Patient-Centered Surgical Care Meets the Social Determinants of Health
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INVITED COMMENTARY
Patient-Centered Surgical Care Meets the Social Determinants of Health Michael Williams1
Accepted: 5 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
In August 2020, the Centers for Medicare and Medicaid services (CMS), a division of the Department for Health and Human Services in the United States government, proposed reimbursement cuts of between 7 and 9% for outpatient surgical care, including general surgery-specific procedures such as cholecystectomy [1]. If enacted, this new Fee Schedule may well have a chilling effect on the utilization of elective surgical procedures in the Medicare population due to cost shifts that are unaffordable for patients. It can easily be imagined that patients will therefore choose to delay care until symptoms are so severe that urgent and emergent procedures are required rather than on an elective basis. Secondary victims of this potential shift in utilization of surgical care will be those patients who are either uninsured or currently qualify for their state’s Medicaid program, which provides health insurance for low-income adults and children. Combined with the ongoing COVID-19 pandemic, increasing pressure will be placed on healthcare systems to provide care for the uninsured in America. Both of these facts amplify the importance of the critical work by Hatton et al., ‘‘Timely Care is Patient-Centered Care for Patients with Acute Cholecystitis at a Safety-Net Hospital’’ [2]. The authors have taken an important step in reframing the discussion of surgical care and its value, from the patient’s perspective, differing from the preponderance of the literature which often focuses on either physician or health system-centric perspectives, goals and outcomes. By using qualitative methods including structured and semi-structured interviews, the authors have added to our knowledge
& Michael Williams [email protected] 1
base considerably. By identifying, in rank order from the study participants’ perspective, patient-specific and patient-centric goals of care including focusing on such determinants of health as Time-to-Return-to-Work, among a population for whom loss of work productivity is often associated with termination of employment, the authors have elegantly re-examined the question of value-based care, through an equity lens. When analyzed in the context of a US healthcare system that operates as ‘‘Big Business’’ while simultaneously being a fundamental necessity for the basic functioning of our society, the work by Hatton et al. becomes even more impactful. With health systems and other systems of care under increasing pressure to both contain costs and continually improve quality, papers such as this that focus on Safety-Net Hospitals and health systems are crucial in our shared efforts to realize an equitable healthcare system in this country. By ‘‘flipping the script’’ and examining length of stay (LOS) from the patient’s perspective, not in days but hours, while redefining ‘‘Timeliness’’ from the same perspective, the authors
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