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Clinical Care Redesign to Improve Value for Trigger Finger Release: A Before-and-After Quality Improvement Study
Burn MB, Shapiro LM, Eppler SL, Behal R, Kamal RN.
Trigger finger release (TFR) is a commonly performed procedure. However, there is great variation in the setting, care pathway, anesthetic, and cost. We compared the institutional cost for isolated TFR before and after redesigning our clinical care pathway.
From pre- to post-implementation, the study surgeon’s total direct cost decreased by 18%, while the control surgeons decreased by 2%. Median time spent at the surgery center decreased by 41 minutes post-implementation with significantly shorter setup time in the operating room (OR), total time in the OR, and time spent in recovery prior to discharge.
Patient Willingness to Pay for Faster Return to Work of Smaller Incisions.
Alokozai A, Lindsay SE, Eppler SL, Fox PM, Ladd AL, Kamal RN.
The primary aim of this exploratory study was to assess hand surgery patient willingness to pay supplementary out-of-pocket charges for a procedure that theoretically leads to an earlier return to work or smaller incisions when there are 2 procedures that lead to similar results (clinical equipoise).
Physical and Occupational Therapy Use and Cost After Common Hand Procedures.
Shah RF, Zhang S, Li K, Baker L, Sox-Harris A, Kamal RN.
The use of routine physical therapy (PT) and occupational therapy (OT) after certain hand procedures, such as carpal tunnel release, remains controversial. The objective of this study was to evaluate baseline use, the change in use, variation in prescribing patterns by region, and costs for PT/OT after common hand procedures.
Performance Metrics in Hand Surgery: Turning a Blind Eye Will Cost You.
Roe AK, Gil JA, Kamal RN.
The Medicare Access and Children's Health Insurance Program Reauthorization Act established the Quality Payment Program (QPP), which mandates that physicians who meet the threshold in volume of Medicare patients for whom they care participate in this program through either advanced Alternative Payment Models or the Merit-Based Incentive Payment System. Anticipating physicians' concerns regarding the burden of implementing the QPP, feedback from physicians became a critical component of the continued implementation process in 2018. The purpose of this review is to inform hand surgeons regarding the current QPP (early 2019) and for future observation periods.