurses who can manage complex chronic conditions. Healthcare leaders also need to understand and consider the changing population composition when implementing care coordination-related policies. This study provides data regarding trends in hospital and home care utilization and evidence of the effectiveness of care coordination policies before the COVID-19 interruption. These findings apply to current healthcare management because COVID-19 has incentivized home care, which may have a strong potential to minimize high-cost care for people with complex chronic conditions. More research is warranted to continue monitoring care coordination changes over a longer period. [ABSTRACT FROM AUTHOR]

Study Design. Systematic Review and Meta-analysis. Objective. The objective of this study is to synthesize the early data regarding and analyze the safety profile of outpatient lumbar fusion. Summary of Background Data. Performing lumbar fusion in an outpatient or ambulatory setting is becoming an increasingly employed strategy to provide effective value-based care. As this is an emerging option for surgeons to employ in their practices, the data is still in its infancy. Methods. This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that described outcomes of inpatient and outpatient lumbar fusion cohorts were searched from PubMed, Medline, The Cochrane Library, and Embase. Rates of individual medical and surgical complications, readmission, and reoperation were collected when applicable. Patient-reported outcomes (PROMs) were additionally collected if reported. Individual pooled comparative meta-analysis was performed for outcomes of medical complications, surgical complications, readmission, and reoperation. PROMs were reviewed and qualitatively reported. Results. The search yielded 14 publications that compared outpatient and inpatient cohorts with a total of 75,627 patients. Odds of readmission demonstrated no significant difference between outpatient and inpatient cohorts [OR= 0.94 (0.81-1.11)]. Revision surgery similarly was no different between the cohorts [OR =0.81 (0.57-1.15)]. Pooled medical and surgical complications demonstrated significantly decreased odds for outpatient cohorts compared with inpatient cohorts [OR=0.58 (0.34-0.50), OR=0.41 (0.50-0.68), respectively]. PROM measures were largely the same between the cohorts when reported, with few studies showing better ODI and VAS Leg outcomes among outpatient cohorts compared with inpatient cohorts. Conclusion. Preliminary data regarding the safety of outpatient lumbar fusion demonstrates a favorable safety profile in appropriately selected patients, with PROMs remaining comparable in this setting. There is no data in the form of prospective and randomized trials which is necessary to definitively change practice. [ABSTRACT FROM AUTHOR]

This article discusses the concept of value-based healthcare and how it can help control rising healthcare costs. The author, David M. Kalainov, emphasizes the importance of value analysis committees (VACs) in this process. VACs are responsible for adopting and standardizing products that are deemed important for patient care. The article presents five principles for running an effective orthopaedic VAC, including establishing thoughtful membership, pursuing information on product safety and outcomes, comparing costs to similar solutions, establishing subcommittees to standardize solutions, and avoiding succumbing to groupthink. The author also acknowledges the shortcomings of VACs and suggests potential changes for the future. [Extracted from the article]

Registered dietitian nutritionists working in ambulatory clinics should not be waiting for an administrator to invite them to the planning group for the transition from fee for service to value-based care payment models. Registered dietitian nutritionists should be identifying and promoting the services they can provide to ensure quality healthcare for patients. In this article, we describe value-based care as it is presented in dietetics literature. We also describe how registered dietitian nutritionists in our family medicine practice demonstrate their value as a member of the expanded interprofessional ambulatory care team providing quality care, reducing costs, and providing an exceptional experience for the patient. We call on educators of dietetics students, interns, and professionals to teach the necessary interprofessional skills to be successful in value-based care models of care. [ABSTRACT FROM AUTHOR]

Background and Objective: Routine outcome monitoring is becoming standard in care evaluations, but costs are still underrepresented in these efforts. The primary aim of this study was therefore to assess if patient-relevant cost drivers can be used alongside clinical outcomes to evaluate an improvement project and to provide insight into (remaining) areas for improvement. Methods: Data from patients who underwent transcatheter aortic valve implantation (TAVI) between 2013 and 2018 at a single center in the Netherlands were used. A quality improvement strategy was implemented in October 2015, and pre- (A) and post-quality improvement cohorts (B) were distinguished. For each cohort, clinical outcomes, quality of life (QoL), and cost drivers were collected from the national cardiac registry and hospital registration data. The most appropriate cost drivers in TAVI care were selected from hospital registration data using a novel stepwise approach with an expert panel of physicians, managers, and patient representatives. A radar chart was used to visualize the clinical outcomes, QoL and the selected costs drivers. Results: We included 81 patients in cohort A and 136 patients in cohort B. All-cause mortality at 30 days was borderline significantly lower in cohort B than in cohort A (1.5% vs 7.4%, P =.055). QoL improved after TAVI for both cohorts. The stepwise approach resulted in 21 patient-relevant cost drivers. Costs for pre-procedural outpatient clinic visits (€535, interquartile range [IQR] = 321-675, vs €650, IQR = 512-890, P <.001), costs for the procedure (€1354, IQR = 1236-1686, vs €1474, IQR = 1372-1620, P <.001), and imaging during admission (€318, IQR = 174-441, vs €329, IQR = 267-682, P =.002) were significantly lower in cohort B than in cohort A. Possible improvement potential was seen in 30-day pacemaker implantation and 120-day readmission. Conclusion: A selection of patient-relevant cost drivers is a valuable addition to clinical outcomes for use in evaluation of improvement projects and identification of room for further improvement. [ABSTRACT FROM AUTHOR]

