The Macon Value The Macon Value FormulaFormula

James B. Macon, M.D.James B. Macon, M.D.

Framingham NeuroSpineFramingham NeuroSpine

Framingham, MassachusettsFramingham, Massachusetts

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

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

MaconMacon Value FormulaValue Formula

Formula VariablesFormula Variables

n is the number in the intervention groupn is the number in the intervention group OOk k is the outcome for individual k (0-100)is the outcome for individual k (0-100) 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 to be treated based on ICD9 codesIdentify condition to be treated based on ICD9 codes Identify intervention groups based on CPT codeIdentify intervention groups based on CPT code Define group size n and number of groups in study Define group size n and number of groups in study Define severity range of condition ( risk adjustment )Define severity range of condition ( risk adjustment ) Define outcome measure for the data set (0-100 scale)Define outcome measure for the data set (0-100 scale) Define success range for outcome data (70-100)Define success range for outcome data (70-100) Collect outcome data at the end of study time intervalCollect outcome data at the end of study time interval Collect cost data = total payments to all providersCollect cost data = total payments to all providers Enter outcome and cost data into spread sheetEnter outcome and cost data into spread sheet 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 value as a function of time to identify trendsPlot value as a function of time to identify trends

Value Formula Summary Value Formula Summary TableTable

CPT VALUE SUCCESS CPT VALUE SUCCESS COST COST

62311 64 70% 62311 64 70% $9,045 $9,045

63030 8 90% 63030 8 90% $103,750 $103,750

62311/63030 21 100% 62311/63030 21 100% $38,645 $38,645

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 maximum effectivenessMaximum value is not maximum 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.com and and requestrequest

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 size and numberGroup size and number Outcome measurementsOutcome measurements Success range definitionSuccess range definition Severity range of conditionSeverity range of condition Crossover designCrossover design Return e-mail addressReturn e-mail address