Introduction: Reimbursements are increasingly reliant upon Value-­-Based Purchasing / Pay for Performance rather than Fee-­-For-­-Service. However, value is difficult to define (1). Therefore, we surveyed patients in a general neurosurgery spine clinic to determine patient’s perceptions regarding the quality / value of spine care.

Methods: We administered questionnaires to patients at 2 tertiary care institutions who presented to a spine clinic for evaluation. Questions assessed patient perceptions regarding quality of spine care as impacted by provider / institution-specific factors (8 choices including US News & World Report rankings, consumer website survey results, medical website survey results, etc) and by patient-specific factors (7 choices including convenience of access, distance, prior experience, etc). Standard statistical methods were used. The Institutional Review Boards approved the study.

Results: 233 surveys from consenting adults were included. Of all choices, patients reported that of most importance were credentials of the healthcare provider and US News & World Report Rankings of the institution. Of slightly less importance in the provider-institution factors was word of mouth reputation. Significant patient-specific factors included professionalism, timing of access from referral, and accommodation of requests and choice of provider. Of least importance were prior experience with the provider / institution, distance to clinic, and consumer website (e.g., Angie’s List) and medical website ratings.

Conclusions: Patients perceived that the most important contributors to quality in healthcare are the reputations of the provider and institution. Additionally the personalization of the provider-patient relationship also contributed to the perception of quality. Interestingly, out-of-pocket costs and prior experience with provider/institution were noted to be less important. Further investigation would explore the correlation of these patient perceptions to payer perceptions of the factors most important to quality in spine care.

Patient Care: Patient satisfaction is increasingly being factored into provider / hospital reimbursement. Understanding the factors which determine a patient's perceptions regarding the quality / value of spine care will allow for health system based improvements to enhance patient satisfaction.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the macro economic changes to physician reimbursement, 2) discuss, in small groups, patient perceptions regarding quality / value in spine care, 3) identify

References: Porter ME. What is value in health care? The New England Journal of Medicine. 2010;363:2477-2481