BACKGROUND The Merit-Based Incentive Payment System (MIPS) seeks to promote value-based care through qualityadjusted Medicare payments. OBJECTIVE To assess 2020 MIPS performance and quality measure selection by Mohs surgeons. METHODS Retrospective, cross-sectional review of Medicare Quality Payment Program and Part B billing data sets. RESULTS In 2020, 8,778 dermatologists and 2,148 Mohs surgeons received a MIPS score. Mohs surgeons primarily participated through groups (51.6%) or individuals (36.4%). Most of them (77.4%) received a final score enabling a positive payment adjustment in 2022, with a notable proportion (22.3%) being eligible for a neutral payment adjustment in the setting of COVID-19 exemptions. The members of the American College of Mohs Surgery were more likely to meet the exceptional performance threshold (71.5% vs 59.0%, p < .0001), as were Mohs surgeons with, 15 years of experience (73.3% vs 54.8%, p < .0001). Measures related to dermatology or Mohs surgery were reported by most individuals (92.0%) and dermatology groups (90.4%), yet less frequently by multispecialty groups (5.9%). CONCLUSION Many Mohs surgeons exceeded the performance threshold and used dermatology- or Mohs-related quality measures in 2020. Further assessments correlating quality measures with patient outcomes are needed to better understand the utility and appropriateness of the current value-based payment system and guide further policies. [ABSTRACT FROM AUTHOR]

Background: An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. Purpose: The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. Approach: A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). Results: The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. Conclusions: In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. Practice Implications: Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs. [ABSTRACT FROM AUTHOR]

Shared decision-making is increasingly embraced in health care and recommended in cardiovascular guidelines. Patient involvement in health care decisions, patient-clinician communication, and models of patient-centered care are critical to improve health outcomes and to promote equity, but formal models and evaluation in cardiovascular care are nascent. Shared decision-making promotes equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. Broad endorsement of shared decision-making as a critical component of high-quality, value-based care has raised our awareness, although uptake in clinical practice remains suboptimal for a range of patient, clinician, and system issues. Strategies effective in promoting shared decision-making include educating clinicians on communication techniques, engaging multidisciplinary medical teams, incorporating trained decision coaches, and using tools (ie, patient decision aids) at appropriate literacy and numeracy levels to support patients in their cardiovascular decisions. This scientific statement shines a light on the limited but growing body of evidence of the impact of shared decision-making on cardiovascular outcomes and the potential of shared decision-making as a driver of health equity so that everyone has just opportunities. Multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

To drive system strategy and compensate nurses for their contributions to patient outcomes and quality metrics, a large healthcare system in Texas designed and implemented a new pay program to reward nursing staff. [ABSTRACT FROM AUTHOR]

