Applying Value-based Health Care

This is an example that I will use to illustrate application of value-based health care principles in patients undergoing a breast mass excision under local anesthesia and outpatient basis.

Applying the principles will redound to providing value-based health care in such patients.

Before I go presenting the illustration, let me define in my own words, what is value-based health care? It is providing health care in such a way that the cost of the health care management is kept to the lowest minimum possible or most reasonable expense possible while continuing to maintain and improve quality and safe outcomes.

For a patient undergoing a breast mass excision, say a fibroadenoma, the quality and safe outcomes  consist of the so-called excellent intraoperative and postoperative outcomes which in turn consist of no surgical complications and unwanted side-effects and which in turn consist of complete removal of the mass to avoid recurrence; just mild intraoperative and postoperative pain; no postoperative hematoma; no postoperative infection; and acceptable (not ugly) scar.

There are two scenarios when operating room cost is factored in.

First scenario, the operation was done by surgeon 1; the outcomes are excellent; and the total operating room cost is P6,000.00

Second scenario, the operation was done by surgeon 2; the outcomes are excellent (as good as those in the first scenario); the total operating room cost is P3,000.00.

Assuming the size and other characteristics of the fibroadenoma and operating rooms are the same in both scenarios, we can say that surgeon 2 is practicing or providing value-based health care.

What accounts for the P3,000.00 difference?  Supposing a comparative analysis of the items used in the operating room by the surgeons was done.  Surgeon 2 did not use an electrocautery machine which accounted for the P1,800 in Patient 1.  He used only one suture material all throughout the operation while Surgeon 1 used two sutures, accounting for the P600 difference in the suture expenses between the two patients.  Surgeon 1 used more gauze than Surgeon 2.  Surgeon 1 used antiseptic solutions in prepping the operative field with an expense of P400 more than the ones used by Surgeon 2 for Patient 2.

What is the basic differential factor in the two surgeons that accounted for the P3,000 difference in operating room costs but with the same excellent outcomes?  It is the conscientiousness of Surgeon2 to bring down the costs while maintaining quality and safe outcomes.

This is value-based operating room care.

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