A Relative Value A Relative Value Calculator For Pain Calculator For Pain

ProceduresProcedures

James B. Macon, M.D.James B. Macon, M.D.Framingham NeuroSpineFramingham NeuroSpine

Framingham, MassachusettsFramingham, Massachusetts

Copyright 2010 James B. Macon, M.D.Copyright 2010 James B. Macon, M.D.

DisclosureDisclosure

James B. Macon, M.D. is a James B. Macon, M.D. is a consultant for Spine Surgical consultant for Spine Surgical

Innovations, Inc.Innovations, Inc.

Value DefinitionValue Definition

Value for patientsValue for patients ==

Health Outcomes perHealth Outcomes per

$ Cost Expended$ Cost Expended

Porter, M.E. “A Strategy for Health Porter, M.E. “A Strategy for Health Care Reform – Toward a Value-Care Reform – Toward a Value-

Based System” Based System” NEJMNEJM 361: 109- 361: 109-112, 2009112, 2009

Value = Value = Successful Successful OutcomesOutcomes

Provider Provider PaymentsPayments

Outcome TiersOutcome Tiers Tier I : Tier I : primary outcome primary outcome (pain, neuro status,(pain, neuro status, return to work, disability status)return to work, disability status)

Tier II : Tier II : complicationscomplications (infections, root injury, (infections, root injury, CSF leak, delay to recovery)CSF leak, delay to recovery)

Tier III : Tier III : recurrencesrecurrences ( re-herniation, re-op, ( re-herniation, re-op, delayed adverse events- scarring)delayed adverse events- scarring)

Convert all outcomes to % recovery to baselineConvert all outcomes to % recovery to baseline

MaconMacon Value FormulaValue Formula

A Quantitative Value Analysis A Quantitative Value Analysis Formula for Comparison of Formula for Comparison of

Spine Interventions Based on Spine Interventions Based on Outcome and Cost DataOutcome and Cost Data

Formula VariablesFormula Variables

OOk k is the outcome for individual k (0-100)is the outcome for individual k (0-100) n is the number in the intervention groupn is the number in the intervention group s is 1 if outcome success and 0 if failures is 1 if outcome success and 0 if failure DDk k is the total provider payment (min. is the total provider payment (min.

$100)$100) c is 1 for additional cost and 0 if no costc is 1 for additional cost and 0 if no cost V is the relative value calculated (0-1000)V is the relative value calculated (0-1000)

Formula StepsFormula Steps Identify condition ICD9 codes (722.10/724.3) <4 wksIdentify condition ICD9 codes (722.10/724.3) <4 wks Identify intervention groups CPT code (62311/63030)Identify intervention groups CPT code (62311/63030) Define group size n to be studied (10)Define group size n to be studied (10) Define severity rating for the condition (8-10/10 pain)Define severity rating for the condition (8-10/10 pain) Select outcome measures to be studied ( Tiers 1-3)Select outcome measures to be studied ( Tiers 1-3) Convert outcome measure to scale (0-100% pain Convert outcome measure to scale (0-100% pain

relief)relief) Define success range for outcomes (70-100)Define success range for outcomes (70-100) Collect outcomes for study time interval (3-12 months)Collect outcomes for study time interval (3-12 months) Collect cost data = total payments to all providersCollect cost data = total payments to all providers Enter outcome and cost data into spreadsheetEnter outcome and cost data into spreadsheet Prepare formula summary table based on resultsPrepare formula summary table based on results Use table results to optimize value and successUse table results to optimize value and success Plot graph of value over study duration to compare Plot graph of value over study duration to compare

proceduresprocedures

Lumbar Epidural SteroidLumbar Epidural Steroid

Lumbar DiscectomyLumbar Discectomy

Cross Over to DiscectomyCross Over to Discectomy

Value Formula Summary Value Formula Summary TableTable

12 Months12 Months

CPT VALUE SUCCESS CPT VALUE SUCCESS COST COST

62311/63030 23 100% 62311/63030 23 100% $36,195 $36,195

63030 9 100% 63030 9 100% $103,750 $103,750

Value-Based ConclusionsValue-Based Conclusions The goal of care is to maximize group valueThe goal of care is to maximize group value Maximum value is not always max effectivenessMaximum value is not always max effectiveness Maximum value is not always evidence-basedMaximum value is not always evidence-based Less effective procedures may have high valueLess effective procedures may have high value Sequence procedures to maximize group valueSequence procedures to maximize group value Order procedures to perform high value firstOrder procedures to perform high value first Perform high success low value procedures lastPerform high success low value procedures last Eliminate ineffective unsuccessful procedures Eliminate ineffective unsuccessful procedures

To use the Macon Value To use the Macon Value FormulaFormula

Request a copy of the spread sheet for Request a copy of the spread sheet for use in your practice to compare use in your practice to compare intervention groupsintervention groups

E-mail : E-mail : macon@fnspine.commacon@fnspine.com and request and request Website: www.fnspine.comWebsite: www.fnspine.com The Macon value formula is copyright The Macon value formula is copyright

protected by the U.S. Copyright Officeprotected by the U.S. Copyright Office Credit the formula to the author when Credit the formula to the author when

data is presented or published.data is presented or published.

E-mail :E-mail : macon@fnspine.commacon@fnspine.com ICD 9 of study ICD 9 of study CPT for all groupsCPT for all groups Group sizeGroup size Number of groups in studyNumber of groups in study Success range definitionSuccess range definition Crossover designCrossover design Return e-mail addressReturn e-mail address