The clinical use of patient-reported outcome measures (PROMs) in musculoskeletal care is expanding, encompassing both individual patient management and population-level applications. However, without thoughtful implementation, we risk introducing or exacerbating disparities in care processes or outcomes. We outline examples of opportunities, challenges, and priorities throughout PROM implementation to equitably advance value-based care at both the patient and population level. Balancing standardization with tailored strategies can enable the large-scale implementation of PROMs while optimizing care processes and outcomes for all patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: On January 1, 2021, the Centers for Medicare and Medicaid Services implemented a hospital price transparency rule. Consumerism as a means of reducing healthcare expenditure is predicated on informed consumers making discrete choices. STUDY DESIGN: For 10 months, immediately after a preoperative clinic visit at an academic medical center, patients and their surgeons were surveyed regarding their estimation of hospital cost and hospital reimbursement for the upcoming operation. Responses were compared to average institutional cost (fiscal year 2019) for Medicare patients undergoing a laparoscopic approach for each operation. We calculated the difference between actual reimbursement and cost with patients' estimates and actual reimbursement and cost with surgeons' estimates. RESULTS: Sixty-six questionnaires were collected from patients who underwent laparoscopic operations, that included cholecystectomy (n = 20), inguinal hernia (n = 17), umbilical hernia repair (n = 6), ventral hernia repair (n = 6), incisional hernia (n = 6), hiatal hernia repair (n = 1), and lipoma or cyst excision (n = 10). Patients' estimates of hospital cost exceeded actual hospital cost by a median of $4,502 and were less than hospital reimbursement by a median of $1,834. Surgeon estimates for direct cost were $825 less than hospital direct cost and $1,659 less than hospital reimbursement. CONCLUSIONS: Patients as well as their surgeons do not estimate healthcare cost or remuneration accurately and therefore will be ineffective change agents in reducing surgical spending based on price transparency without further education of both parties. Patients consistently overestimated surgical cost while surgeons consistently underestimated surgical cost and reimbursement. It is likely that better-informed surgeons and patients are necessary prerequisites for Centers for Medicare and Medicaid Services price transparency rules to be effective in reducing Medicare expenditures in surgery. [ABSTRACT FROM AUTHOR]

The following two abstracts are from presentations at the Forum on Advances in Healthcare Management Research that took place in March 2023 during the Congress on Healthcare Leadership of the American College of Healthcare Executives. An annual event, the Forum presents theoretical and empirical research with the potential for high impact on healthcare management. An abstract by Jennifer Ford of the Veterans Health Administration and Patricia MacTaggart of George Washington University titled "Innovative Comprehensive Care Model: Pittsburgh VA Oncology" also was presented at the Forum after publication in the November/December 2021 issue of the Journal of Healthcare Management. [ABSTRACT FROM AUTHOR]

Patient-centered care is essential to providing high-quality value-based care. Patient-reported outcome measures (PROMs) are arguably the best tools available to orthopaedic providers for providing patient-centered care. Many clinical opportunities exist for the implementation of PROMs into routine practice, such as shared decision-making, mental health screening, and prediction of postoperative disposition. Routine use of PROMs is also an adjunct to the streamlining of documentation, patient intake, and telemedicine visits, and hospitals can aggregate PROMs for the purpose of risk stratification. Physicians can harness the power of PROMs for quality improvement initiatives and improvement of the patient experience. Despite these numerous applications, PROMs are frequently underutilized tools. Understanding the many benefits of PROMs may allow orthopaedic practices to justify investing in these valuable tools. [ABSTRACT FROM AUTHOR]

Current payment systems make it difficult for both specialists and primary care practices to provide all of the services needed by patients with chronic conditions. "Value-based payment" programs have failed to solve these problems. In a patient-centered payment system, there should be 4 separate payments designed specifically to support each of the phases of chronic condition care: (1) Diagnosis Payment, (2) Care Planning Payment, (3) Initial Condition Management Payment, and (4) Monthly Condition Management Payments. Physicians should be accountable for delivering evidence-based services to patients in each phase of care, and payment amounts should be higher for more complex patients. [ABSTRACT FROM AUTHOR]

SUMMARY Goal: Clinical physician leaders have become an increasingly important asset to hospitals and hospital systems in a changing healthcare environment. Specifically, the role of the chief medical officer (CMO) has expanded and evolved amid the shift to value-based payment models and sharpened focus on patient safety, quality, community engagement, and equity in healthcare, as well as a global pandemic. In light of these changes, this study examined the transformation of CMOs and similar roles and evaluated the current needs, challenges, and responsibilities of clinical leaders today. Methods: The primary data source used in this analysis was a survey fielded to 391 clinical leaders in 290 Association of American Medical Colleges–member hospitals and health systems in 2020. In addition, this study compared responses to the 2020 survey with findings from two prior iterations of the survey from 2005 and 2016. The surveys collected information regarding demographics, compensation, administrative titles, qualifications for the position, and the scope of the role, among other questions. All surveys consisted of multiple-choice, free response, and rating questions. The analysis was conducted using frequency counts and percentage distributions. Principal Findings: Thirty percent of eligible clinical leaders responded to the 2020 survey. Twenty-six percent of the clinical leader respondents identified as female. Ninety-one percent of the CMOs were members of the senior management team in their hospital or health system. CMOs reported that they were responsible for five hospitals, on average, with 67% indicating they were responsible for more than 500 physicians. Practical Applications: This analysis provides hospital and health systems with insight into the expanding scope and complexity of CMOs as they take on greater leadership responsibilities within their institutions amidst a shifting healthcare landscape. In reflecting on our results, hospital leaders can understand the current needs, barriers, and responsibilities of today's clinical leaders. [ABSTRACT FROM AUTHOR]

