Recently, the reimbursement or payment model in healthcare has begun to shift from a fee-for-service to a value-based system. While some physicians are concerned about this shift, I think it is a welcome change that will ultimately improve patient care. Surgeon volume is one area that received much attention as a means of improving value and thus patient care. Studies in multiple specialties have demonstrated that higher surgeon volume is associated with improved patient outcomes and decreased complications. This is good not only for the patient (improved outcome), but also for the healthcare system because of decreased cost (via lower complication) and for our society (reliable return to work).
A recent study out of Penn State entitled "Patient Outcomes as a Function of Shoulder Surgeon Volume: A Systematic Review" summarized studies between 1990 and 2016; the authors analyzed over 150,000 shoulder procedures from 13 studies. They broke their findings down by shoulder replacements and rotator cuff repairs.
- Patients who had a shoulder replacement with a low-volume surgeons had a 4.4x risk of mortality and a 59% increased rate of complications compared to a high-volume surgeon.
- In terms of rotator cuff repair, there was a lower re-admission rate, lower length of stay, and shorter surgical time for high-volume surgeons. All of these factors provide value by decreasing the burden to the patient and decreasing the cost to our healthcare system.
Clearly volume isn’t the only factor in obtaining a good outcome. There is no benefit to fast and reckless for instance, but as we have learned from authors such as Malcom Gladwell who popularized the 10,000-hour rule, increased time spent doing something is typically associated with expertise.
In surgery, I believe that volume allows one to not only create a more systematic approach and decrease surgical time but also notice the subtle variation in each patient to prevent complications. Improved outcomes for patients, lower complication rates and reliability for patients to get back in the workforce are benefits that cannot be ignored. As we move forward in the value-based initiatives, we will have to continue to understand how different factors affect patient outcomes.