(235) High-Value Otolaryngologist Scorecard: Barriers and Lessons Learned in Multi-Hospital System

Introduction: Delivering value in health systems has become paramount as payer contracts move away from fee-for-service payment models; accurately measuring value (i.e., quality over cost) is key to this transition. This study describes the Otolaryngology High-Value Surgeon Scorecard, surgeon adherence, and barriers to implementation in a multi-facility health system.

Methods: We developed and implemented the Otolaryngology High-Value Surgeon Scorecard, within a multi-hospital non-profit health system. The Scorecard is an internal auditing and feedback mechanism for employed and affiliated otolaryngologists to see their performance across quality metrics. A point system is derived from benchmark values in each category, resulting in a total “value” score for each surgeon. Scorecard categories were defined based on five clinical pathways measuring pre-operative, intra-operative, and post-operative metrics. These include pre-operative patient screening and optimization, appropriate peri-operative antibiotic stewardship, appropriateness for surgery, on-time starts, opioid prescribing patterns, and unanticipated post-operative return rates. Surgeons are given a quarterly report and offered mentoring and continuing education resources to improve.

Results: At the time of implementation (Q1 2021), 23 of 105 otolaryngologists (21.9%) met the High-Value criteria, which increased to 63.5% in the most recent iteration (Q2 2023). Since implementation, antibiotic and opioid prescription rates have decreased by 52.8% and 32.2%, respectively. Barriers persist in getting reliable, accurate, and timely data, particularly when measuring meaningful quality outcomes.

Conclusions: Since implementing the High-Value Surgeon Scorecard, surgeons meeting the criteria for high value has significantly increased. This has been associated with a significant decrease in inappropriate peri-operative antibiotic administration and opioid prescribing patterns. Future research is needed to determine the most meaningful metrics for ascertaining value in care delivered by otolaryngologists.