Physician associates/assistants (PAs) and advanced practice RNs (APRNs) are a vital part of the healthcare team. As the PA and APRN workforce continues to grow, collaborations can move beyond the bedside. With organizational support, a shared APRN/PA Council allows these clinicians to raise a collective voice on issues that are unique to their practice and to implement meaningful solutions, thus improving the quality of their work environment and clinician satisfaction. [ABSTRACT FROM AUTHOR]

BACKGROUND: In single-institution studies, overtriaging low-risk postoperative patients to ICUs has been associated with a low value of care; undertriaging high-risk postoperative patients to general wards has been associated with increased mortality and morbidity. This study tested the reproducibility of an automated postoperative triage classification system to generating an actionable, explainable decision support system. STUDY DESIGN: This longitudinal cohort study included adults undergoing inpatient surgery at two university hospitals. Triage classifications were generated by an explainable deep learning model using preoperative and intraoperative electronic health record features. Nearest neighbor algorithms identified risk-matched controls. Primary outcomes were mortality, morbidity, and value of care (inverted risk-adjusted mortality/total direct costs). RESULTS: Among 4,669 ICU admissions, 237 (5.1%) were overtriaged. Compared with 1,021 control ward admissions, overtriaged admissions had similar outcomes but higher costs ($15.9K [interquartile range $9.8K to $22.3K] vs $10.7K [$7.0K to $17.6K], p < 0.001) and lower value of care (0.2 [0.1 to 0.3] vs 1.5 [0.9 to 2.2], p < 0.001). Among 8,594 ward admissions, 1,029 (12.0%) were undertriaged. Compared with 2,498 control ICU admissions, undertriaged admissions had longer hospital length-of-stays (6.4 [3.4 to 12.4] vs 5.4 [2.6 to 10.4] days, p < 0.001); greater incidence of hospital mortality (1.7% vs 0.7%, p = 0.03), cardiac arrest (1.4% vs 0.5%, p = 0.04), and persistent acute kidney injury without renal recovery (5.2% vs 2.8%, p = 0.002); similar costs ($21.8K [$13.3K to $34.9K] vs $21.9K [$13.1K to $36.3K]); and lower value of care (0.8 [0.5 to 1.3] vs 1.2 [0.7 to 2.0], p < 0.001). CONCLUSIONs: Overtriage was associated with low value of care; undertriage was associated with both low value of care and increased mortality and morbidity. The proposed framework for generating automated postoperative triage classifications is reproducible. In this longitudinal cohort study, overtriage was associated with low value of care; undertriage was associated with increased mortality and morbidity and low value of care. These findings suggest that a postoperative triage classification system using automated electronic health record data is reproducible. [ABSTRACT FROM AUTHOR]

Given that pediatric concurrent hospice care has been available for more than a decade, it is appropriate to seek an understanding of the value of this care delivery approach. Value is the cost associated with achieving beneficial health outcomes. In pursuit of this goal, the current literature on pediatric concurrent hospice care was synthesized and used to develop a model to explain its value. Because of its relevance, the Value Assessment Framework was used to conceptualize the value of pediatric concurrent hospice care. This framework gauges the value of a health care service through 2 components: long-term effect and short-term affordability. The framework considers comparative clinical effectiveness, cost-effectiveness, other benefits or disadvantages, contextual considerations, and potential budget impact. Evidence from the literature suggested that the value of concurrent care depended on clinical outcomes evaluated, costs examined, medical services used, care coordinated, context considered, and budget impacted. The literature demonstrated that pediatric concurrent hospice care does offer significant value for children and their families. The conceptual model highlighted the need for a comprehensive approach to assessing value. The model is a useful framework for future research examining the value of concurrent hospice care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this multihospital study was to investigate how the intervention of coaching to bedside shift report (BSR) correlates with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcomes and relates to Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (VBP) Program points over a 4-year period (2017-2020) for an acute care hospital health system. BACKGROUND: Hospital leaders' responsibilities include intertwined areas of patient experience and fiscal accountability. Coaching to BSR is reported to have numerous benefits to the patient's experience. Published studies completed with hospital systems evaluating the intervention of coaching to BSR and how it correlated to patient experience and VBP are limited. METHODS: Coaching to BSR was implemented at 16 adult acute care hospitals. Patient-reported BSR rates were collected in tandem with HCAHPS for 4 years. Statistical correlations were assessed between patient-reported BSR and HCAHPS and consequential effect on VBP dimension scores. RESULTS: Coaching to BSR had a significant impact on top- and bottom-box "rate the hospital" HCAHPS scores at a system and hospital level. Value-based purchasing points and percentages increased over 2017-2020, potentially leading to lower CMS penalty claims over the period the BSR was implemented. CONCLUSIONS: Coaching is a key factor when creating a favorable patient experience. The implementation and sustainability of coaching to BSR may result in improved patient experience ratings and increase VBP point accumulation to hospital systems. [ABSTRACT FROM AUTHOR]

