Interdisciplinary Value-Based Care Q&A with Dr. Thomas R. Vetter: Part 4 of Our Special Series Featuring Strategies for Improving Orthopedic Patient Outcomes

Author: Kathryne Auerback


The way we deliver care across the episode is changing, driven by the pursuit of a patient-centric model – an undertaking that can only be achieved by breaking down the silos of a fragmented health system.

The upcoming ACPM Interdisciplinary Conference on Orthopaedic Value-based Care provides a game-changing opportunity for surgeons, anaesthesiologists, nurses, and healthcare administrators to join forces in uncovering cutting edge industry trends and insights.

In Part 4 of our special series, we spoke with conference speaker, Dr. Thomas R. Vetter, MD, MPH, Director of Perioperative Care at Dell School of Medicine, about his best practices for value-based care.

Can we start off by talking about your background in anesthesiology?

I’ve been practicing medicine for almost 35 years. I spent the first 17 years of my career doing pediatric anesthesia. At that point I also developed an interest in pediatric pain management. In Akron, Ohio, we developed one of the first pediatric pain medicine programs in the United States in the early to mid-1990s.

Around 2004, I came to the realization that I wanted to spend the balance of my career in academics. So I relocated to Indiana University, and while I was there working at the children’s hospital, I pursued my Masters in Public Health in Clinical Outcomes Management through Emory University.

Obtaining this degree was transformative for me. I came at it further along in the professional growth process that I think many physicians undergo. It really empowered me with a new skill set, and it also gave me a new perspective on healthcare – at both the micro and the macro economic levels. And it got me to really start thinking about the healthcare system in United States, and where there are tremendous opportunities to provide greater value.

I then was hired to reinvigorate pain medicine as a specialty at the University of Alabama at Birmingham. Eventually, we began to develop one of the first perioperative surgical home models in the United States. At that point, I refocused on geriatric pain medicine as well as perioperative medicine. I was at UAB for nine years, and we did a lot of good work there, then I moved here to Austin and began working at Dell Medical School.

How has the shift to value-based care influenced the work that you do?

Conventionally, we’ve been working in a fee-for-service system where the more patients you see, the more diagnostic tests you order, the more interventional procedures (surgical and others) that you perform, the more you get paid. Not only does the physician get paid more, but the system in which they work – they’re going to get paid more for doing more.

We all like to believe we’re practicing high quality, evidence-based medicine. But there’s a tremendous amount of variability in how different physicians practice, both anesthesiologists as well as surgeons.

The practice of medicine is still an art, based upon human relationships with one’s patients and one’s colleagues. But healthcare is a business. And that has been a difficult axiom for many physicians to accept. Many of us say, “I didn’t go into medicine to be a business person.”

I came to Austin with two primary objectives: to co-lead the development of a perioperative surgical home at Seton Healthcare, and to develop a comprehensive interdisciplinary pain management program based primarily at Dell Medical School. And both of those are going to put a tremendous emphasis on the delivery of value-based healthcare.

People are starting to realize we can do better in terms of return on our investment – both from a societal perspective as well as for the individual consumer. As individual patients are being asked to pay more out of pocket, they are one of the major stakeholders that are demanding better value.

Can you tell us about your conference topic, “How to Set Up a Successful Preoperative Management Clinic: Perspectives of an Anesthesiologist versus a Hospitalist?” Why is this topic important to you, personally?

I firmly believe that the preoperative phase of care is a tremendous opportunity for anesthesiologists to make a significant contribution to delivering value-based perioperative care.

One of the things we’ve developed here in Austin is the PASS-GO program, which stands for Perioperative Assessment and Global Optimization. It’s both a program and brick-and-mortar clinics.

It’s like the board game of Monopoly – when you pass go, you collect $200 – except in this case, when you pass go, you’re prepared and “cleared” by anesthesiology to go to surgery.

The program is staffed by anesthesiology and internal medicine, so we can take advantage of the skill set and the clinical experience of both specialties. I’m very excited about this opportunity. For me, personally, this is a dream come true to work alongside an internal medicine colleague who has skills and clinical experience that I do not have.  

How does anesthesiology influence the opportunity for enhanced recovery for the patient? Why is it so important from the patient perspective?

I left a very conventional academic medical center with a longstanding Department of Anesthesiology and Perioperative Medicine, and its Chair was completely autonomous from the Chair of Surgery and the Chair of Medicine. That’s how things are traditionally done – they function in silos, and they often times compete for the same resources.

Now I am an anesthesiologist and perioperative physician, but I work in a Department of Surgery and Perioperative Care. My boss is a surgeon. For many anesthesiologists, that’s troubling, because anesthesiology – before it became a separate, bonafied specialty – was part of surgery.

Many years ago, the surgical intern would often be the one who would provide the anesthetic. As the Department of Anesthesiology came of age, they wanted to maintain their autonomy. But this model of care that we’re developing at Dell Medical School – which I think is aligned with what value-based orthopedic care is about – is breaking down those silos and the barriers to more effective communication, more effective collaboration, and more efficient delivery of care, that’s also patient centered.

What does the future of value-based care look like to you? What’s next?

I think change is difficult. It’s maybe a cliché – but I think change is very hard for people. And I think healthcare is a very conservative business, and very risk-averse.  Healthcare administrators, by nature, are thus very conservative and risk-averse. They will often respond to external forces more readily than they will respond to internal forces of innovation.

I don’t mean that to chastise my colleagues – they have a business to run. There’s a common expression: “No margin, no mission.” The new expression is: “No outcome, no income.” But we’re still functioning under “No margin, no mission.” If they don’t put heads in the beds, they see their vital operating margins go down.

It’s important to emphasize that delivering value-based health care is also advantageous for businesses. One would think that in the halls of Congress and in the Oval Office, the needs of businesses are still going to drive the implementation of value-based healthcare.

I think we’re on a path, but it’s not a linear path. It’s like saying, “This is coming to a theatre near you” at some point in the future, and you would be well advised to invest in learning something about this, and how you might implement it.

Physicians are coming to the realization that our salaries will not keep pace with inflation. What will be interesting is, as inflation picks up again, we are not going to see upward inflationary pressures in healthcare spending. We’ve got to figure out how we’re going to survive with a very lean reimbursement.

At the end of the day or in the final analysis, we’re the richest country in the history of the world – we should be able to provide basic health care to all of our citizens.

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The American College of Perioperative Medicine hosts the Interdisciplinary Conference on Orthopedic Value-Based Care, February 9-11, 2018, in Newport Beach, CA. An immersion weekend that covers the operational, financial and clinical aspects of orthopedics practice, the conference is an opportunity to learn more about the Perioperative Surgical Home – Enhanced Recovery model.

OrthoServiceLine.com is pleased to sponsor this event. Enter OSLTRANSCEND at registration to claim your 10% subscriber discount.


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