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Patient Expectations Important when Determining Surgical Appropriateness

BY AMANDA FLAUM – Too often patients receive unnecessary care. More than 1 million hip and knee replacements are performed each year. While joint replacement is very effective, it is not for everyone. About 20 percent of recipients of successful replacements are unsatisfied with their surgery, and unmet expectations are a common cause of dissatisfaction. Also, 2014 research shows that more than one-third of knee replacements in the U.S. were classified as inappropriate.

According to a report from The National Academy of Medicine, less than half of all patients think that their doctor asks necessary questions to understand their goals and concerns. This suggests that provider preferences, rather than patient needs, may be driving some joint replacement decisions.

Blue Shield is focused on providing access to quality healthcare at an affordable price. To deliver on that goal, we have developed innovative programs and collaborations with care providers to ensure members are receiving appropriate care at the right time. For example, Blue Shield worked with the Society for Patient Centered Orthopedics and the California Orthopedic Association to develop a joint replacement program to address surgical appropriateness and ensure that replacement is the best option for the patient.

The program is centered on engagement between the patient and surgeon to determine whether surgery will meet the patient’s expectations, or whether non-operative treatment is preferred when all the options are presented. To be sure this question is answered appropriately, Blue Shield introduced patient-centered assessment tools and surveys that emphasize shared decision making.

To learn more about the program and the importance of patient-surgeon engagement, read this Health Affairs blog from Dr. James Rickert, president of The Society for Patient Centered Orthopedics: “An Innovative Patient-Centered Total Joint Replacement Program.”

Amanda Flaum is vice president of medical care solutions at Blue Shield of California