Introduction: The use of data to inform lifelong learning has become increasingly important in continuing professional development (CPD) practice. Despite the potential benefits of data-driven learning, our understanding of how physicians engage in data-informed learning activities, particularly for CPD, remains unclear and warrants further study. The purpose of this study was to explore how physicians perceive cultural factors (individual, organizational, and systemic) that influence the use of clinical data to inform lifelong learning and self-initiated CPD activities. Methods: This qualitative study is part of an explanatory sequential mixed-methods study examining data-informed learning. Participants were psychiatrists and general surgeons from Canada and the United States. Recruitment occurred between April 2019 and November 2019, and the authors conducted semistructured telephone interviews between May 2019 and November 2019. The authors performed thematic analysis using an iterative, inductive method of constant comparative analysis. Results: The authors interviewed 28 physicians: 17 psychiatrists (61%) and 11 general surgeons (39%). Three major themes emerged from the continuous, iterative analysis of interview transcripts: (1) a strong relationship between data and trust, (2) a team-based approach to data-informed learning for practice improvement, and (3) a need for organizational support and advocacy to put data into practice. Conclusion: Building trust, taking a team-based approach, and engaging multiple stakeholders, such as data specialists and organizational leadership, may significantly improve the use of data-informed learning. The results are situated in the existing literature, and opportunities for future research are summarized. [ABSTRACT FROM AUTHOR]

Background: In 2019, the COVID-19 pandemic emerged. Variation in COVID-19 patient outcomes between hospitals was later reported. Purpose: This study aims to determine whether sustainers—hospitals with sustained high performance on Hospital Value-Based Purchasing Total Performance Score (HVBP-TPS)—more effectively responded to the pandemic and therefore had better patient outcomes. Methodology: We calculated hospital-specific risk-standardized event rates using deidentified patient-level data from the UnitedHealth Group Clinical Discovery Database. HVBP-TPS from 2016 to 2019 were obtained from Centers for Medicare & Medicaid Services. Hospital characteristics were obtained from the American Hospital Association Annual Survey Database (2019), and county-level predictors were obtained from the Area Health Resource File. We use a repeated-measures regression model assuming an AR(1) type correlation structure to test whether sustainers had lower mortality rates than nonsustainers during the first wave (spring 2020) and the second wave (October to December 2020) of the pandemic. Results: Sustainers did not have significantly lower COVID-19 mortality rates during the first wave of the pandemic, but they had lower COVID-19 mortality rates during the second wave compared to nonsustainers. Larger hospitals, teaching hospitals, and hospitals with higher occupancy rates had higher mortality rates. Conclusion: During the first wave of the pandemic, mortality rates did not differ between sustainers and nonsustainers. However, sustainers had lower mortality rates than nonsustainers in the second wave, most likely because of their knowledge management capabilities and existing structures and resources that enable them to develop new processes and routines to care for patients in times of crisis. Therefore, a consistently high level of performance over the years on HVBP-TPS is associated with high levels of performance on COVID-19 patient outcomes. Practice Implications: Investing in identifying the knowledge, processes, and resources that foster the dynamic capabilities needed to achieve superior performance in HVBP might enable hospitals to utilize these capabilities to adapt more effectively to future changes and uncertainty. [ABSTRACT FROM AUTHOR]

Design, implementation, and evaluation of effective multicomponent interventions typically take decades before value is realized even when value can be measured. Value-based health care, an approach to improving patient and health system outcomes, is a way of organizing health systems to transform outcomes and achieve the highest quality of care and the best possible outcomes with the lowest cost. We describe 2 case studies of value-based health care optimized through a learning health system framework that includes Strategic Clinical Networks. Both cases demonstrate the acceleration of evidence to practice through scientific, financial, structural administrative supports and partnerships. Clinical practice interventions in both cases, one in perioperative services and the other in neonatal intensive care, were implemented across multiple hospital sites. The practical application of using an innovation pipeline as a structural process is described and applied to these cases. A value for money improvement calculator using a benefits realization approach is presented as a mechanism/tool for attributing value to improvement initiatives that takes advantage of available system data, customizing and making the data usable for frontline managers and decision makers. Health care leaders will find value in the descriptions and practical information provided. [ABSTRACT FROM AUTHOR]

