Debunking the Surgical Intent Metric and Focusing on Real Cost Savings

As self-insured employers and health plans consider implementing musculoskeletal (MSK) solutions to benefit their employees and members, it's crucial to understand the effectiveness of these programs. Many competing MSK solutions in the market claim to reduce surgeries and opioid use, basing their impact on patient-reported surgical intent, also sometimes crafted as “Avoided Surgeries.“ There is insufficient evidence from peer-reviewed studies to support the use of this metric in measuring surgery reduction. Additionally, it may not provide an accurate reflection of the actual cost savings from a program. In this blog post, we'll explore why SimpleTherapy chooses not to rely on surgical intent to measure the impact of our virtual physical therapy program and what alternative evidence-based measures should be considered.

With the rise of virtual physical therapy programs, employers and health plans are often faced with the challenge of choosing the right solution for their members. Amidst the noise and competing claims in the market, one metric that has garnered attention is the reduction of surgical intent as a measure of program success. In this blog post, we discuss the reliability of this metric and provide insights from orthopedic surgeons on the importance of objective data in measuring the impact of virtual physical therapy programs.

The Flaws of Surgical Intent Metric

Using surgical intent as a measure of program impact involves asking members about their likelihood of having surgery in the next 12 months. Although some MSK solutions guarantee returns by calculating savings using surgical intent reduction, there is no proof that reducing surgical intent actually leads to reduced costs in claims. Furthermore, there are no peer-reviewed studies supporting the reliability of this metric for measuring surgery reduction.

Surgical intent is a subjective measure that can be influenced by various factors, such as the patient's perception of their condition, personal beliefs about surgery, and their understanding of alternative treatments. While it has been used as one of the outcome measures in some clinical studies, often in conjunction with other clinical, functional, and quality-of-life measures, these studies typically assess the effectiveness of interventions in reducing the patient's intention to undergo surgery. They do not provide direct evidence to support surgical intent as a reliable, independent metric for evaluating the true impact on surgical claims and further overestimate the impact of virtual physical therapy or MSK programs in terms of cost.

Moreover, relying on surgical intent to calculate cost savings assumes a direct correlation between reduced surgical intent and actual cost savings in medical claims. However, there is no proof that reducing surgical intent leads to reduced healthcare costs.

The Orthopedic Surgeon's Perspective

"As a surgeon, my primary focus is on the best course of treatment for my patients, taking into account their unique circumstances and medical history. Relying on a patient-reported measure of surgical intent, a patient's subjective opinion, especially within a short time frame of 6-8 weeks, may not accurately capture the true impact of a physical therapy program. Objective data, such as claims-based cost savings and measurable clinical improvements, are far more reliable indicators of a program's effectiveness"

— Tae Won Kim, M.D
Program Director, Orthopaedic Surgery Residency Program
Director, Orthopaedic Oncology Center
Cooper University Heath Care

Orthopedic surgeons also acknowledge the limitations of relying on patient-reported measures like surgical intent. It's difficult to depend on a measure taken just 6-8 weeks after starting a program when the true impact of the program may require a much longer timeframe to become evident. Moreover, it's crucial to consider factors such as the severity of the patient's condition, the patient's overall health, and the potential risks and benefits of surgery, which cannot be captured by simply asking about surgical intent.

An orthopedic surgeon would likely perceive the patient-reported outcome measure of the likelihood of surgery with skepticism. Surgeons base their decisions on a comprehensive assessment of the patient's condition, medical history, and the severity of their symptoms. They take into account various diagnostic tests, clinical guidelines, and their expertise to determine the most appropriate course of action for the patient.

A patient-reported measure of the likelihood of surgery, while potentially informative, is subjective and may not accurately reflect the clinical need for surgery. Patients might overestimate or underestimate their need for surgery based on personal beliefs, fear, or lack of understanding of alternative treatment options. As a result, orthopedic surgeons might not rely solely on a patient-reported measure of surgical intent when making a decision about the best course of treatment.

Orthopedic surgeons may also consider factors such as the patient's functional limitations, pain levels, and response to conservative treatments like physical therapy or medications. They would likely view a combination of these objective measures as a more accurate and reliable way to determine the need for surgery and the potential benefits of non-surgical interventions.

A Physical Therapists perspective

The time it takes for physical therapy (PT) to reduce the chances of surgery can vary significantly depending on several factors, such as the type and severity of the condition, the patient's overall health, and their adherence to the prescribed PT program.

In some cases, patients may experience significant improvements in their symptoms within a few weeks or months, while others may require a longer period of consistent physical therapy to achieve noticeable progress. It is essential for patients to follow their PT program diligently and maintain open communication with their healthcare providers to monitor their progress and adjust the treatment plan as needed.

"Ultimately, the decision to pursue surgery should be based on a comprehensive evaluation of the patient's condition, response to conservative treatments like PT, and consultation with their healthcare providers. It is important to remember that individual experiences may vary, and there is no one-size-fits-all timeline for the effects of PT in reducing the chances of surgery."

— Kelly McLaughlin, DPT, ATC Cert MDT

Alternative Measures for Evaluating MSK Program Impact

It's essential to rely on objective, evidence-based measures when evaluating the effectiveness of a physical therapy or MSK program. This can include functional outcomes, pain reduction, quality of life improvements, and actual healthcare cost savings resulting from reduced surgical procedures, hospitalizations, and medication use.

SimpleTherapy focuses on such cost savings and is willing to put money at RISK. By using cohort-matched studies and reviewing claims data, we demonstrate the real-world impact of our MSK program on healthcare costs and patient outcomes. This approach demonstrates actual cost savings and reflects the true effectiveness of our virtual physical therapy program. By focusing on real savings, SimpleTherapy is confident in our program's ability to make a difference, and we're willing to put our money at risk to prove it.

The SimpleTherapy Difference: Focusing on Transparency and True Cost Savings

At SimpleTherapy, we recognize the need for objective data and transparency in evaluating the impact of our virtual physical therapy program. Our Advanced Claims Analytics Engine (ACE) is designed to help employers gain insights into the true cost savings achieved through our program by analyzing medical claims data and providing accurate, reliable metrics identified in these studies.

By focusing on cohort-matched studies that review claims data, we can demonstrate the real-world cost savings associated with our program. This approach aligns with the opinions of orthopedic surgeons who emphasize the importance of objective data in measuring program success, as opposed to relying on subjective measures like surgical intent.

We are confident in our ability to deliver true cost savings and are willing to put our money at RISK. SimpleTherapy is dedicated to providing high-quality, accessible virtual physical therapy services that lead to real, measurable improvements in our users' health and well-being.

Check-out some of our case studies that showcase the claims-based analysis conducted for our clients.

Conclusion

As healthcare decision-makers, it is crucial to be critical of the metrics used to evaluate the effectiveness of MSK solutions. Patient-reported surgical intent is not a reliable, standalone measure for determining the impact of a virtual physical therapy program. Instead, consider evidence-based measures, such as functional outcomes, pain reduction, quality of life improvements, and actual healthcare cost savings. By focusing on these more meaningful metrics, SimpleTherapy aims to provide an effective and accessible solution for musculoskeletal pain management while promoting health equity and diversity.