This document is a reply to a letter to the editor regarding the potential of generative artificial intelligence (AI) and large language models (LLMs) to contribute to value-based healthcare. The author acknowledges the importance of responsible AI regulation and governance in ensuring the development and adoption of high-quality AI models. The rapid emergence of generative AI and LLMs has led to innovative data-driven solutions in healthcare, but their performance and adoption depend on safe and trustworthy development and use. The author emphasizes the need for collaboration and cohesion across professional organizations to develop regulatory guidance and best practices for AI. The document also discusses the U.S. Executive Order and the European Union's AI Act as examples of regulatory efforts in this field. The author agrees with the letter writer's points on the responsibilities and opportunities for orthopaedic surgeons in AI research and development. The document concludes by highlighting the need for supportive infrastructures and guidance around intellectual property, inventorship, and commercialization in the AI field. [Extracted from the article]

The article discusses nurse navigators, in a role that originally focused on a single health condition and improving specified services for an individual patient, have expanded to include care management and care coordination. Topics include outcomes for several key health quality indicators, including life expectancy, avoidable mortality, obesity, smoking, and effective primary and secondary care reflected by 30-day readmissions rank lower than most other developed nations.

The Magnet® journey has increased in relevance as the sources of evidence reflect the complex role of the nurse in quality, safety, and the patient care experience. Creating a business case to secure the resources required to embark and travel on the Magnet journey is an essential tool for the chief nurse. Identifying expenses, cost savings or avoidance, and return on investment for nursing services are all important elements of a business case. [ABSTRACT FROM AUTHOR]

Background: Effective management of hypertension (HTN) is a priority in primary care, necessary to decrease the costs, morbidity, and mortality associated with cardiovascular disease. Strategies to support quality improvement (QI) efforts in primary care are needed to make significant improvements in population health, especially for patients who experience socioeconomic inequalities. Local problem: To address the high rate (>50%) of uncontrolled HTN in the state of Ohio, a statewide QI project was implemented in high-volume Medicaid practices, aimed at improving blood pressure control and addressing racial disparities. The initiative expanded to include coaching QI to support efforts in primary care practices. Methods: The Model for Improvement guided development of Plan-Do-Study-Act (PDSA) cycles facilitated by QI coaching and APRN collaboration to implement key components of HTN guidelines: accurate blood pressure measurement, effective treatment, and timely follow-up. Interventions: Interventions were implemented after PDSA cycles over 18 months in two practice sites to address HTN control. Linking multiple PDSA test cycles and review of data bimonthly allowed for reflection on the impact of interventions for non-Hispanic Black patients and the overall patient population. Results: The percentage of patients with controlled HTN, repeat blood pressure measurement, and timely follow-up improved in an urban primary care practice associated with an academic medical center and in a rural federally qualified health center. Conclusions: Primary care practices can benefit from the external support of coaching when implementing QI processes to make meaningful change. APRNs are key collaborators for expanding QI efforts in primary care. [ABSTRACT FROM AUTHOR]

The Centers for Medicare & Medicaid Services' (CMS's) Transforming Clinical Practice Initiative (TCPi) was the largest national-scale practice transformation model. We analyzed the effect of TCPi on new enrollment into Medicare Alternative Payment Models (APMs) through January 2020 (3 months after program end), using 6958 physician practices enrolled in TCPi and a closely matched comparison group of 6958 practices. More TCPi practices enrolled in Medicare APMs and Medicare Advanced APMs relative to comparison practices overall and in subgroups, including rural, small, and specialty practices. Results suggest that large-scale technical assistance can boost participation in Medicare APMs for a diverse set of practices. [ABSTRACT FROM AUTHOR]

Background: The 1980s to 1990s saw many health systems in the United States enter and exit the insurance market in the form of provider-sponsored health plans (PSHPs). Reforms and value-based reimbursement methods have stimulated health care organizations to reconsider PSHP as a logical strategy. Purpose: The aim of this study was to examine market and organizational factors associated with PSHP ownership and motivations for engaging in PSHP after health care reforms. The resource dependence theory was used as a theoretical lens. Methodology/Approach: A sequential quantitative to qualitative mixed-methods design was used. The quantitative analysis examined data for 5,849 U.S. hospitals. Results were synthesized with qualitative findings from 10 semistructured interviews representing eight health systems in five states. Results: Organizational and environmental characteristics were significantly associated with PSHP ownership. Hospital and payer concentration, Medicare penetration, income, unemployment rate, government, and for-profit and metro area hospitals were associated with a lower likelihood of PSHP ownership. Salaried physician arrangements, clinically integrated network membership and adoption of other risk-bearing arrangements were associated with higher odds of PSHP ownership. Interviewees described PSHP as the culmination of the journey to value-based care and as a strategy to improve patient care, compete, and diversify revenue streams. Conclusions: Both market and organizational factors are important considerations for hospitals contemplating PSHP ownership, and motivations for ownership cover a broad range of financial, competitive, strategic, and mission-based goals. Practice Implications: Hospitals considering PSHP ownership must carefully evaluate their competitive landscapes and organizational resources to ensure optimal conditions for this strategy. PSHP ownership has high start-up costs and requires a long-term organizational commitment. [ABSTRACT FROM AUTHOR]

Nurse navigators, in a role that originally focused on a single health condition and improving specified services for an individual patient, have expanded to include care management and care coordination. As the role evolves, nurse navigators are demonstrating proficiency and achieving success transforming care delivery to improve population health while improving quality outcomes, patient satisfaction, and decreasing cost. One innovative health system's clinical nurse specialist team partnered with primary care providers, ancillary care teams, home care, skilled nursing facilities, community agencies, and partners in public health and schools. Clinical nurse specialists, now called "transitional care nurses (TCNs)," have created an accountable community of health for their high-risk population. By following patients from one setting to the next, TCNs identified opportunities for improvement, created innovative programs to bridge gaps, improved teamwork, and integrated care, resulting in lower cost, high-quality care. Results included 50% reduction in hospitalization for patients with chronic disease, pre- and post-TCN partnership. Patients with diabetes were supported with access to diabetes coaches, which resulted in a 12% reduction in AIC, while patients completing pulmonary rehabilitation programs experienced reduced readmission rates from 24% to 2.7%. [ABSTRACT FROM AUTHOR]

Previous Finance Matters columns in Nursing Administrative Quarterly have emphasized the importance of utilizing financial statements to build and promote a successful evidence-based business case. The latest column addressed return on investment substantiation to solidify the business case being presented. Given the current and future state of federal value-based payment models (where health care delivery providers will accept more downside risk for reimbursement), the cost-benefit and cost-effectiveness analyses can be useful measurements. This column defines utilization of cost-benefit analysis and cost-effectiveness analysis when framing the cost, value, and benefit of an innovative health care intervention. [ABSTRACT FROM AUTHOR]

Shared decision-making (SDM) is a collaborative process wherein clinicians share their knowledge of conditions, treatment options, and potential harms and benefits, and patients share their preferences, values, and goals before making individualized and confident healthcare decisions together. My Patients Want Me to Make the Decision Surgeon perceptions of patient preferences and control over decision-making may be misaligned with patient perceptions, despite the availability of PROs and patient decision aids, which are intended to limit this mismatch [[1]]. Patient decision aids have been developed to facilitate SDM, and they have been shown to consistently improve a patient's knowledge about their condition and treatment options as well as decision quality, resulting in more informed and confident decisions [[5]]. [Extracted from the article]

Goal: The goal of this study was to describe the prevalence and pattern of population health partnerships by hospitals and examine whether these partnerships were associated with different types of payment model programs. Methods: We conducted a cross-sectional analysis of 3,012 U.S. hospitals using data from the American Hospital Association's Annual Survey, the Area Health Resources File, and the County Health Rankings & Roadmaps data. We ran a multivariable Poisson regression model to examine the relationship between value-based payment designs and the number of population health partnerships. Binary logistic regression models were used to assess whether participation in value-based payment design programs was associated with specific types of population health partnerships. Principal Findings: We found that two thirds or more of hospitals used more informal collaborative partnerships with local or state government, faith-based organizations, and local businesses; formal alliances were most common with health insurance companies and other healthcare providers. Accountable care organizations and bundled payment program participation were associated with greater numbers of population health partnerships, whereas hospital ownership of a health plan was not associated with significantly greater numbers of population health partnerships. Applications to Practice: Hospitals were engaged in an intermediate number of partnerships (mean = 3.5, out of 8.0 possible), with opportunities for more partnerships with specific types of organizations (faith-based organizations, health insurance companies). Our findings also suggest that certain types of payment models, particularly those that are less capital intensive and entail less extensive organizational transformation on the part of hospitals, may support hospital engagement in population health partnerships. Hospital leaders need to monitor these partnerships continually to determine if they can capitalize on opportunities to play a more prominent role in population health management in local communities. [ABSTRACT FROM AUTHOR]

Objective: To understand the surgeon's perceived value of PROMs in 5 different surgical subspecialties. Summary of Background Data: PROMs are validated questionnaires that assess the symptoms, function, and quality of life from the patient's perspective. Despite the increasing support for use of PROMs in the literature, there is limited uptake amongst surgeons. Furthermore, there is insufficient understanding of the surgeons' perceived value of PROMs. The aim of this study is to understand how surgeons perceive value in PROMs. Methods: We conducted an exploratory qualitative study to understand the perceived value of PROMs from the perspective of surgeons in various subspecialties. Per convenience sampling, we conducted semi-structured interviews with 30 surgeons from 5 subspecialties across 3 academic medical centers. The surgical subspecialties included bariatric surgery, breast oncologic surgery, orthopedic surgery, plastic and reconstructive surgery, and rhinology. Interviews were transcribed, coded, and evaluated with thematic analysis. Results: Surgeons endorsed that PROMs can be used to enhance clinical management, counsel patients in the preoperative and postoperative settings, and elicit sensitive information from patients that otherwise may go undetected. Obstacles to PROMs use include failure to generate actionable data, implementation obstacles, and inappropriate use of PROMs as a performance metric, with concerns regarding inadequate risk adjustment. Conclusions: Establishing an effective PROMs program requires an understanding of the surgeon's perspective of PROMs. Despite obstacles, different subspecialty surgeons find PROMs to be valuable in different settings, depending on the specialty and clinical context. [ABSTRACT FROM AUTHOR]

The article discusses the use of relational coordination (RC) as a merger and acquisition framework for nurse leaders. It mentions the aim of RC to improve the quality of communication and relationships among employees. It explains the RC communication dimensions capable of enhance communication exchanges and trust among members of a work group. Also noted is the aim of the RC relationship dimension to cultivate relationships based on shared goals and knowledge, and mutual respect.

Background: The United States is steadily shifting away from volume-based payments toward value-based payment for health care. The nursing model's emphasis on high-value care, such as disease prevention and health maintenance, ideally positions nurse practitioner (NP) practice owners to contribute to the goals of value-based care. However, little is known about NP participation in value-based care. Purpose: To better understand NP-owned practice participation in value-based care. Methodology: Using convenience sampling, we developed a registry of NP owned practices, which we used to conduct a web-based survey from November 2019 to February 2020. Results: Of the 47 NP-owner respondents, 40 practice in primary or specialty care. Practices are relatively small with a mean clinical staff of 4 full-time equivalent (FTE; range: 1-17), mean total staff of 7 FTE (1-28.5), and with a mean of 325 patient visits annually. A third participate in value-based payment arrangements, whereas a half are considering and three quarters are knowledgeable about value-based payment arrangements. Over 70% of practice owners report lack of knowledge, lack of financial protections, and lack of payer partnership as barriers to participation in value-based payment models. Conclusions: NP practice owners face many challenges to taking on risk, including insufficient patient volume. Implications: Joining together may allow small NP practices to participate in and thrive under value-based payment. Reducing the barriers and regulation of all NPs will enable the health care system to capitalize on the nursing model to meet the goals of value-based care. [ABSTRACT FROM AUTHOR]

This article discusses the concept of value-based healthcare and emphasizes that cost containment does not necessarily equal value creation. The authors highlight the increasing healthcare expenditures in the United States and other countries, without a corresponding improvement in health-related outcomes. They argue that cost-cutting measures should be focused on increasing value for patients, rather than simply reducing expenses. The authors recommend three principles for orthopedic leaders to consider before engaging in cost-cutting: measuring health and well-being before and after cost-cutting initiatives, targeting low-value care for cuts, and building trust during the cost-cutting process. They emphasize the importance of considering health outcomes and the well-being of patients and care delivery teams when determining the most appropriate approach to cost containment. [Extracted from the article]

Hospital value–based purchasing (HVBP) is a budget neutral initiative from the Centers for Medicare & Medicaid Services designed to adjust the hospital payment system based on health care quality data. Hospital value–based purchasing is designed to promote improved clinical outcomes and better patient experience in the acute care setting. Advanced practice registered nurses (APRNs) in the acute care setting are instrumental to the success of health care institutions under the current payer model in the United States health care system. When APRNs use their advanced knowledge and leadership skills to champion quality improvement and patient experience projects, they may increase financial reimbursement within the HVBP system, thus demonstrating value to the health care institution. Four basic steps could help APRNs demonstrate value to the organization, understand the standard, evaluate your performance compared with the standard, identify opportunities, and implement projects or participate in projects. This article provides a broad overview of the HVBP structure and describes how APRNs can positively influence performance measures, thereby potentially increasing hospital reimbursement. [ABSTRACT FROM AUTHOR]